Oral Lesions In Children Research Articles

Concordância: impressão clínica vs. histologia oral pediátrica

ABSTRACT Several pathologies often lead to disagreements regarding their identification in clinical practice, particularly in the context of oral pathologies. The data obtained during anamnesis and physical examination frequently require revision to reach a diagnosis. Objective: The present study aimed to evaluate the agreement between clinical and histopathological diagnoses and report the frequency of completing forms for specimens submitted to histopathological examination, examined retrospectively. Methods: Data on 93,950 specimens submitted for histopathological examination were retrieved from medical records. Results: A total of 5,052 reports from patients aged 0 to 14 years were included. Agreement was defined based on categorizing the nature of the injury according to its diagnostic category. The highest agreement rate was observed for mucocele and papilloma (86%), followed by pyogenic granuloma (60%). Low rates of histopathological confirmation of clinical impressions were observed for hemangioma (17.5%) and peripheral giant cell lesion (35%). Among lesions related to dental tissues, odontoma showed the highest agreement (84%), followed by keratocyst (74%), while radicular cyst showed the most discordance (21%). Conclusion: This study found an acceptable level of agreement for the most frequent injuries. However, understanding the characteristics of oral lesions in children and their clinicopathological correlations is crucial for providing optimal treatment in each case.

Oral lesions of viral, bacterial, and fungal diseases in children: A decision tree.

Oral mucosal lesions are common in the pediatric population and, apart from traumatic and tumoral etiologies, they can be symptoms of viral, bacterial, fungal or parasitic diseases. Yet, pediatricians and pediatric dentists find it challenging to reach a diagnosis and provide appropriate care when facing lesions of the masticatory or lining mucosa, of the hard or soft palate, of the tongue or salivary glands. Here, we propose a decision tree for the diagnosis of the most frequent viral, bacterial, and fungal diseases starting from their oral lesions in children. By first focusing on describing the elementary lesion itself before its localization and characteristics, it aims to guide the practitioner toward the diagnosis and any necessary complementary exams. To generate this tool, we conducted a literature review of the childhood viral, bacterial, fungal and parasitic diseases with oral mucosal symptoms. For each of the 42 reported diagnoses−20 viral, 9 bacterial, 5 fungal, and 8 parasitic—we collected the infection mechanism and agent(s), the oral lesions and their description, the associated systemic signs and the incidence/prevalence. In fine, our decision tree indexes the 28 diseases for which epidemiological data was available, mainly in Europe and the United States.

Oral lesions in children/teenagers: a cross-sectional study of 225 reports in a pathology service in Amazon.

Epidemiologic studies of oral lesions in pediatric patients are scarce in Brazil, and especially in the northern region of the country. We aim to describe the distributions of oral lesions in children and teenagers diagnosed in a Pathology service of Amazon for over 15 years. The oral pathology files were retrospectively retrieved from January 2002 to December 2016 of patients younger than 18 years old at the Pathology Service of the Federal University of Amazonas. Patient information such as gender, age, race, aspect of the lesion, anatomical site, and histological type was compiled from the file of requisitions and histopathologic reports. Oral lesions were subdivided into 11 categories. From a total of 2437 histopathological oral reports, 225 of them were from children. Of these, 125 (55.6%) were from male patients and 100 (44.4%) from female patients with a median age of 13 years. Of the 11 categories of oral pathologies, the one of the highest numbers was salivary gland disease (N.=50, 22.2%) with the subtype mucocele (N.=41, 18.22%) as the most prevalent followed by Miscellaneous pathology (N.=27, 12%) with the predominance of the subtype granulation tissue (N.=11, 4.89%) and finally Odontogenic tumors (N.=26, 11.6%) in third place, with odontoma (N.=16, 7.11%) as the most prevalent subtype. Mucocele was the most prevalent lesion found, showing that a traumatic etiology is likely to be the most common situation in children and teenagers, while neoplastic lesions are generally rare.

