Difficulty Eating Research Articles

Satisfaction of Parents and Caregivers with Dental Treatment of Children Under General Anesthesia in a Day Care Surgery Setting.

The aim of this study was to examine the satisfaction of parents and caregivers of patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting. Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA. The survey consisted of 4 parts: general data, data about procedure, satisfaction with various aspects of care and the perception of parents/caregivers about the condition of their child in relation to the time before dental treatment in GA. 66 parents/caregivers (30.5%) responded to the questionnaire. Overall satisfaction with the treatment was high (4.69). Respondents expressed the highest degree of satisfaction with communication with nurses (4.92), and the lowest with the waiting time for the procedure (3.89). Parents/caregivers of patients who reported difficulty eating expressed significantly lower overall satisfaction than the subjects whose children did not report difficulty eating. Also, the more treatments the patients underwent, the lower was the overall satisfaction than of those subjects whose children were never treated in such a manner before. Since patient satisfaction has a beneficial impact on treatment outcome and adherence to preventive recommendations, all health care providers should strive to achieve it.

Binge eating disorder: What are the differences in emotion regulation, impulsivity, and eating behaviors according to weight status?

The emotional and eating characteristics of individuals with both obesity and binge eating disorder (BED) and those with obesity without BED have been widely studied. However, it is unclear whether the difficulties of these individuals are attributable to BED or obesity. The principal objective is to compare the emotional difficulties, impulsive traits, and eating styles of individuals diagnosed with BED with those of individuals without BED based on their weight (i.e., obesity, overweight, normal weight). The second objective is to compare these components according to their weight status in individuals living with BED. The 429 participants responded to a diagnostic interview to assess the presence of eating disorders and filled out questionnaires evaluating emotions (positive and negative emotions, emotional competencies, and regulation strategies), impulsive traits, and eating styles. Group comparisons between individuals with BED (presence/absence) according to their weight statuses were calculated. Participants with BED have more emotional and eating difficulties and engage in more impulsive behaviors than individuals without BED of the same weight. There were few differences between normal weight, overweight, and obese individuals with BED. Although BED has been little investigated among normal-weight individuals, this study shows that it is necessary to evaluate this eating disorder in this population to offer them adequate support and prevent weight gain. • Individuals who are overweight/obese and BED have more emotional, impulsivity, and eating difficulties than no-BED. • Normal-weight individuals with BED have more emotional eating difficulties than those without BED. • Weight status does not influence the difficulties experienced by individuals with BED.

PHARMACOLOGICAL MANAGEMENT OF ORAL LESIONS IN ADENOID CYSTIC CARCINOMA PATIENTS UNDERGOING RADIOTHERAPY

Objective: This case report aimed to describe the pharmacological management of oral lesions in adenoid cystic submental carcinoma patients undergoing radiotherapy.
 Methods: A 48 y old female undergoing radiotherapy complained of difficulty eating, swallowing, and speaking due to severe pain in her oral cavity for three weeks. Intra-oral examination revealed painful yellowish-white plaques that could not be scrapped on the tongue, maxillary and mandibular anterior gingiva, left and right buccal mucosa, and palate, diagnosed with oral candidiasis. We also found multiple shallow ulcers on the left buccal mucosa and upper labial mucosa that can be seen as oral mucositis.
 Results: The patient was given nystatin oral suspension for oral candidiasis, benzydamine hydrochloride for the complaint of pain when swallowing, and saline for promoting wound healing and keeping the oral mucosa moist. These lesions healed in a week and she could eat solid food without pain.
 Conclusion: Appropriate pharmacological management of oral lesions in a patient undergoing radiotherapy provides significant healing to better quality of life.

Pemberdayaan Kesehatan Masyarakat Melalui Seminar Pencegahan Stunting di Desa Sei Merah Kabupaten Deli Serdang

This community service activity aims to provide public health education regarding the prevention of stunting. Counseling in the form of seminars was used in this service. This service targeted the mothers in the village of Sei Merah, Deli Serdang Regency. The evaluation instrument for this activity used a questionnaire and interviews, which were then analyzed descriptively. The results of this service indicated that pregnant women's level of understanding of nutrition was still low because they had never followed counseling guidance. However, after this service seminar was conducted, there was a change in increasing the understanding of mothers regarding stunting prevention, namely by steps of (1) fulfilling nutrition during pregnancy, (2) fulfilling child nutrition optimally, (3) practicing proper hygiene, (4) overcoming children who have difficulty eating, and (5) consultation with the health care team.

