Oral lichen planus and thyroid gland diseases: possible associations.

BACKGROUND: Lichen planus (LP) is a chronic inflammatory mucocutaneous disease that commonly affects the oral cavity. Previous reports have suggested a possible association between LP and thyroid gland diseases (TGDs). The purpose of this study was to investigate possible associations between oral lichen planus (OLP) and TGDs. METHODS: Patients diagnosed with OLP, both clinically and histopathologically (N = 102), were classified according to clinical course (symptomatic/asymptomatic), type (reticular/plaque, atrophic and erosive) and location of lesions. Data on TGDs was compared to age- and gender-matched controls (N = 102) without OLP. Diagnosis of any type of TGD and related medication for study and control groups was recorded from the medical files provided by patients' physicians. Statistical analysis used Student's t-test and Fisher's exact test; significance was set at p < 0.05. RESULTS: TGDs (all), hypothyroidism and related medications were found in 16.6, 12.7 and 12.7% of patients with OLP, respectively. These findings were similar to the control group: TGDs (all) -15.7%, hypothyroidism - 9.8% and thyroid gland disease-related medication - 9.8% (p > 0.05). No significant associations were found between different characteristics of OLP and hypothyroidism or other TGD (p > 0.05). CONCLUSIONS: We found no significant associations between the co-existence of OLP and TGD or related-medications. Our findings are in agreement with some of the previously published similar studies but in controversy with others. Further well-designed, multicenter studies with large groups of patients and controls may help to establish the nature of the associations between OLP and TGDs.

The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse.

OBJECTIVE: The aim of the study was to assess the efficacy of 2 different concentrations of minocycline mouthwashes on the symptoms of recurrent aphthous stomatitis (RAS). STUDY DESIGN: The 2-year study was designed as a randomized, double-blind, crossover study. Healthy patients with frequent RAS episodes received 2 sealed and computer-randomized marked kits containing minocycline mouthwashes (0.2% and 0.5% solution). The patients were asked to use 1 of the kits on the first episode of RAS, starting with the first onset of prodromal symptoms, until the symptoms resolved or up to a maximum of 10 days (whichever came first). The patients were asked to use their second kit during a subsequent episode. RESULTS: A total of 14 patients (8 males, 6 females) completed the 2 arms of the study. The mean intensity of pain was significantly lower when the 0.5% solution was used compared with the 0.2% solution (P = .027). The difference reached the level of statistical significance as soon as the end of the second day of use (P = .032). Only minor and temporary adverse reactions were documented. CONCLUSIONS: We found that 0.5% minocycline mouth rinse was more effective than the 0.2% concentration, which had been suggested by our group in previous studies for the management of RAS.

Immunologic and psychologic parameters associated with geographic tongue.

OBJECTIVE: Several conditions have been associated with geographic tongue (GT). However, there is no consensus on the etiology of GT. The purpose of this study was to investigate whether immunologic and psychologic parameters are associated with diagnosis of GT. STUDY DESIGN: A case-control study was performed on 170 participants (85 with GT, 85 controls). Unstimulated whole saliva was collected, and tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) concentrations were measured. Anxiety level was measured using psychologic and physiologic testing instruments. An independent t test and a Pearson correlation analysis were performed with SPSS (α = .05). RESULTS: There was a significant difference between the 2 groups regarding the salivary concentrations of TNF-α (P = .008) and IL-6 (P = .001). The concentration of salivary cortisol and state and trait anxiety levels in the GT group were significantly higher than those in the control group (P = .001). CONCLUSIONS: Immunologic and psychologic parameters appear associated with GT and may constitute risk factors of this condition.

Oral lichen planus: malignant transformation and human papilloma virus: a review of potential clinical implications.

