Extraoral Lesions Research Articles

Metagenomic Analysis of Bacterial Microflora in Dental and Atherosclerotic Plaques of Patients With Internal Carotid Artery Stenosis.

Internal carotid artery stenosis is primarily attributed to atherosclerosis in the carotid artery bifurcation. Previous studies have detected oral bacteria in atherosclerotic lesions, suggesting an association between oral bacteria and atherosclerosis. In this study, we compared the bacterial flora of the atherosclerotic plaque in the carotid artery and dental plaque of patients with internal carotid artery stenosis using 16S ribosomal RNA (16S rRNA) metagenomic sequencing. Fifty-four patients who underwent internal carotid endarterectomy for internal carotid artery stenosis at the Showa University Hospital between April 2016 and February 2018 were included. Polymerase chain reaction targeting the 16S rRNA gene detected bacterial DNA in the carotid plaques of 11 cases, of which only 5 could be further analyzed. Thereafter, DNA extracted from the carotid and oral plaques of these 5 cases were analyzed using metagenomic sequencing targeting 16S rRNA. In addition, their general condition and oral conditions were evaluated. The patients were classified into symptomatic and asymptomatic groups based on the presence or absence of symptoms of transient ischemic attack, and their bacterial flora was evaluated. The results demonstrated that the microflora of carotid plaques (n = 5) contained bacterial species from 55 families and 78 genera. In addition, 86.5% of the bacteria detected in the carotid plaques were also detected in oral plaques. Cariogenic and periodontopathic bacteria accounted for 27.7% and 4.7% of the bacteria in the carotid plaques, respectively. These results suggest that oral bacteria are directly or indirectly involved in the pathogenesis of atherosclerosis. More extensive studies of oral commensal bacteria detected in extra-oral lesions are warranted to comprehensively investigate the role of oral bacteria in the pathogenesis of systemic diseases.

Verruciform Xanthoma: Clinical and Morphologic Spectrum Across Oral, Genital, and Cutaneous Sites.

Verruciform xanthoma (VX) is an uncommon, benign epithelial lesion of the oral mucosa. While this entity can also present extraorally, including on the skin and in anogenital areas, the variation in its histologic features in extraoral sites is not yet well defined. Differences in the demographics and morphologic features of oral versus extraoral VX were assessed to help facilitate the accurate diagnosis and management of this lesion. After obtaining IRB approval, 110 cases of diagnosed VX were retrospectively collected from our institutional archives spanning from 2000 to 2022. Patient age, gender, available medical history, lesion appearance, and duration were obtained for each case. The median age was 55years (range 13-86) with a male-to-female ratio of 1.2:1. The most common oral sites, in descending order, were the palate (n = 24, 22%), buccal mucosa (n = 18, 16%), gingiva (n = 16, 15%), and tongue (n = 13, 12%). Extraoral sites comprised 9% of all lesions, including the scrotum (9), vulva (2), cheek (1), wrist (1), gluteal region (1), and abdominal wall (1). The median size for all lesions was 6.0mm, and extraoral lesions were associated with a 6.7mm larger size compared to oral lesions (B ± SE: 6.7 ± 2.5cm, p = 0.01). The lesions were most frequently pink or white in color and often described as papillary, pedunculated, verrucous, and/or exophytic. Microscopically, the presence of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated inflammation significantly differed between oral and extraoral lesions. Prominent wedge-shaped parakeratosis (p = 0.04) and keratin projections above the epithelium/epidermis (p < 0.001) were more prevalent in extraoral lesions. There was no significant link between keratin projections and epithelial atypia (p = 0.44). Familiarity with the broad morphological spectrum of VX, including the presence and degree of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated underlying inflammation, will be helpful in diagnosing it in unusual locations.

A rare case of bilateral pulse granuloma of maxilla

Pulse or hyaline ring granulomas are rare but are well-defined oral and extraoral lesions due to implantation of the cellulose moiety of plant foods in contrast starch components. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. It is Microscopic oral inflammatory lesion characterized by the presence of giant cells and hyaline rings. The features of pulse granuloma are not considered clinically distinctive and remain primarily microscopic. Extensive knowledge of abnormal sites of origin and clinical manifestations enables clinicians to recognize the diagnostic risks of confusing pulse granuloma with other entities.