Oral lesions of higher clinical frequency in children – literature review

Abstract 
 Objective: The objective of this article is to present to the dental professionals, through a literature review, the main oral lesions that are part of the odontopediatric stomatology, in order to improve the knowledge and attention to the health of the pediatric patients. Methods: The searches were carried out in the following bibliographic databases - PubMed, Web of Science, LILACS and Bireme. Data synthesis: This article deals with the description of the most frequent oral lesions in Pediatric Dentistry, ranging from characteristic changes in the newborn to pathological, non-pathological, congenital, fluid retained, ulcerative and those related to the main infectious diseases of childhood, with clinical manifestations in the oral cavity. Conclusion: It is very important, for General Practitioner and Pediatric Dentistry to,recognize oral lesions in children, to make a correct and early diagnosis of them, in order to improve the knowledge, attention to the health and quality of life of the pediatric patients.
 RESUMO
 Objetivo: apresentar aos profissionais da Odontologia, por meio de uma revisão da literatura, as principais lesões bucais que fazem parte da Odontopediatria, a fim de melhorar o conhecimento e a atenção à saúde dos pacientes pediátricos. Métodos: As buscas foram realizadas nas seguintes bases de dados bibliográficas - PubMed, Web of Science, LILACS e Bireme. Síntese dos dados: Este artigo trata da descrição das lesões bucais mais frequentes na Odontopediatria, desde mudanças características no recém-nascido até patológicas, não patológicas, congênitas, lesões com retenção de líquido, ulcerativas e aquelas relacionadas às principais doenças infecciosas da infância, com manifestações clínicas na cavidade bucal. Conclusão: É muito importante, para o clínico geral e para o odontopediatra, reconhecer as diversas lesões que podem acometer a cavidade bucal das crianças, propiciando um diagnóstico correto e precoce das mesmas, a fim de melhorar o conhecimento, atenção à saúde e qualidade de vida dos pacientes pediátricos. .

The Most Common 5 Pediatric Oral Lesions in Middle Nile Delta, Egypt

Background: The prevalence studies on common pediatric oral lesions (POLs) are still rare compared with those on dental caries and periodontal diseases. POLs vary among different geographic regions, age, racial and lifestyle of each population. The purpose of this study was to determine the most common 5 POLs referred to 5 different dental and medical branches in Middle Nile Delta, Egypt. Materials and methods: A qualitative study design was used depending on expert opinions on oral lesions in children (aged 0-14 years). A total of 1164 dental and medical staff members, dentists and physicians at the hospitals of Universities and Ministry of Health, and Specialized Medical Centers & hospitals in the Middle Nile Delta region were included. The target population of the study was experts in 5 branches: Pedodontics, Oral Medicine and Periodontology, Oral and Maxillofacial Surgery, Pediatrics, and Dermatology and Venereology. Data were collected using a checklist including the common diseases within the scope of the study and each expert was asked to give percentages for children seen with each disease entity in his/her branch. Data analysis: Data were statistically analyzed using Statistical Package for the Social Sciences version 19. For each disease, the number and percentage were calculated and differences between observation recorded by health care workers in University and Ministry of Health were tested by chi-square test. P values < 0.05 were considered significant. Results: The most common 5 lesions in Middle Nile Delta region were herpes infection (70.1%), candidiasis (69.2%), aphthous ulcer (67.3%), geographic tongue (56.1%), and acute dental abscess (49.7%). According to each branch; in Pedodontics; acute dental abscess (95.5%), pulp polyp (94.5%), parulis (88.6%), herpes infection (82.7%), and acute pericoronitis (82.3%) were recorded. In Oral Medicine and Periodontology; herpes infection (95.5%) was on the top, followed by physiologic pigmentation (83.5%), candidiasis (76.8%), aphthous ulcer (75.0%), and geographic tongue (70.5%), while in Oral and Maxillofacial Surgery; acute dental abscess (68.1%), acute pericoronitis (59.2%), odontoma (55.0%), eruption cyst (49.2%), and hemangioma (46.7%) were recorded. In the Pediatric branch; the top lesion was candidiasis (96.2%), followed by the geographic tongue (79.2%), herpes infection (74.2%), aphthous ulcer (68.7%), and scarlet fever (35.0%). In Dermatology and Venereology; candidiasis (87.0%), herpes infection (74.5%), geographic tongue (72.1%), physiologic pigmentation (70.0%), and chickenpox (66.7%) were the top 5 lesions. Conclusion: In Middle Nile Delta, Egypt; the most common 5 pediatric oral lesions were herpes infection, followed by candidiasis, aphthous ulcer, geographic tongue, and acute dental abscess. The most common 5 lesions in each department; the results of Oral Medicine and Periodontology, Dermatology and Venereology, and Pediatrics were nearly similar but differ in the ranking, however, the Pedodontics and Oral &Maxillofacial Surgery reported different lesions from the others but similar to each in 2 lesions.