Pharyngeal biorhythms during oral milk challenge in high-risk infants: Do they predict chronic tube feeding?

Eating difficulties are common in high-risk neonatal intensive care unit (NICU) infants; mechanisms remain unclear. Crib-side pharyngo-esophageal motility testing is utilized to assess contiguous swallowing physiology, and cross-system interplay with cardio-respiratory rhythms. Aims were to: (1) identify whether distinct pharyngeal rhythms exist during oral milk challenge (OMC), and (2) develop a chronic tube feeding risk prediction model in high-risk infants. Symptomatic NICU infants (N=56, 29.7 ± 3.7 weeks birth gestation) underwent pharyngo-esophageal manometry with OMC at 40.9 ± 2.5 weeks postmenstrual age (PMA). Exploratory cluster data analysis (partitioning around k-medoids) was performed to identify patient groups using pharyngeal contractile rhythm data (solitary swallows and swallows within bursts). Subsequently, (a) pharyngeal-esophageal, cardio-respiratory, and eating method characteristics were compared among patient groups using linear mixed models, and (b) chronic tube feeding prediction model was created using linear regression. Three distinct patient groups were identified with validity score of 0.6, and termed sparse (high frequency of solitary swallows), intermediate, or robust (high swallow rate within bursts). Robust group infants had: lesser pharyngeal and esophageal variability, greater deglutition apnea, pharyngeal activity, and esophageal activity (all p < 0.05), but less frequent heart rate decreases (p < 0.05) with improved clinical outcomes (milk transfer rate, p < 0.001, and independent oral feeding at discharge, p < 0.03). Chronic tube feeding risk=-11.37 + (0.22 × PMA) + (-0.73 × bronchopulmonary dysplasia) + (1.46 × intermediate group) + (2.57 × sparse group). Robust pharyngeal rhythm may be an ideal neurosensorimotor biomarker of independent oral feeding. Differential maturation of cranial nerve-mediated excitatory and inhibitory components involving foregut, airway, and cardiac rhythms distinguishes the physiologic and pathophysiologic basis of swallowing and cardio-respiratory adaptation.

Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns.

Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.

Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life. We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors. In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]). Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life. The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

WHY DO GENERALISTS ORDER FOOD ALLERGEN IGE PANELS? A QUALITY IMPROVEMENT NEEDS ASSESSMENT

<h3>Introduction</h3> Food allergy (FA) IgE panels are inappropriately ordered by generalists to evaluate eczema and other non-IgE-mediated conditions, resulting in inaccurate diagnosis of FA, increased costs, and potentially increased FA development due to delayed introduction of allergenic foods. We present a needs assessment utilized to plan a quality improvement (QI) project to reduce FA panel utilization funded by the ACAAI Allergists' Foundation Community Grant Program. <h3>Methods</h3> Reasons for ordering FA IgE panels and barriers to change were obtained from a literature review, listening sessions with generalists, and surveys. This study was reviewed and exempted from IRB approval. <h3>Results</h3> The top indications for ordering FA IgE panels were immediate reaction to a meal, eczema, idiopathic urticaria, screening prior to allergen introduction, caregiver request without medical indication, rhinitis and asthma, and difficulty eating. Over 90% of generalists have ordered a FA IgE test. However, generalists report a lack of self-efficacy in interpreting FA IgE testing, educating parents about the pathophysiology of eczema, and about early introduction of food allergens in infancy. Barriers to reducing FA IgE testing include caregiver pressure to test, misinformation caregivers receive about FA testing, lack of patient education materials, and lack of time for face-to-face education. <h3>Conclusion</h3> Eczema is the most common non-IgE-mediated indication for FA IgE testing. Improving generalist knowledge and self-efficacy about eczema diagnosis and management, including the protective benefits of early food allergen introduction, may reduce inappropriate FA IgE testing.