Bullous Lichen Planus of Oral Mucosa: A Case Report

Oral bullous lichen planus is a rare form of lichen planus LP characterized by vesicles or bullae which frequently occur in the setting of pre-existing LP lesions. Histopathology corroborates the diagnosis which is based on clinical suspicion. Bullous lichen planus does not have a standard therapy. Dapsone acitretin topical and systemic corticosteroids are a few of the efficient options. A case of oral bullous lichen planus in a 36- year old female patient with extra oral lesions on the legs successfully treated with topical Triamcinolone acetonide is described here in this case report.

Reticular Oral Lichen Planus: A Clinical Experience of ENT Surgeons.

Reticular Oral lichen planus (OLP) is a chronic autoimmune disease that presents as fine, white, linear and lacelike lesions of the oral cavity referred to as Wickham striae. The clinical characteristics of 30 patients with reticular oral lichen planus is presented so that cases are not missed/misdiagnosed by ENT surgeons. The clinical records noted for each patient were gender, ageandclinical presentation of reticular OLP (site affected, presence of symptoms and extraoral manifestations of the disease, smoking habit, and consumption of alcoholic beverages). Twenty patients were females (66.7%) and 10 (33.3%) were males giving a female to male ratio of 2:1. Majority of patients (50%) among both males and females were in the age group of 31-40years followed by 41-50years (20%). Oral discomfort/burning sensation was the chief symptom in 24 (80%) patients followed by asymptomatic oral white patches in 5 (16.6%).The buccal (cheek) mucosa was the site most affected (76.8%) followed by the buccal mucosa plus retromolar trigone mucosa (10%) and tongue (6.6%), Extraoral lesions were observed in 2 (6.6%) of patients at presentation with oral lesions and were on the nails in 1 patient and wrist in 1 patient. Tobacco smoking, alcohol use, diabetes and hypertension were reported in 3 (10%), 0%, 2 (6.7%) and 4 (13.3%) patients respectively. ENT surgeons routinely see patients with oral discomfort/oral ulcerations and as such they should be well versed with classical clinical characteristics of reticular oral lichen planus.

ORAL MUCOSAL MELANOMA: A CASE REPORT OF A LIFE-THREATENING DISEASE

Oral mucosal melanoma (OMM) is a rare malignancy of melanocytic origin, with a poor prognosis and low overall survival. We report a case of a 45-year-old male patient who presented with an ill-defined blackish-grey nodule, sometimes as a macule, affecting the maxillary gingiva and hard palate, with painless palpable lymph nodes. No clinical evidence of other extraoral lesions was found. Serologic tests for human immunodeficiency virus 1/2 were negative, and radiographs demonstrated a bone loss near the maxillary incisors. An incisional biopsy was performed in different sites, with OMM and Kaposi's sarcoma as clinical hypotheses. The histopathologic diagnosis was consistent with OMM and the patient was referred to the oncologist. OMM is a life-threatening disease, and its overall behavior is more aggressive than its cutaneous counterpart. All potential primary sites must be investigated in cases in which the oral cavity may not be the primary site.

Bullous pemphigoid: Case report and review of literature​

Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by subepithelial blistering mostly affecting elderly but may be seen in all ages. A 52-year-old female patient came with a chief complaint of itching, redness and ulcer in the hands and oral cavity for the past 2 weeks. The examination revealed ulcer- ated lesions in palate and buccal mucosa. Erythematous lesions were also seen in upper limb. Incisional biopsy was done and histological examination revealed bullous pemphigoid. The patient was immediately started with systemic and topical steroids and was continued for 3 weeks. The extra-oral lesions were healed and intraoral ulcerations subsided after 3 weeks.

Developing confidence in oral and maxillofacial dental core trainees: a national review of the trainee experience

This study considers the confidence of dental core trainees (DCTs) as they mature and progress through their first six months in an oral and maxillofacial surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS: to develop additional skills before settling into general dental practice; as a step towards specialty training; and to help decide about their career direction. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians. We surveyed 123 DCTs at three stages over a six-month period to monitor their confidence in 10 clinical domains: assessing dentofacial infection, mandibular fractures, midface fractures, intraoral/extraoral swellings, airway risks, intraoral/extraoral lesions (benign/malignant), CT/MRI scans, and performing intraoral/extraoral suturing. The study demonstrates an increase in trainee confidence across all domains over the first six months of an OMFS post, with a particularly significant increase in the assessment of dentofacial infection, mandibular/midface fracture, and both intraoral and extraoral lesions and swellings.