Defective regression models for cure rate modeling with interval‐censored data

Regression models in survival analysis are most commonly applied for right-censored survival data. In some situations, the time to the event is not exactly observed, although it is known that the event occurred between two observed times. In practice, the moment of observation is frequently taken as the event occurrence time, and the interval-censored mechanism is ignored. We present a cure rate defective model for interval-censored event-time data. The defective distribution is characterized by a density function whose integration assumes a value less than one when the parameter domain differs from the usual domain. We use the Gompertz and inverse Gaussian defective distributions to model data containing cured elements and estimate parameters using the maximum likelihood estimation procedure. We evaluate the performance of the proposed models using Monte Carlo simulation studies. Practical relevance of the models is illustrated by applying datasets on ovarian cancer recurrence and oral lesions in children after liver transplantation, both of which were derived from studies performed at A.C. Camargo Cancer Center in São Paulo,Brazil.

A Review on Common Oral Mucosal Lesions Associated with Pediatric Patients

Pediatric oral pathology deals with the conditions causing or resulting from morbid anatomic or functional changes in the structures of the mouth in the pediatrics. Children and adolescents exhibit a wide spectrum of oral lesions including hard and soft tissue lesions of the oral maxillofacial region. Oral pathoses in children are often missed since obtaining detailed history and performing thorough clinical examination and more difficult in comparison with an adult. Oral lesions in children include mucosal conditions, developmental anomalies, neoplastic, reactive or inflammatory lesions. Thus this review article provides a brief note on the oral lesions commonly dealt with pediatric patients.

Prevalence of oral lesions among Jordanian children

Introduction: Prevalence studies on oral lesions in children are scarce, and none of them was conducted in Jordan. Objectives: To determine the prevalence of oral mucosal lesions among Jordanian children. Materials and Methods: A stratified cluster random sampling technique was used to select a sample of first and sixth-grade school children. Systematic oral examination was performed using natural light, and lesions were diagnosed based on the clinical diagnostic criteria proposed by the WHO. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA), and P < 0.05 was considered statistically significant. Data were analyzed using Chi-squared test or Fisher's exact test where appropriate. Results: The study included 1366 school children (639 [46.8%] males and 727 [53.2%] females) of whom 620 (45.4%) were 6-year-old and 746 (54.6%) were 12-year-old. The prevalence of oral lesions among children was 47.4%, without a significant difference in prevalence between males (46.6%) and females (47%). Prevalence was significantly higher in 12-year-old children (50%) compared to 6-year-old children (44.2%; P = 0.032). The most commonly diagnosed lesions were racial pigmentation (16.8%), fissured tongue (14.6%), and hematoma (5.3%). Discussion: Oral mucosal lesions are common in children in general, with no overall preference to gender, but the prevalence increases significantly with age. General dental practitioners and pediatric dentists should be aware of the common oral mucosal lesions in their communities for optimum diagnosis, management, and possible prevention. Conclusions: Oral lesions are common among Jordanian children and dentists should be aware of their diagnosis and management.

Lesões bucais na infância: revisão sistemática de interesse da fonoaudiologia

RESUMO Este estudo tem como tema, fonoaudiólogos, médicos e dentistas que são profissionais que, frequentemente, em suas ações profissionais, realizam exames intrabucais em seus pacientes. Muitas crianças, desde seu nascimento, apresentam o acometimento por lesões bucais que podem trazer transtornos temporários ao cotidiano. O objetivo é apresentar aos profissionais de saúde uma revisão sistemática acerca das lesões bucais mais frequentes em crianças e de interesse da fonoaudiologia. Os profissionais de saúde devem buscar sempre aumentar seus conhecimentos melhorando a atenção à saúde de seus pacientes.

Gingival proliferative lesions in children and adolescents in Brazil: A 15-year-period cross-sectional study.

Background:Studies assessing the prevalence of oral lesions in children and adolescents, particularly in gingiva are scarce in the literature. The aim of the study was to describe the distribution of gingival proliferative lesions based on clinical and histopathological diagnoses in children and adolescents.Materials and Methods:A review of clinical charts of children and adolescents aged between 0 and 18 years old, admitted to the Oral Medicine Outpatient Unit, of Universidade Federal do Paraná, for 15 years (1994–2009) was performed.Results:Six hundred and sixty-nine out of 5,129 patients treated during this period were aged between 0 and 18 years old, and 45 of these had gingival lesions. The largest number of lesions was observed between 11 and 16 years old. The majority of the patients were referred by Curitiba's public health system. Pyogenic granuloma was the most frequent lesion (19 = 42.2%), followed by peripheral giant cell lesion (11 = 24.4%), gingival fibromatosis (10 = 22.2%), and peripheral ossifying fibroma (5 = 11.1%).Conclusion:Gingival proliferative lesions can show similar clinical characteristics. Appropriate clinical and histopathological diagnoses are necessary to guide the healthcare professional to establish the adequate treatment and to estimate the risk of recurrence.