“It’s part of our life now”: a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer

PurposeFamily members (FMs) of patients with head and neck cancer (HNC) report a change in their social eating experience. They miss out on the opportunities and benefits that eating with others provides. However, few studies investigate FM’s social eating experiences, with existing research primarily focusing on the patient experience. Therefore, the aim of this study was to explore the social eating experiences of FMs of patients who have had treatment for HNC.MethodsA qualitative research design using semi-structured interviews was used to understand FM’s social eating experiences. Key themes were inductively developed from the data using reflexive thematic analysis.ResultsTwelve interviews were conducted with FMs, and three key themes were identified: (1) changes and challenges experienced by FMs due to HNC patients’ social eating difficulties, (2) living with social eating changes is a balancing act, and (3) FMs’ efforts to promote social eating for a patient with HNC. FMs expressed significant changes to their social eating habits within and outside the home, indicating the need for support to meet their own emotional, psychological and social needs.ConclusionFMs experience many demands and tensions, having to balance the psychological impact they experience, which are often minimised, whilst attempting to find the best ways to support, protect and encourage their loved ones to adjust and adapt to social eating changes. Therefore, interventions need to support FMs’ challenges and equip them to know how to best support patients living with HNC and themselves.

Effects of Cancer Treatment on the Comfort of Children and Adolescents with Cancer: A Scoping Review

Objectives: To map and examine the scientific evidence concerning the effects of cancer treatment on the comfort of children and adolescents with cancer. Materials and Methods: This scoping review was carried out in the following electronic information resources: BVS, PubMed, Cinahl, SciVerse Scopus, Lilacs, Web of Science, and Google Scholar. Two independent reviewers analyzed the studies’ relevance. Results: The search yielded 4,295 publications, of which 20 comprised the final sample. Following evidence mapping, the effects (20; 100 %) on comfort were found, and the most prevalent were pain (12; 60 %), fear (9; 45 %), nausea (5; 25 %), difficulty eating (4; 20 %), and distress (4; 20 %). Regarding the oncologic treatment modality, antineoplastic therapy prevailed in 11 (55 %) of the selected articles. Conclusions: Cancer treatment affects the comfort of children and adolescents with cancer, causing suffering and changing their well-being. It indicates the need to evaluate its impact and take nursing care measures to reduce complications and improve these patients’ adaptation to treatment.

How does the increase in eating difficulties according to the Development and Well-Being Assessment screening items relate to the population prevalence of eating disorders? An analysis of the 2017 Mental Health in Children and Young People survey.

We examine the test accuracy of the Development and Well-Being Assessment (DAWBA) eating disorder screening items to explore whether the increased eating difficulties detected in the English National Mental Health of Children and Young People (MHCYP) Surveys 2021 reflect an increased population prevalence. Study 1 calculated sensitivity, specificity, and positive and negative predictive values from responses to the DAWBA screening items from 4057 11-19-year-olds and their parents, in the 2017 MHCYP survey. Study 2 applied the positive predictive value to data from 1844 11-19-year-olds responding to the 2021 follow-up to estimate the prevalence of eating disorders in England compared to 2017 prevalence. Parental report most accurately predicted an eating disorder (93.6%, 95% confidence interval: 92.7-94.5). Sensitivity increased when parent and child answers were combined, and with a higher threshold (of two) for children. The prevalence of eating disorders in 2021 was 1% in 17-19-year-olds, and .6% in 11-16-year-olds-similar to the prevalence reported in 2017 (.8% and .6%, respectively). However, estimates for boys (.2%-.4%) and young men (.0%-.4%) increased. We found tentative evidence of increased population prevalence of eating disorders, particularly among young men. Despite this, the DAWBA screening items are useful for ruling out eating disorders, particularly when parents or carers screen negative, but are relatively poor at predicting who will have a disorder. Data from both parents and children and applying a higher cut point improves accuracy but at the expense of more missed cases. The prevalence of eating disorders did not markedly change from 2017 to 2021, but we found tentative evidence of an increase, particularly among young men. This is despite larger increases in problematic eating, which need further investigation. The DAWBA screen is best suited to ruling out eating disorders which limits its clinical applications as it would provide many false positives requiring further assessment.