Oral lichen planus (OLP) occurs in from 2% to 3% of the population and may have a risk of malignant transformation into squamous cell carcinoma (SCC). This risk is not necessarily associated with exposure to tobacco and alcohol. An increased awareness of a possible role of human papilloma virus (HPV) and SCC led us to review a possible association between this virus infection and malignant transformation of OLP. The possible linkage between HPV and the risk of transformation of OLP to malignancy is discussed. Furthermore, management of OLP using immunosuppressive drugs may be associated with enhanced viral replication and could theoretically affect the risk of malignant transformation. Implications for clinical care are discussed.

Management of bisphosphonate-associated osteonecrosis: pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series.

BACKGROUND: Studies of the use of pentoxifylline and α-tocopherol in osteoradionecrosis of the jaw have suggested their efficacy in this condition. We report an initial case series of pentoxifylline and α-tocopherol for patients with bisphosphonate-associated osteonecrosis (BON). METHODS: Six cases referred for management of BON were provided pentoxifylline and α-tocopherol in addition to antimicrobial therapy, and followed for a mean of 10 months. RESULTS: A 74% decrease in area of bony exposure and symptom control was achieved in these cases. DISCUSSION: Pentoxifylline with α-tocopherol may represent a strategy for management of BON. Controlled trials in cases of BON appear warranted.

Oral manifestations of habitual khat chewing: a case-control study.

BACKGROUND AND OBJECTIVES: Khat, or qat (Catha edulis), is a shrub indigenous to Yemen and certain parts of eastern Africa. Chewing the leaves, which have sympathomimetic and euphoric effects, is a popular habit in numerous countries including the Yemenite population in Israel. Khat has potentially significant toxic effects; however, its oral effects have been only sporadically examined and some changes suggested. The aim of this study was to assess the association between habitual Khat use and oral/dental pigmentation, gingival health, and reports of oral dryness. STUDY DESIGN: Forty-seven Yemenite Israeli individuals >30 years old, who chewed Khat at least twice a week for over 3 years, and 55 control subjects were studied. All individuals underwent standard clinical oral examinations for color changes and gingival health. RESULTS: White changes were significantly more prevalent in the khat chewers, identified primarily at the chewing site (83% vs. 16%). The difference in the prevalence of oral mucosal pigmentation between nonchewing nonsmoking (66.7%) and the khat-chewing (100%) groups was highly significant. The mean gingival index and the depth of periodontal pockets of the khat-chewing subjects were significantly reduced at the chewing side compared with the nonchewing side. Increased gingival recession was recorded on the khat-chewing side. Discoloration of the teeth adjacent to the site of chewing was recorded. Oral dryness occurring 30 minutes after initiating the khat-chewing session was reported by khat users. CONCLUSION: Khat chewing may result in a number of changes in the oral mucosa and the dentition. The mechanical and chemical irritation may result in the development of mucosal white lesions and dark pigmentation. Khat chewing may reduce aspects related to risk of gingival and periodontal inflammation, but it appears to be associated with attachment loss at the site of chewing.

Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature.

Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder: A Case Report and Review of the Literature Shoshana Reiter Ephraim Winocur Carole Goldsmith Alona Emodi-Perlman Meir Gorsky Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large-sized arteries, most commonly the extracranial branches of the carotid artery. Early diagnosis and treatment are essential to avoid severe complications. This article reports on a GCA case and discusses how the orofacial manifestations of GCA can lead to misdiagnosis of GCA as temporomandibular disorder. GCA should be included in the differential diagnosis of orofacial pain in the elderly based on the knowledge of related signs and symptoms, mainly jaw claudication, hard end-feel limitation of range of motion, and temporal headache.

Oral lesions in patients participating in an oral examination screening week at an urban dental school.