Severe Gingival Swelling and Erythema

A 62-year-old man presented to an oral medicine specialist with gingival inflammation of at least 1 year's duration. He reported mild discomfort when consuming spicy foods and denied associated extraoral lesions. His medical history revealed hypertension, hypothyroidism, and psoriasis.

Ligneous Periodontitis: A Case Report with Different Treatment Approaches and Eleven Years of Follow Up

Ligneous mucosal disease is a rare, destructive condition of plasminogen deficiency characterized by generalized membranous gingival enlargement leading to rapid tooth loss. We report a case of long-standing, generalized ligneous periodontitis with an eleven years of follow- up. The patient did not have any extra oral lesions although she had been suffering from plasminogen deficiency. Treatment approaches had no benefit. An abnormal healing process is the main pathogenetic mechanism; still, intensive periodontal health care is essential for the patients who suffer from ligneous mucosal disease. This report describes a ligneous periodontitis case with a history of ligneous conjunctivitis and its clinical and histopathologic findings, therapeutic approaches and eleven years of follow-up.

Detection of extraoral primary cancers by positron emission tomography/computed tomography in patients with oral squamous cell carcinoma.

Extraoral primary cancers (EPCs) can appear in patients with oral cancer. This study investigated the use of positron emission tomography/computed tomography (PET/CT) to detect EPCs and to identify characteristics of these cancers. The disease-specific survival rate and the overall survival rate were calculated. We studied records for 891 patients with oral cancer who underwent PET/CT between January 2006 and December 2016 for the detection of EPCs. A total of 35 EPCs were detected by PET/CT in 34 patients with primary oral carcinoma (3.8%). Of this total, 33 patients had 1 EPC and 1 patient had 2 EPCs. The extraoral lesions were found in the upper gastrointestinal tract (11), colon (6), lung (5), kidney (3), liver (2), prostate (2), breast (2), bladder (1), thyroid (1), pancreas (1), and hypopharynx (1). The disease-specific survival rate was 84.8% and the overall survival rate was 64.6%. PET/CT was useful for early detection of EPCs. The use of PET/CT for the early detection and treatment of EPCs with no symptoms can improve treatment outcomes.

Clinical profile of 102 patients with oral lichen planus in Thailand.

BackgroundOral lichen planus (OLP) is a chronic inflammatory disease of the skin and mucous membrane presented with various clinical appearances. The aim of the present study was to elucidate the clinical profile of patients with OLP.Material and MethodsThe dental records of 102 patients who visited Oral Medicine Clinic, Dental Hospital, Naresuan University during 2002-2018 were retrospectively reviewed.ResultsThere were 75 (73.5%) women and 27 (26.5%) men, giving a female to male ratio of 2.8:1. The age of OLP patients ranged 20-81 years old with the mean age of 56.4 ± 13.2 years old. Seventy-eight patients (76.5%) had the history of systemic diseases and hypertension was the predominantly one. Most patients were non-smokers (98%), non-drinkers (86.3%) and non-betel nut chewers (98%). The atrophic form (93.1%) was the most common OLP. The lesions were mainly symptomatic (92.2%) and involved multiple locations (67.6%) where the buccal mucosa (79.4%) primarily affected. Only 2% were extraoral lesions detected on the skin. Patients had no family history of OLP or malignant transformation. Ninety-one patients (89.2%) were treated with topical steroid and only 4 patients were prescribed a combination of tropical and systemic steroid.ConclusionsThe results of the study indicated that most of characteristics are in accordance with previous studies. Since, OLP is a chronic inflammatory oral mucosal disease with high recurrence rate, early detection, accurately diagnosis, and long-term follow-up are necessary to evaluate the exacerbation and malignant transformation. Key words:Clinical profile, demographic, oral lichen planus, retrospective study.

Orofacial conditions and their relation to the sense of coherence among participants afflicted with leprosy in West Bengal State: A cross-sectional study.