Oral status of patients in need of cancer chemotherapy

The prevalence and detection of cancer in the world is steadily increasing. The most common methods of treating malignant neoplasms are chemotherapy and/or radiation therapy. Patients undergoing this treatment often experience oral complications. The most common complication is oral mucositis. According to the literature, the probability of its occurrence is from 20 to 80% [2, 3]. Oral mucositis and other complications have a negative impact on the quality of life of cancer patients. They face pain, difficulty eating, swallowing, and damage to the oral mucosa increase the risk of secondary infection.Aim. Evaluation of the dental status of oncological patients starting chemotherapy treatment.Material and methods. The study involved 94 patients aged 45 to 59, who were divided into three groups: 1 – malignant neoplasms of the maxillofacial region (n = 23), 2 – gastrointestinal tract (n = 39), 3 – breast (n = 32). To determine the dental status, the values of the DFM, PMA, OHI-s indices, as well as local factors contributing to the aggravation of the oral cavity (metal structures, sharp edges of the teeth) were studied. To assess the awareness of patients about the rules and methods of maintaining an individual hygienic state of the oral cavity, a survey of patients was conducted.Results. The dental status of cancer patients was assessed. The average value of the DFM index in group I is 13.3 (high), in group II – 11.4 (high), in group III – 5.7 (medium). The average value of the OHI-S index in group I was 3.8 (poor), in group II it was 3.1 (poor), in group III it was 1.7 (poor). The average value of the PMA index in group I was 67 (severe degree of inflammation), in group II – 55.6 (moderate degree of inflammation), in group III – 30.8 (moderate degree of inflammation). According to the survey, low awareness of patients about the means and methods of monitoring individual oral hygiene was revealed. Risk factors have been identified in the form of sharp edges of teeth and metal structures that can contribute to the development of severe complications from the oral cavity during chemotherapy treatment.Conclusion. According to the results of the study, an unsatisfactory dental status of patients with oncological diseases of various localization was revealed. The need for control by dentists is shown.

THE EXTREME HETEROGENEITY OF AMYLOIDOSIS AT CLINICAL PRESENTATION

Amyloidosis is a rare and complex disease characterized by pathological extracellular tissue deposition of insoluble fibrillar protein in tissues which can cause severe organ dysfunction and result in various clinical manifestations depending on the affected area and the amount of material deposited. The symptoms of the disorder are nonspecific and, therefore, it may be difficult to suspect a diagnosis. To show the diagnostic spectrum in a disease with broad clinical and nonspecific manifestations, such as extreme weight loss, macroglossia and nephrotic syndrome. A 70-year-old man seeked medical attention due to important edema of ankles with Godet Sign 3+. During clinical evaluation, urinalysis exhibited proteinuria of 6000mg/24h, indicating nephrotic proteinuria. The patient reported mild fatigue and dyspnea. An echocardiogram suggested cardiac amyloidosis, which was confirmed after a fat pad biopsy stained with Congo Red under polarized light. The patient performed autologous bone marrow transplantation and is doing well after a two year follow up. An 83-year-old woman presented with macroglossia, leading her to have difficulty in eating. At physical examination, the skin manifestation known as raccoon's eyes due to vascular infiltration of amyloid fibrils in a symmetrical periorbital distribution was present. A fat pad biopsy was performed and revealed amyloid deposits. Furthermore, due to the presence of anemia, a bone marrow smear detected Multiple Myeloma (20% plasmocytes), suggesting secondary amyloidosis. The patient began treatment with daratumumab two months ago. A 62-year-old man seeked medical attention due to intense weight loss of over 39 pounds in a 6-month period. At physical examination, the patient was pale (3+/4), had intense muscle atrophy, depicting a consumptive syndrome. Due to anemia, a bone marrow trephine was performed, surprisingly revealing amyloid deposits. This report shows three very different clinical presentations of amyloidosis, reinforcing the extreme heterogeneity of the disorder. Besides the most common sites for amyloid deposits, it's important to notice the possibility of bone marrow infiltration and extreme weight loss. Therefore, it's crucial to beware of amyloidosis's multiple manifestations for better clinical investigation. In case 1, the patient was diagnosed with nephrotic syndrome, hence the kidneys being one of the most affected organs by amyloid deposits. The patient also showed cardiac involvement, where manifestations may include arrhythmias and heart failure. Those symptoms, when associated with signs of nephrotic syndrome, should raise suspicion for amyloidosis as the underlying cause. In case 2, a woman presenting with macroglossia developed, later on, periorbital purpura from amyloid deposits. The manifestation, known as raccoon's eyes, is characteristic of amyloidosis, but it is rare and only present in less than 10% of cases. In case 3, a 62-year-old patient presented with extreme weight loss and a consumptive syndrome. Due to his state of anemia, a bone marrow biopsy was performed and revealed amyloid deposits. A bone marrow biopsy is highly useful when determining the precursor protein while also screening for possible tissue infiltration and deposition.

