Chronic Oral Lesions Research Articles

Tuberculosis of the tongue

Introduction: Tuberculosis mostly affects the lungs, but may also affect the central nervous system, lymphatic system, circulatory system, genitourinary system, bones, joints, and skin. Extrapulmonary involvement in tuberculosis is rare, accounting for just 10 to 15% of cases. The lymph nodes are the second most common site of tuberculosis infection. Oral tuberculosis has long been thought to be an unusual phenomenon. Oral manifestations are thought to occur in just 0.05 to 5% of all tuberculosis cases. Surface ulcers, patches, papillomatous lesions, and indurated soft tissue lesions are the most common oral manifestations. Case Presentation: A 69-year-old man presented to the Department of Ear, Nose, Throat at MGM Hospital in Aurangabad, India, with a painful ulcer and tiny nodules on the tongue’s tip and lateral surface. The ulcer appeared 3–4 weeks ago without any obvious trigger with a prickling feeling and increased soreness over the area., Onintraoral inspection multiple small nodules is measuring about 0.1 cm and multiple circular ulcer measuring about 0.2 x 0.1 cm in diameter at the tip and lateral border of the tongue. A granulomatous center and a whitish, well-defined border with mild elevation characterized the ulcer. Conclusion: Despite the rarity of tuberculosis evidence in the oral cavity, oral tuberculosis should be included in the differential diagnosis of chronic oral lesions. To prevent ineffective oral therapy, accurate diagnosis is crucial for successful care by concentrating on the pathological source.

Management of Risk Factors Associated with Chronic Oral Lesions in Sheep

Simple SummaryOral injuries are widespread disorders of sheep that can cause significant economic losses in farms. These usually painful conditions prevent animals from feeding properly, leading to chronic weight loss and, very often, causing the final culling of the animals. This study analyses the management risk factors associated with the presence of mandibular and maxillary disorders in a representative cohort of sheep in Spain. These lesions are usually the external and final manifestation of underdiagnosed oral disorders. It was concluded that hard foods with sharp edges such as maize straw as well as acidic foods such as silages, favor the development of these disorders. Furthermore, the study shows that the use of mineral supplementation prevents the appearance of oral lesions.Oral disorders constitute a significant cause of weight loss in sheep. In a study of disorders of the oral cavity of 36,033 sheep from 60 meat sheep flocks in Spain, we looked for management risk factors associated with chronic oral lesions. Mandibular and maxillary disorders were assessed as an external manifestation of oral lesions by palpation, searching for tissue swellings, fistulae, or open wounds. The prevalence of flocks containing sheep with jaw disorders was 98.3%, with an average individual prevalence of 5.5%. The majority of lesions were located in in the mid-region of the mandible, and the most relevant risk factor was increasing age. Use of acidic diets based on silage and inclusion of hard foods, such as maize straw or hay, was associated with the occurrence of jaw inflammation. It was concluded that hard diets containing plant material with edges and sharp areas, plus acidic foods including silage, are more likely to cause lesions of the gingiva, enabling entry of pathogens to the oral mucosa that eventually establish locally in bony tissues, usually as mandibular osteomyelitis. It was also observed that mineral supplementation appears to prevent the occurrence of these lesions.

Recommandations pour la prise en charge buccodentaire des patients atteints de maladies bulleuses auto-immunes avec atteinte buccale

Autoimmune bullous diseases (AIBD) may cause chronic oral lesions that progress insidiously. To provide recommendations for optimal oral-dental management of patients presenting AIBD with oral involvement. In the absence of scientific studies with high levels of proof, these recommendations have been drawn up at two meetings by a committee of experts on AIBD comprising 7 dermatologists, 1 stomatologist, 1 maxillofacial surgeon, 2 odontologists and 4 parodontologists. The oral lesions associated with AIBD may be classified into three grades of severity: severe (generalised erosive gingivitis affecting at least 30% of dental sites), moderate (localised erosive gingivitis affecting less than 30% of dental sites) and controlled (no erosive oral lesions). Good oral-dental hygiene suited to the severity of the oral lesions, must be practised continually by these patients so as to avoid the formation of dental plaque, which aggravates symptoms. Dental and parodontal care must be considered in accordance with the severity grade of the oral lesions: in severe cases, the dental plaque must be eliminated manually with a curette, but several types of care (descaling, treatment for tooth decay, non-urgent extractions, etc.) must be suspended until the grade of severity is moderate or until the disease is stabilised.