BACKGROUND: Dental education must emphasize early diagnosis and management of oral mucosal disease, including early detection of oral premalignant lesions and cancer. The authors evaluated clinical findings of oral screening examinations of dental patients during a one-week period in an urban dental school clinic. METHODS: Third- and fourth-year dental students conducted clinical screening examinations for all dental patients of record seen during the Yul Brynner Foundation's Oral, Head and Neck Cancer Awareness Week in April 2006. RESULTS: Of 262 patients, 100 (38.2 percent) reported that they had used tobacco for a mean of 8.1 years. Most patients reported having denture or tooth and gingival problems. The dental students reported abnormal findings in 55 patients (21 percent). Two patients had suspected premalignant lesions that were diagnosed as lichen planus and traumatic keratosis. CONCLUSIONS AND CLINICAL IMPLICATIONS: The one-week screening provided an educational opportunity for the dental students, and the results demonstrate the value of having a focused week to reinforce the importance of head and neck and oral soft-tissue examination. The finding of mucosal lesions in 21 percent of patients of record reflects the fact that lesions were present but undetected. In addition, there are important implications for teaching and patient care. The screening week provided an opportunity for students to be active in a national campaign for cancer detection, and it represents an opportunity for visible community participation in the recognition of oral mucosal diseases in dental training programs and broadly for the profession.

Screening for and diagnosis of oral premalignant lesions and oropharyngeal squamous cell carcinoma: role of primary care physicians.

UNLABELLED: OBJECTIVE; To describe the role that primary care physicians can play in early recognition of oral and oropharyngeal squamous cell carcinomas (OOSCCs) and to review the risk factors for OOSCCs, the nature of oral premalignant lesions, and the technique and aids for clinical examination. QUALITY OF EVIDENCE: MEDLINE and CANCERLIT literature searches were conducted using the following terms: oral cancer and risk factors, pre-malignant oral lesions, clinical evaluation of abnormal oral lesions, and cancer screening. Additional articles were identified from key references within articles. The articles contained level I, II, and III evidence and included controlled trials and systematic reviews. MAIN MESSAGE: Most OOSCCs are in advanced stages at diagnosis, and treatment does not improve survival rates. Early recognition and diagnosis of OOSCCs might improve patient survival and reduce treatment-related morbidity. Comprehensive head and neck examinations should be part of all medical and dental examinations. The head and neck should be inspected and palpated to evaluate for OOSCCs, particularly in high-risk patients and when symptoms are identified. A neck mass or mouth lesion combined with regional pain might suggest a malignant or premalignant process. CONCLUSION: Primary care physicians are well suited to providing head and neck examinations, and to screening for the presence of suspicious oral lesions. Referral for biopsy might be indicated, depending on the experience of examining physicians.

Topical minocycline for managing symptoms of recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) is a common ulcerative condition of the oral mucosa. In this study, minocycline oral rinses were compared to a placebo in patients suffering from frequent episodes of RAS. Thirty-three patients with RAS were randomly allocated to topical therapy with 0.2% minocycline or a placebo aqueous solution mouthwash. Seven patients also participated in a blind crossover study. The intensity of pain was recorded daily using a visual analogue scale. Minocycline mouthwashes resulted in significant reduction in the severity and duration of pain due to RAS. The findings in the subgroup that participated in the crossover were consistent with outcomes in the randomized study. The findings of this study show that minocycline oral rinses reduce pain in patients with RAS and may have implications for the use of minocycline in other non-infectious inflammatory ulcerative oral mucosal diseases.

A survey of the current approaches to diagnosis and management of oral premalignant lesions.

BACKGROUND: Early diagnosis of oral premalignant lesions (OPLs) and oral squamous cell carcinoma facilitates treatment with less aggressive approaches and results in a better prognosis. The authors conducted a study to identify current practices in the diagnosis and management of these oral lesions by oral medicine professionals. METHODS: The authors sent a questionnaire to 176 diplomates of the American Board of Oral Medicine and asked them to complete the questionnaires and return them by mail. RESULTS: The initial clinical approach taken by most of the responders included visual examination, elimination of possible local causes and two-week follow-up. Adjuvant clinical tests included toluidine blue, oral brush biopsy and exfoliative cytology. If there was no clinical improvement after two weeks, most responders recommended that a biopsy be performed. Induration, red component, nonhomogeneous surface and ulceration were characteristics of lesions that increased the responders' decisions to perform a biopsy. Lesion symptoms and location also contributed to their decisions to perform a biopsy. Follow-up more frequently than twice a year was recommended for red lesions, lesions with histologically confirmed dysplasia or both. Most clinicians recommend a biopsy during follow-up of an OPL whenever the lesion changes in appearance. CONCLUSIONS: The findings of this survey may provide background for initial guidelines to be used by oral practitioners to diagnose and manage OPL. Clinicians' awareness of the complexity of OPL diagnosis and management is important, and referral to an experienced provider is recommended.