Peritoneal Shunt Extraction in Children Using Laparoscopy: A Case Report

Laparoscopy is one way to perform various simple procedures or surgeries in the abdominal cavity. Laparoscopy can be useful in the management of ventriculo-peritoneal shunt (VP Shunt) fractures. The peritoneal component of the shunt remaining in the abdominal cavity can be removed using laparoscopy. A pediatric patient with hydrocephalus with a history of VP Shunt insertion 5 years ago, came with complaints of weakness, vomiting and difficulty eating. Physical examination revealed the presence of edema in the chamber area. A CT scan of the head and plain abdominal radiographs were performed. The diagnosis was made as a shunt fracture, with the peritoneal component of the shunt remaining in the abdominal cavity. The patient received treatment in the form of a revised VP shunt and peritoneal shunt extraction using standard laparoscopy which is commonly used for adult patients. The patient's condition improved after the procedure. Peritoneal shunt extraction in cases of VP shunt fracture can be safely performed using laparoscopy. If there are limited tools, this procedure can still be performed on children using standard laparoscopy which is usually used for adult patients. Authors report this case due to no previous report in Mojokerto area were known.

Premature birth did not have a pronounced impact on eating behaviour of four-year-old children, but some effects were observed in girls.

Feeding of preterm-born children has been extensively studied during infancy. Few studies have focused on later life but the available data indicate that feeding problems may persist after infancy. We studied this topic using two cohorts of full-term and preterm-born children. The Children's Eating Difficulties Questionnaire was used to assess the appetite, food enjoyment, pickiness and neophobia, the fear of new foods, of 347 four-year-old children born in 2009-2011. Of these, 179 (52% boys) were born preterm at 24 to 36 weeks and recruited from paediatric clinics in southeast Sweden. The 168 children (54% boys) born full-term were recruited from a maternity health clinic in the same region. The parents graded 12 statements about their child's eating behaviour from very false to very true. A low gestational age at birth was associated with less reported appetite in girls. Estimates describing appetite and food enjoyment correlated with gestational age at birth in girls but not in boys. This difference between boys and girls was significant (p < 0.05). Prematurity had no major effects on food-related behaviour in four-year-old children. However, some estimates of reduced appetite and food enjoyment were associated with lower gestational age at birth in girls but not in boys.

396. LONG-TERM QUALITY OF LIFE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SINGLE CENTER EXPERIENCE

Abstract Esophageal cancer typically requires multimodal treatment, with neoadjuvant chemotherapy and radiation followed by esophagectomy, which has helped improve the 5-year survival of this disease. Short-term quality of life (QOL) has been previously evaluated in patients who have undergone esophagectomy. As survival rates improve and patients are living longer after having multimodal therapy, there exists a need to better understand how long-term QOL is impacted after esophagectomy. A single-center cross-sectional QOL study was performed on a cohort of patients who underwent esophagectomy for esophageal cancer (2010–2017) with a post-operative survival period of at least four years. Patients who met inclusion criteria were contacted by phone in 2021–2022 to complete the European Organisation for Research and Treatment of Cancer (EORTC) OES-30 and OES-18 questionnaires, after standardization of interviews via a telephone script. Descriptive statistics were performed. One hundred and fifty-five patients met inclusion criteria, and 64 (41.3%) completed the QOL questionnaires. Mean age was 64 years, the majority were white (98.4%) men (82.3%), and 82% underwent preoperative chemoradiation treatment. All patients underwent a minimally invasive surgical approach. At the time of QOL surveillance, the mean time from operation was 6.9 years. The median global QOL score in this population was 79.2 (Max 100). The population had median reported severity scores for dysphagia (100), reflux (33.3) trouble eating (16.7), and pain (11.1) (Max 100). A median score of 0 was found for all other esophageal symptom categories. In patients surviving at least four years from esophagectomy for esophageal cancer, symptom severity scored highest for dysphagia. Elevated severity scores were also seen in descending order for reflux, difficulty eating, and pain. Despite these continued symptoms, long-term overall QOL remained high for this population after esophagectomy.