Retrospective analysis of 1286 oral and maxillofacial biopsied lesions of Iraqi children over a 30 years period

ObjectivesTo determine the prevalence of oral lesions by age and gender among the pediatric population in Iraq. Materials and methodsA review of the archives of the oral pathology department of Baghdad University from, 1970 Materials and Methods: A review of the archives of the oral pathology department of Baghdad University from 1970 to 2013 for all biopsies from children aged 0–15 years old. ResultsA total of 1286 child specimens represented 11.98% of all biopsied lesions. The pyogenic granuloma was the most frequent lesion in children, and the periapical cyst was the most frequent lesion from an odontogenic origin. The incidence of malignant lesions was higher in the 0–3 age group than other groups. ConclusionsThe majority of lesions were inflammatory or benign in nature, while 5.6% were malignant tumors. This study provides a data base for predicting the distribution of oral lesions in children with a different method from other similar studies.

Epidemiological survey of oral lesions in children and adolescents in a Brazilian population

ObjectivesTo identify the most frequent oral lesions in children and adolescents in Reference Units of Oral Lesions of Public Universities of Bahia, Brazil, in the period between 1996 and 2010, and estimate the association between socio-demographic factors and type of oral lesions found. MethodsCross-sectional study using secondary data obtained from medical records, records of requests and reports of biopsies from patients aged between 0 and 19 years treated in Reference Units of Oral Lesions of Public Universities in Bahia, Brazil, in the period between 1996 and 2010. For data analysis, we used descriptive analysis of the variables, bivariate analysis by calculating the prevalence ratios (PR) to assess the association between oral lesions and gender, age and skin color, and the analysis of potential modifying and confounding effects by logistic regression modeling. To calculate the p-value of associations, we used the chi-square test, and p<0.05 was considered statistically significant. ResultsThere were 360 records of patients between 0 and 19 years (8.7% of total records). The results revealed 72 different types of lesions. The most prevalent lesions were mucoceles (14.2%), fibroma (5.6%) and pyogenic granuloma (5.3%). The variable “age” was the only socio-demographic characteristics among those analyzed that showed a statistically significant association with both neoplastic and non-neoplastic lesions, according to bivariate analysis, considering the rates adjusted for potential confounders. Neoplastic lesions appeared more often in the age group 0–9 years, while the non-neoplastic lesions were more prevalent in individuals 10–19 years. There was no effect modification noted in the predictive models analyzed. ConclusionsThe study identified the existence of a broad range of oral lesions affecting children and adolescents. Most of the lesions found were of the non-neoplastic type. The age of individuals was associated with the type of oral lesion found.

Co-morbidities associated with molar-incisor hypomineralisation in 8 to 16 year old pupils in Ile-Ife, Nigeria

BackgroundThis study aimed to identify the prevalence of oral co-morbidities in 8 to 16 years old children with Molar Incisor Hypomineralisation (MIH) and compare this with the prevalence of same oral lesions in children without MIH.MethodStudy participants were selected through a multi-staged sampling technique. The children were asked if they had dentine hypersensitivity or any concerns about their aesthetics. Children were examined for MIH, caries, traumatic dental injury and their oral hygiene status. The association between MIH and each of the independent variables was determined.ResultsOnly children with MIH had aesthetic related concerns and dentine hypersensitivity. The differences in the oral hygiene status (p < 0.001) and caries prevalence (p < 0.001) of children with and without MIH were statistically significant. The prevalence of traumatic dental injury did not differ statistically between children with MIH and those without MIH (p = 0.24).ConclusionChildren with MIH had more oral pathologies than children without MIH. These co-morbidities (dentine hypersensitivity, aesthetic concerns, caries and oral hygiene) are capable of impacting negatively on the quality of life of the children. Screening for children with MIH may help facilitate prompt access to treatment.

Lip and oral lesions in children with Down syndrome. A controlled study.