Radiographic and clinical features of temporomandibular dysfunction in patients following indirect trauma: a retrospective study.

OBJECTIVES: Patients developing temporomandibular dysfunction (TMD) following a motor vehicle accident (MVA) have been reported to respond poorly to standard TMD treatment compared with TMD patients who have not sustained an MVA. The purpose of this study was to determine clinical and radiographic differences between post-MVA and nontrauma TMD patients and to determine whether radiographic findings in post-MVA patients undergoing litigation show more severe anatomical changes than post-MVA patients not undergoing litigation. STUDY DESIGN: One hundred thirty-six files with magnetic resonance imaging (MRI) and/or bone scan studies of TMD patients were randomly drawn (54 post-MVA and 82 nontrauma TMD). RESULTS: Patients with post-MVA TMD demonstrated significantly more orofacial pain complaints but significantly less disk displacements on MRI (47.5% post-MVA vs. 69.2% control; P = .03). Litigating post-MVA patients had significantly more nonreducing disks than the nonlitigating group (37.7% litigating vs. 7.7% nonlitigating; P = .05). CONCLUSION: Based on these findings, it is suggested that treatment limited to the temporomandibular joints (TMJs) in post-traumatic TMD patients may fail without consideration that pain may originate in structures other than the TMJs. Within the post-MVA group, the more severe anatomical changes were found in the litigating patients, suggesting that some of their symptoms are associated with anatomical changes.

Association between hepatitis C virus infection and oral lichen planus in Israeli patients.

BACKGROUND: Oral lichen planus is a cell-mediated immune condition of unknown etiology. A possible association of OLP with hepatitis C virus infection has been documented in specific populations. However, no such possible association has been studied in Israel. OBJECTIVES: To assess the prevalence of HCV antibodies among patients with OLP in Israel. METHODS: The prevalence of HCV seropositivity was studied in OLP patients (n=62) and compared with that of a control group (n=65) and with the prevalence among healthy volunteer blood donors (n=225,452) as representatives of the general population. RESULTS: The prevalence of HCV, as detected by the presence of anti-HCV antibodies screened by enzyme-linked immunosorbent assay, and confirmed by recombinant immunoblot assay, was 4.8%, 1.5% and 0.1%, respectively. HCV seropositivity in the OLP patients was significantly higher than in the healthy blood donors (P< 0.001). CONCLUSIONS: A possible association between OLP and HCV is suggested. Therefore, screening OLP patients for antibodies to HCV is recommended.

Topical minocycline and tetracycline rinses in treatment of recurrent aphthous stomatitis: a randomized cross-over study.

Recurrent aphthous stomatitis (RAS) is a common ulcerative condition of the oral mucosa. We assessed minocycline and tetracycline oral rinses in patients with frequent episodes of RAS in a clinical randomized crossover trial. Seventeen patients with high frequency recurrent minor RAS were randomly allocated to a cross-over topical therapy with 0.2 percent minocycline or 0.25 percent tetracycline aqueous solution mouthwash. The minimum interval between the cross-over was 30 days. The intensity of pain was recorded daily using a visual analogue scale. Minocycline mouthwashes as compared to topical tetracycline rinses resulted in significantly improved pain control, by reducing the severity and duration of pain. Topical minocycline rinse may be a potential treatment for other mucosal diseases that result in mucosal ulceration and pain.