OP178: Progression of oral cancer from early to late stage after invasive dental treatments

Patients with oral cavity squamous cell carcinoma (OSCC) often present initially to a dentist complaining of a dental problem. These early cancerous changes are at times misdiagnosed as chronic infection resulting in invasive and often multiple dental procedures. This not only delays diagnosis and treatment, but also affects the integrity of cortical bone and promotes mandibular invasion, resulting in accelerated progression of the disease. A retrospective review of OSCC patients, presenting after multiple dental treatments, was performed. The clinical findings, imaging, treatment and pathology were reviewed. There were a total of 15 patients (nine females). The median duration of symptoms before their initial dental visit was 21 months (range: 6 months to 15 years). The presenting complaints included chronic oral lesions, ulcerations, swelling or jaw pain. Dental treatment, in the form of dental extractions, periodontal surgery or scaling and root planning without tissue biopsy, was the first treatment rendered on all of these patients. Nine patients (60%) were diagnosed with an OSCC within 6 months of the dental procedure, two were diagnosed within 1 year and the others over one year following the procedure. The primary tumors were located on the gingiva, floor of mouth or retromolar trigone. Eleven patients (73%) had bone involvement, eight patients (53%) had nodal metastases and five patients (33%) had perineural invasion at the time of diagnosis. Disrupting the mandibular periosteum in the proximity of an otherwise T1 lesion could facilitate bone invasion and thus accelerate the progression of OSCC to T4 tumor. If oral cancer is suspected, a biopsy should be performed prior to dental procedures such as extraction or periodontal surgery is initiated. This could expedite diagnosis, prevent treatment delays and potentially improve therapeutic outcome.

A chew-and-spit method of corticosteroid delivery

We read with great interest “Treatment of severe chronic oral erosive lesions with clobetasol propionate in aqueous solution” by Gonzales-Moles et al (2002;93:264-70). In fact, many dermatological diseases manifest with troublesome and chronic oral lesions, often posing a therapeutic challenge. We would like to share our experience and further highlight a few observations on the topical use of corticosteroids in the oral mucosa.

Immunologic Profile of Patients Suffering from Herpes Simplex Virus (HSV) -Associated Oral Lesions Treated with Natural Human Interferon Alpha (Egiferon).

10 consecutive patients with HSV-associated chronic oral lesions were treated with Egiferon for ten days. There were a statistically significant increase in the Large Granule Lymphocyte (LGL) counts and the number of spontaneous E rosette forming cells by the end of the treatment period. Interferon alpha brought about a preferential expression of CD8, CD11b, CD14, CD25 and CD45RO cell surface molecules without any effect on the expression of CD2, CD3, CD4, CD20 and HLA-DR.

Feline calicivirus strain differentiation using monoclonal antibody analysis in an enzyme-linked immuno-flow-assay

Six monoclonal antibodies raised against feline calicivirus (FCV) strain F9 were used in an enzyme-linked immuno-flow-assay (ELIFA) to analyse 55 isolates of FCV. Forty seven field isolates were obtained from cats with acute oral/respiratory disease, chronic oral lesions, and from cats showing vaccine reactions, i.e. clinical signs of FCV infection shortly after vaccination. Eight reference strains including F9 and three vaccine strains based on F9 were also examined. All of the strains of F9, derived from various sources, reacted with all six of the monoclonal antibodies, whereas some of the field isolates did not react with any. In general, the field isolates showed a spectrum of reactivities and selected isolates could be distinguished. However, there were no clear cut differences between the clinical groups. Overall, the oral/respiratory group showed less reactivity with the monoclonals, suggesting they were less related to F9. Although the other groups appeared to be more closely related to F9, none of the isolates reacted with all six monoclonal antibodies.

Pigmented purpuric stomatitis

The pigmented purpuric dermatoses are a group of disorders in which there is chronic capillaritis, with pigmented purpuric lesions predominantly on the lower limbs. We report a case with chronic oral lesions that had histologic features most in keeping with the purpuric lichenoid dermatitis of Gougerot and Blum syndrome.

Prepubertal Oral Pemphigus Vulgaris

Although rare, oral pemphigus vulgaris must be considered in those patients who have a prolonged history of oral lesions. The fact that chronic oral lesions characteristically precede skin changes in pemphigus emphasizes the importance of this disease to the dental profession. Patients with long-term and recurrent vesiculoulcerative oral lesions should undergo biopsy examination to establish the diagnosis. The dentist and the physician must collaborate to establish an appropriate diagnostic and therapeutic plan for the management of these patients.

Gumma of the palate

This case history reviews a gumma of the palate which destroyed the hard palate and continued as an active lesion at the time the patient sought dental treatment. Although chronic oral lesions of syphilis are uncommon, the dental examiner must be constantly aware of their presence, since acute forms of the disease may go undetected or be refractory to treatment.

Development and clinical investigation of a new oral surface anesthetic for acute and chronic oral lesions

Various solutions of antihistamines and dyclonine hydrochloride were compared with lidocaine hydrochloride as topical applications for relief of pain in patients with severe oral lesions. Preliminary screening indicated that dyclonine hydrochloride and lidocaine hydrochloride demonstrated excellent anesthetic qualities and that solutions of diphenhydramine hydrochloride produced mild anesthesia of prolonged duration. The combination of dyclonine hydrochloride and diphenhydramine hydrochloride in saline solution produced effective anesthesia in the lowest concentrations under study. Anesthesia persisted for periods of one to two hours in forty-four patients studied for periods ranging from seven to 540 days. One allergic reaction to 0.5 per cent dyclonine hydrochloride—0.5 per cent diphenhydramine hydrochloride solution was described. Self-administered, either applied with cotton-tipped applicators directly to the mucosal lesion or used as a mouthwash, a 0.5 per cent dyclonine hydrochloride—0.5 per cent diphenhydramine hydrochloride solution gave adequate to excellent relief from pain in most of the patients studied.