Background Down syndrome (DS) is the most common chromosomal abnormality affecting numerous organs, including the orofacial region. The objective of the present study was to assess the prevalence of lip and oral soft tissue lesions, with particular emphasize on the incidence of fissured tongue, lip fissures and angular cheilitis, among individuals with DS in Yemen. Material and Methods This controlled cross-sectional study included 50 children with DS (6-18 years), and 50 age-and gender-matched healthy controls. The prevalence of orofacial soft tissue lesions was evaluated in both groups. Data were analyzed by Chi-square and Fisher tests, and p < 0.05 was considered to be statistically significant. Results Ten orolabial lesions were identified among the subjects. The most frequently seen lesions were: Fissured tongue (78.0%), lip fissures (64.0%), angular cheilitis (38.0%) and Cheilitis (14.0%). The frequencies of these lesions were significantly higher in children with DS than healthy controls (P< 0.001). Most of lip fissures were in the lower lip, and 80% of the fissures were in the midline. Conclusions The prevalence of lip and oral lesions among individuals with DS is remarkably high. Hence, oral physicians should be more aware of the orofacial findings seen more frequently in this genetic disorder. Key words:Down syndrome, lesions, lips, oral.

Capacity of dermatologists to diagnose oral and perioral lesions compared with orthodontists, primary care physicians, and pediatricians.

Oral pathology is an interdisciplinary field of unclear boundaries. Only a few studies have been previously published comparing the diagnostic capacity among different specialists taking care of the disorders involving oral mucosa and perioral skin. The goal of this study was to assess the capacity for diagnosing dermatologic conditions involving the oral mucosa and perioral skin in children and adults among orthodontists, dermatologists, and primary care physicians. Samples of orthodontists (n = 118), dermatologists (n = 100), pediatricians (n = 75), and family doctors (n = 68) were selected for the study. Two tests of 30 color clinical photographs each were prepared, one containing oral lesions in children and other one in adults. Statistical and comparative analyses of correct and incorrect answers were performed in each group and subgroup of participants. Dermatologists were clearly better trained than other specialists in oral and perioral pathology. This advantage over their counterparts in other specialties was seen in both residents and board-certified dermatologists. Though by small margin, orthodontists showed better performance than pediatricians and family doctors. Dermatologists showed higher capacity to achieve the right diagnosis in common oral and perioral disorders than orthodontists, pediatricians, and family doctors.

A review of oral biopsies in children and adolescents: A clinicopathological study of a case series.

Objective: The aim of this study was to evaluate the clinicopathological features of oral lesions in children and adolescents diagnosed in an Oral Pathology Laboratory. Study design: Between 2000 and 2010, all oral lesions diagnosed in patients younger than 18 years old, from the Oral Pathology Laboratory, Federal University of Pernambuco, Brazil, were selected for the study. The clinical data were obtained from the patient charts filed in the Laboratory. All cases were microscopically reviewed and the diagnosis classified into 10 categories. Results: From the 2395 lesions, 315 (13.1%) occurred in this age group. The lesions were more common in the female gender (59%) during the second decade of life (69%). The inflammatory/reactive lesions were the most common (64.4%), followed by the epithelial and soft tissue neoplasms (8.6%). The mucocele (33.3%) was the most common lesion, with the lip mucosa representing the most affected site (48%). In 61.5% there was concordance between clinical hypothesis of diagnosis and histopathological diagnosis. Conclusions: Inflammatory/reactive lesions were the most common biopsied lesions and the lip the most frequent site. Similar studies are important, reinforced by the low correlation between clinical diagnosis and histopathological diagnosis. Key words:Adolescents, children, differential diagnosis, oral diseases, prevalence.

Identification and characterization of acyclovir-resistant clinical HSV-1 isolates from children

Background The occurrence of herpes simplex virus (HSV) with acyclovir (ACV) resistance is a cause for concern due to the frequent use of ACV for treatment, suppressive therapy, and prophylaxis of HSV infection. Although HSV infection is prevalent among children, very little is known about the drug susceptibility of HSV circulating in this patient population. Objective To determine the status of ACV resistant HSV-1 among children. Study design A reporter cell-based HSV infection assay (mVILA) was developed to conveniently evaluate the ACV susceptibility of HSV-1 clinical strains and used to analyze 68 HSV-1 primary isolates from oral lesions in children. Results Compared with PRA, mVILA is easier to perform. Using mVILA, HSV-1 isolates C106, C153, and C174 were found completely resistant to ACV, with a greater than 100-fold increase in IC50s. Sequence analysis of thymidine kinase (TK) and DNA polymerase (DNA POL) genes identified 11 new mutations. Structural modeling of the TK and DNA POL proteins suggested structural changes that might alter their interactions with ACV and ACV triphosphate, respectively. The insertion of a single G in a seven-guanine homopolymeric repeat sequence generated a truncated TK protein in C106. Conclusion This study provides preliminary data on the ACV susceptibility status of HSV-1 in children. The prevalence rate of ACV-resistant HSV-1 in children was higher than predicted. Moreover, multiple mechanisms leading to the resistance were identified. These results suggest that new anti-herpetics with different working mechanisms should be valuable.