The efficacy of oral lumenoscopy (ViziLite) in visualizing oral mucosal lesions.

Early diagnosis of oral mucosal lesions has been advocated as a means of improving outcomes of cancer therapy. Improved visualization of mucosal lesions may aid in diagnosis by guiding tissue sampling or referral. This multicenter study reports the effect of chemiluminescent light (ViziLite) upon visualization of mucosal lesions. The chemiluminescent light did not appear to improve visualization of red lesions, but white lesions and lesions that were both red and white showed enhanced brightness and sharpness.

Assessment of the use of sialogogues in the clinical management of patients with xerostomia.

This study was conducted to assess the clinical efficacy and adverse effects of pilocarpine, bethanechol and cevimeline in patients with xerostomia. In this open-label crossover assessment in 20 patients with xerostomia, a one- to two-week course of each medication with a one-week washout period was prescribed. Side effects, symptoms, whole stimulated and unstimulated saliva were measured. Each sialogogue was found to increase saliva and decrease symptoms. A mixed-effects analysis showed a greater increase in stimulated saliva on bethanechol compared to pilocarpine (0.106, p = 0.0272). Increased sweating was the most common side effect, experienced more frequently with pilocarpine as compared to bethanechol (p = 0.0588) or cevimeline (p = 0.0143). A carryover effect beyond the washout period was seen. Effects on saliva and side effects vary between sialogogues, suggesting a benefit of trials with different sialogogues to determine individual patient preference. The observed carryover effect suggests that intermittent treatment may be an alternative to continuous treatment with sialogogues.

Dental management of patients with myasthenia gravis: a literature review.

Myasthenia gravis is a chronic neuromuscular disease characterized by muscular weakness and fatigability. Dental management of patients diagnosed with myasthenia gravis presents a challenge to the dental profession. A MEDLINE search of the English medical (limited to provision in dental care) and dental literature on myasthenia gravis and dental management published between 1975 and 2004 was conducted. In the dental literature, 12 articles were found, and only a few focused on myasthenia gravis and dental care. The purpose of this article was to review and summarize the clinical signs and symptoms associated with myasthenia gravis, highlighting the role of the dental profession in the process of the diagnosis and management of the oral and dental complications that might be associated with the disease, while avoiding myasthenic crisis.

Patients with oropharyngeal cancer: a comparison of adults living independently and patients living in long-term care facilities.

The low survival rate of persons with oropharyngeal cancer (OPC) is directly related to the size of the primary tumor, lymph node involvement and to the smoking history. The association between medical independence and the survival rate of oral cancer is unclear. The purpose of this study was to assess the survival rate of institutionalized patients with oral cancer compared to those living independently. Information regarding gender, age, tobacco habits, disease characteristics, and survival status were recorded and statistically analyzed from 30 patients with oral cancer who were institutionalized compared to 543 patients with oral cancer who were non-institutionalized. Patients living in long-term care facilities (LTC) were significantly older than the independent patients (67% were 70 years or older versus 28% of independent patients) (p = 0.0001). No differences in smoking habits were noted between the two groups but more patients who were institutionalized stopped smoking at the time of diagnosis (p = 0.47). More patients who were institutionalized were diagnosed with positive lymph node involvement (p = 0.09). Significantly higher all-cause and disease-free 5-year survival rates were noted in the patients living independently, compared to the adults who were institutionalized (32% and 60% compared to 7% and 26% respectively; p < 0.05). The disease-specific 5-year survival was directly related to age (p = 0.001), size of the tumor (p = 0.001), and lymph node involvement (p < 0.001). Significant longer survival rates were observed for patients living independently. The more advanced disease seen in the patients who were institutionalized may be due to a delay in diagnosis, which may be associated with fewer symptoms, limited report of symptoms, a lack of attention or a misdiagnosis of the oral lesion.