About 4 million people are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. In India, it is highest in West Bengal, Maharashtra, Uttar Pradesh, and Bihar. The objective of the study is to assess the quality of life in terms of sense of coherence (SOC) among patients afflicted with leprosy in the state of West Bengal (located in eastern India on the Bay of Bengal). A cross-sectional descriptive epidemiological study was conducted among estimated sample size of 350 participants who were afflicted with leprosy drawn from across the state of West Bengal, India. Data were collected on a specially designed pro forma. Most of the participants afflicted with leprosy were in the age group of 40-77 years, and there was predominance of males, with most of them belonging to the upper-lower socioeconomic class. On evaluating the incidence of extraoral lesions through ranking, facial nodules and facial spots were highest 182 (52%), while among intraoral lesions such as melanin pigmentation 176 (50%) and inflammatory papillary hyperplasia 150 (42.8%), was seen in greater fraction. The results of bivariate analysis between SOC and variables under investigation show that majority of the cases, i.e., 258 (47.14%) revealed the SOC interpretation as "poor." Statistical analysis showed significant difference in relation to age (P ≤ 0001) and socioeconomic status (P = 0.053) of participants. We conclude that 52% of the population were having facial nodules and facial spots and 50.2% of the population had intraoral manifestation such as melanin pigmentation. Analysis of SOC revealed that majority of the cases were interpreted as "poor."

Oral lesions as a clinical sign of systemic lupus erythematosus

Background: Oral lesions represent one of the most important clinical symptoms of systemic lupus erythematosus (SLE), an autoimmune disease with a high degree of clinical variability rendering it difficult to arrive at a prompt and accurate diagnosis. There are many unknown causes and multiple organ systems involved, with the result that permanent organ damage may occur before treatment commences. Purpose: The purpose of this case report is to discuss the importance of recognizing the lesions related to SLE which may help dentists to make an early diagnosis. Case: A 17-year-old female patient was referred by the Internal Medicine Department with a suspected case of SLE. Prior to admittance to the hospital, the patient was diagnosed with tuberculosis. A subsequent extraoral examination revealed ulceration with a blackish crust on the upper lip. An intraoral examination showed similar ulceration covered with a blackish crust on the labial mucosa accompanied by central erythema in the hard palate. Blood tests indicated decreased levels of hemoglobin, hematocrit and platelets, but increased levels of leukocytes. A diagnosis of oral lesions associated with SLE and angioedema was formulated. Case management: The patient was given 1% hydrocortisone and vaseline album for extraoral lesions, while 0.2% chlorhexidine gluconate and 0.1% triamcinolone acetonide was used to treat intraoral lesions. An improvement in the oral lesions manifested itself after two weeks of treatment. Conclusion: Early detection of oral lesions plays a significant role in diagnosing SLE. It is important for the dentist to recognize the presentation of diseases that may be preceded by oral lesions. A multidisciplinary approach and appropriate referrals are necessary to ensure comprehensive medical and dental management of patients with SLE.

Oral Biofilms from Symbiotic to Pathogenic Interactions and Associated Disease -Connection of Periodontitis and Rheumatic Arthritis by Peptidylarginine Deiminase.

A wide range of bacterial species are harbored in the oral cavity, with the resulting complex network of interactions between the microbiome and host contributing to physiological as well as pathological conditions at both local and systemic levels. Bacterial communities inhabit the oral cavity as primary niches in a symbiotic manner and form dental biofilm in a stepwise process. However, excessive formation of biofilm in combination with a corresponding deregulated immune response leads to intra-oral diseases, such as dental caries, gingivitis, and periodontitis. Moreover, oral commensal bacteria, which are classified as so-called “pathobionts” according to a now widely accepted terminology, were recently shown to be present in extra-oral lesions with distinct bacterial species found to be involved in the onset of various pathophysiological conditions, including cancer, atherosclerosis, chronic infective endocarditis, and rheumatoid arthritis. The present review focuses on oral pathobionts as commensal and healthy members of oral biofilms that can turn into initiators of disease. We will shed light on the processes involved in dental biofilm formation and also provide an overview of the interactions of P. gingivalis, as one of the most prominent oral pathobionts, with host cells, including epithelial cells, phagocytes, and dental stem cells present in dental tissues. Notably, a previously unknown interaction of P. gingivalis bacteria with human stem cells that has impact on human immune response is discussed. In addition to this very specific interaction, the present review summarizes current knowledge regarding the immunomodulatory effect of P. gingivalis and other oral pathobionts, members of the oral microbiome, that pave the way for systemic and chronic diseases, thereby showing a link between periodontitis and rheumatoid arthritis.