Effect of CD4+ lymphocyte count, viral load, and duration of taking antiretroviral treatment on presence of oral lesions in a sample of South African children with HIV+/AIDS

This was to determine the presence and types of oral mucosal lesions in a sample of HIV(+)/AIDS South African children taking antiretroviral therapy and to investigate the relationship between CD4(+) lymphocyte counts, viral load, duration of taking antiretroviral therapy (DART), and age on presence of oral lesions. The samples consisted of 56 South African children aged 0-4 years (mean age =7.09 years) with HIV(+)/AID, infected at birth. Subjects were divided into two groups according to the presence of oral lesions with test group (patients with oral lesions) and control group (patients with no oral lesions). Children were also divided into two groups, those <6 years and those >6 years old to study the effect of age on presence of lesions. Oral Candidiasis was the most common lesion reported in 19/56 children, followed by Recurrent Herpetic Infection in 9 children. Other lesions such as Kaposi's sarcoma, Multifocal Epithelial Hyperplasia, Oral Hairy Leukoplakia, Linear Gingival Erythema, and oral ulceration were also present. A statistical significant difference in CD4(+) lymphocyte count (p value 0.005), and viral load (p value 0.002) was found between the oral lesion and no oral lesion groups, those with oral lesions having a significantly higher viral load and lower CD4+ count. No statisticaly significant difference between the two groups in terms of the DART effect (p value 0.811) was found. Furthermore, there was no effect of age groups on the presence of lesions in children with HIV(+)/AIDS. This study contributes to the relatively scant literature on the prevalence of oral lesions in children with HIV infection in South Africa and also the relationship of these lesions to the viral load and CD4(+) lymphocyte counts.

Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania.

BackgroundThe aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count.MethodsParticipants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH) HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells.ResultsA total of 237 HIV-associated oral lesions were observed in 210 (39.5%) patients. Oral candidiasis was the commonest (23.5%), followed by mucosal hyperpigmentation (4.7%). There was a significant difference in the occurrence of oral candidiasis (χ2 = 4.31; df = 1; p = 0.03) and parotid enlargement (χ2 = 36.5; df = 1; p = 0.04) between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005), oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003) and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03). There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15). There was also a significant association between the presence of oral lesions and CD4+ cell count < 200 cell/mm3 (χ2 = 52.4; df = 2; p = 0.006) and with WHO clinical stage (χ2 = 121; df = 3; p = 0.008). Oral lesions were also associated with tobacco smoking (χ2 = 8.17; df = 2; p = 0.04).ConclusionAdult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children receiving HAART. The occurrence of oral lesions, in both HAART and non-HAART patients, correlated with WHO clinical staging and CD4+ less than 200 cells/mm3.

Prevention of oral lesions in children with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is the most common form of cancer in children and is responsible for severe stomatologic complications. Treatment consists of four phases of chemotherapy, the main side effect of methotrexate, the drug most used during the intensification phase, is oral mucositis. To evaluate the clinical aspects of the oral mucosa of children with ALL and to determine the effect of 0.12% chlorhexidine gluconate on the prevention of stomatologic complications in these patients. Thirty-three children treated for ALL ranging in age from 2 to 15 years, without distinction of gender or race, were submitted to visual examination, digital palpation of the oral mucosa and cytologic examination of the buccal mucosa, and divided into two groups: group I consisted of 23 children using an oral solution of 0.12% chlorhexidine gluconate twice a day, and group II consisted of 10 children who did not receive this solution. All children received daily oral hygiene care guided by the dentist throughout treatment. Mucositis was observed in six children of group I and eight of group II, and was characterized by erythema, edema and ulcers. Uniform cytologic findings were obtained for the two groups, with a clear predominance of cells of the intermediate layer in all smears, in addition to a perinuclear halo in 18% of the smears. The present results suggest that systematic preventive treatment with 0.12% chlorhexidine gluconate and oral hygiene care reduce the occurrence of oral complications in children with ALL undergoing antineoplastic chemotherapy.