Effect of Behcet's disease-associated oral ulcers on oral health related quality of life.

The current study assessed the clinical characteristics of patients suffering from Behcet's disease (BD)-associated oral ulcers and investigated the effect of these oral ulcers on the oral health-related quality of life (OHRQoL). This study included BD patients suffering from active oral ulcers, defined by the revised International Criteria for BD (ICBD) criteria. We collected BD and oral ulcers characteristics. The oral ulcer activity index and OHRQoL were measured by composite index (CI) and Oral Health Impact Profile-14 (OHIP-14), respectively. Genital and ocular manifestations were the most frequent. Ocular manifestations were the main diagnostic manifestation. The mean age of BD diagnosis and first oral ulcer appearance were 32.15±8.96 and 29.62±9.04, respectively. Minor oral ulcers were more frequent; solitary or multiple. CI revealed that pain was more severe than functional disability. OHIP-14 showed that patients suffered more often from pain and difficulties in eating. Patients reported feeling tense, being irritable, doing usual job with difficulty, and having less satisfying life. BD-associated oral ulcers lead to poor quality of life. Female gender, multiple ulcers, and buccal mucosa were associated with more severe pain and functional disability as well as poorer quality of life.

Patient treatment cost of oral diseases in Ghana.

To estimate patient treatment cost of oral diseases in Ghana. A cross-sectional study design using cost-of-illness analysis was employed. The study was conducted at the dental unit of the University of Ghana Hospital, Legon. About 185 patients attending the dental unit of the hospital were selected. None. Direct medical and non-medical costs, indirect costs, and intangible costs of treatment of oral conditions. The estimated average cost of treatment for oral diseases was US$ 35.75. The total cost was US$ 6,614.11, with the direct and indirect costs constituting 94.5% and 5.5%, respectively of the total cost. Direct medical costs constituted 86.9%, while direct non-medical costs constituted 13.1% of the total direct cost. The richer socio-economic group had the highest cost per quintile, with a mean of US$ 46.69. The intangible cost described was highest for pain (47.1%), followed by difficulty in eating (40.8%) and sleeping (34.6%) for both men and women. The costs of oral diseases are huge and cannot be overlooked. Oral diseases also pose significant productivity losses to patients. None declared.

LUDWIG'S ANGINA ASSOCIATED TO CHEMICAL STOMATITIS DUE TO COCAINE USE

A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation. A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation.

UNUSUAL ORAL MANIFESTATION OF PARACOCCIDIOIDOMYCOSIS MIMICKING ORAL SYPHILIS

A 38-year-old White man, rural dweller, presented to the stomatology service reporting a painful nodule with ulcerated areas in the buccal mucosa on the right side extending to the upper and lower lips about 1 year ago. He reported mouth opening limitation and difficulty eating. Facial asymmetry was also noticed in the extraoral examination. Some oral infectious diseases were considered as diagnostic hypotheses. Laboratory exams and partial biopsy were conducted. Serological tests were compatible with syphilis and microscopic features were inconclusive. Treatment with penicillin G benzathine intramuscular and dipyrone was prescribed. The patient returned 3 months later for follow-up examination without regression of signs and symptoms. A new biopsy was performed, and microscopic features confirmed oral paracoccidioidomycosis. The patient was referred to an infectologist and pneumologist. Treatment with itraconazole 100 mg was performed. Partial remission of oral lesions was observed after 2 months.