WHITE SPONGE NEVUS: A REPORT OF FOUR-GENERATIONS

White sponge nevus (WSN) is a rare inherited, autosomal dominant genodermatosis, which is characterized by white and corrugated plaques mainly affecting the oral mucosa. Mutations of keratin 4 and keratin 13 have been associated with WSN. This condition shows a high degree of penetrance and variable expressivity. Our report describes the case of a Hispanic family in which oral WSN lesions were seen in four generations. Clinical examination revealed that of their 18 descendants, 6 (33.3%) were afflicted. Of these, 3 were females and 3 were males. The most commonly affected sites were the buccal and labial mucosa. No extraoral lesions were noted. No history of consanguinity was found within the family. It was determined that both unaffected and affected members had transferred the disease via an autosomal dominant mode of inheritance with incomplete penetrance. This family was discovered after the proband initial consultation of an eight-year old girl.

Diagnosis of lichen planus, the importance of extraoral lesions. Clinic case

Diagnosis of lichen planus, the importance of extraoral lesions. Clinic case

Erythema Multiforme

A 25-year-old woman presented in distress to an oral medicine clinic for evaluation of recurrent oral lesions of 3 years duration. Occurring at least 3 times annually, she reported an acute onset of diffuse oral ulcerations accompanied by hemorrhagic crusting and swelling of the lips that resolved within 4 weeks. She denied extraoral lesions, a history of clinical herpes simplex virus (HSV) infection, and was unaware of any first-degree relatives with a history of oral ulcers. The patient was evaluated in different emergency departments on 5 separate occasions and was diagnosed with aphthous stomatitis or HSV infection. The patient was routinely prescribed topical anesthetics and valacyclovir 1000-2000 mg daily without benefit.

Oral health status among Iranian veterans exposed to sulfur mustard: A case-control study.

Background Sulfur mustard (SM) is a chemical warfare agent that has been repeatedly used since World War I. SM has chronic and deleterious effects on different body organs such as lungs, skin and eyes.Objectives To determine dental and oral health status of chemical victims of SM who were exposed to SM during the Iraqi-Iran war. Material and Methods In this case-control study, 100 male subjects exposed to SM were chosen as cases, and 100 non-exposed volunteers were chosen as controls. These groups were selected randomly according to their referral number, and were matched regarding age. Collection of information was performed using Oral Health Assessment Form designed by the World Health Organization. Quantitative and qualitative data were compared between the groups using independent samples t-test and Chi-square test, respectively. Results There was a significant difference between the case and control groups with respect to the frequencies of oral candidiasis, pharyngeal erythema and/or hyperplasia, hairy tongue and reflux disease, being higher in the former group. There was also a positive association between the frequency of candidiasis and the percentage of disability; pharyngeal erythema and/or hyperplasia and use of salmeterol spray; and between hairy tongue and antibiotic use in the case group. Conclusions Exposure to SM and the use of drugs for controlling long-term complications does not increase the risk of tooth decay, tooth loss, and intra and/or extra oral lesions in patients, but may be associated with increased incidence of oral candidiasis, pharyngeal erythema and/or hyperplasia, hairy tongue and reflux disease.samples of oral precancerous and cancerous lesions to test sensitivity and specificity and thus validate the clinical applicability of fluorescence imaging in (pre)cancerous diagnostics. Key words:Sulfur mustard, oral health, candidiasis.

A retrospective study of 171 patients with oral lichen planus in the East Bohemia - Czech Republic - single center experience.

Objectives: Oral lichen planus is chronic inflammatory disease with a high prevalence in the population. This study describes the epidemiological and clinical characteristics of group of patients with oral lichen planus in the Czech Republic. Material and Methods: Data was taken from the medical records of 171 patients referred to the Oral Medicine Unit at the University Hospital in Hradec Králové with histologically confirmed clinical diagnosis of oral lichen planus in the period 2003 – 2013. The data were retrospectively reviewed. Results: Of the 171 patients, 116 (67.8%) were women and 55 (32.2%) were men. The mean age was 55.2 ± 12.4 years (range of 85.0 – 20.9). The reticular form was the most frequent 93.6% (160 pts.), desquamative gingivitis was 12.9% (22). The buccal mucosa was the site most affected 89.5% (153 pts.). The lesions were asymptomatic in 52 patients (30.4%). Extraoral lesions were observed in 20.5% (35 pts.) of the patients, skin involvement was in 16.4% (28 pts.). Smokers were 29 patients. Local treatment used 116 (67.8%), only 6 patients used systemic short tome corticoid therapy. No evidence between OLP and malignant transformation was observed. Conclusions: This retrospective study show very similar profile and clinical features of the patients with OLP as in other studies. Key words:Oral lichen planus, clinical features, extraoral manifestation.