Dorsum Of Tongue Research Articles

Paediatric geographic tongue (5year old boy): A case report with review of literature

Geographic tongue often develops throughout childhood and affects between 1 and 2.5 percent of people worldwide. It is a benign, inflammatory condition that most frequently affects the tongue's dorsum and may spread to its lateral edges. The loss of filiform papillae and thinning of the epithelium are represented by the erythematous patches. It can be asymptomatic or patient may complains of pain and burning sensation. We report a case of 5 year old boy with early shedding of primary teeth, geographic tongue which was asymptomatic, had itchy skin lesions in the past and still gets the on and off episode of skin lesion ; with review of literature.

Correlation between findings of the oral myofunctional clinical assessment, pressure and electromyographic activity of the tongue during swallowing in individuals with different orofacial myofunctional disorders.

To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.

Percepção do sabor em usuários de prótese dentária total

ABSTRACT Purpose: to assess the recognition of salty, sweet, and citrus tastes in complete denture wearers. Methods: the study included toothless individuals (experimental group) who had been using, for at least 3 months and at the most 5 years, acrylic resin removable bimaxillary complete dentures in good condition and with adequate maxillo-mandibular relationship. The same assessment was performed in the control group, which had 26 toothed individuals. Volunteers had no difficulties ingesting any type of food. Salty, sweet, and citrus tastes were assessed with filter paper strips soaked in such solutions and placed on the tongue dorsum. Assessments were performed in duplicate and in random order. Results: the percentage rate of errors was similar between the control (9.6±13.5%) and experimental groups (10.5±15.5%) (p=0.80). There was no difference in the frequency of correct perception of tastes between denture wearers and toothed individuals. Conclusion: individuals who wore acrylic resin removable bimaxillary complete dentures perceived salty, sweet, and citrus tastes like toothed individuals did.

Correlação entre achados da avaliação clínica miofuncional orofacial, a pressão e a atividade eletromiográfica da língua na deglutição em indivíduos com diferentes alterações da motricidade orofacial

ABSTRACT Purpose To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. Methods 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). Results The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. Conclusion The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.

Análise microbiológica da saburra em dorso lingual de pacientes internados em UTI

ABSTRACT Objective: ssess quantitatively and qualitatively tongue coating microbiota in ICU patients. Methods: Analytical observational study, convenience sample comprising 65 patients was included for medical report analysis and collection of general data, tongue coating assessment through visual inspection and microbiological sample collection for further laboratory analysis. The collection was performed by a single examiner using a sterile swab introduced and rubbing the posterior portion of the tongue close to the oropharynx. Results: Most patients (60%) belonged to the female sex, at mean age of 74.2 years. The main reasons for hospitalization were lung issues (26.2%) - prevailing associated comorbidities were diabetes (43.1%) and high blood pressure (66.2%). The mean length of stay in the ICU was one day. All patients presented tongue dorsum coating. There were Candida albicans (37%), Streptococcus parasanguinis (26.1%) and Streptococcus mitis (32.6%) in 1/3 of lingual extension. Streptococcus mitis (p=0,0265) was the most prevalent species. Conclusion: There was no significance between the amount of coating and number of observed species, although all assessed patients had presented coating. The most prevalent microorganisms were Candida albicans, Streptococcus parasanguinis and Streptococcus mitis.

Sex differences in the oral microbiome, host traits, and their causal relationships

The oral microbiome has been implicated in a growing number of diseases; however, determinants of the oral microbiome and their roles remain elusive. Here, we investigated the oral (saliva and tongue dorsum) metagenome, the whole genome, and other omics data in a total of 4,478 individuals and demonstrated that the oral microbiome composition and its major contributing host factors significantly differed between sexes. We thus conducted a sex-stratified metagenome-genome-wide-association study (M-GWAS) and identified 11 differential genetic associations with the oral microbiome (p sex-difference <5×10-8). Furthermore, we performed sex-stratified Mendelian randomization (MR) analyses and identified abundant causalities between the oral microbiome and serum metabolites. Notably, sex-specific microbes-hormonal interactions explained the mostly observed sex hormones differences such as the significant causalities enrichments for aldosterone in females and androstenedione in males. These findings illustrate the necessity of sex stratification and deepen our understanding of the interplay between the oral microbiome and serum metabolites.

Management of toxic epidermal necrolysis with oral involvement with candidiasis in stage III cervical carcinoma patients

Toxic epidermal necrolysis (TEN) is the most serious cutaneous adverse drug reaction characterized by extensive detachment of epidermis and erosions of oral mucosal. Early diagnosis and proper therapy are an essential for reduction the morbidity and mortality of this disease. This article is aimed to describe the management of TEN with oral involvement accompanied candi-diasis in patient with carcinoma cervix stage III. A 53-year-old female patient with carcinomacervix stage III and diagnosed of TEN was referred to Oral Medicine Clinic with complaint of painful throughout the oral mucosa, on the lips and during swal-lowing. The patient had a medication history after 25th radiotherapy i.e. cefixime and mefenamic acid. Erythema and erosive le- sion were seen at almost of the bodymainly in back, waist and belly except on palm hand and sole. Erosion also found on the lips with hemorrhagic crusts which bleed easily. Erosive lesion andcandidiasis were seen in the labial mucosa, dorsum and late-ral of tongue, and buccal mucosa. The patient was given NaCl 0.9% for lips compress, chlorhexidinedigluconate 0.12%, hya-ruronic acid mouthwash, vaseline album, whilst therapy for candidiasis was nystatin oral suspension 100,000 IU. The pa-tient was also given education to maintain oral hygiene. It was concluded that oral lesions and candidiasis were healed after 2 weeks of therapy and the patient had significant improvement on the oral mucosal. The appropriate pharmacological and non-pharmacological therapies given were successful on reducing the morbidity and mortality to the patient.

Oral Immune-Related Adverse Events Associated with PD-1 Inhibitor Treatment: A Case Series

Introduction: Immune Checkpoint Inhibitor (ICI) drugs have led to a revolution in the treatment of different forms of cancer, shifting the target of action from cancer cells to the patient’s immune system, enhancing their responses against the tumor itself. On the other hand, this mechanism can lead to responses against oneself, with the appearance of immune-related adverse events. The aim of the present study was to examine the immune-related adverse events (irAEs) affecting the mucous membranes of the oral cavity and the possible correlation between these and skin toxicities, which are reported in the literature as the most common adverse events. Materials and methods: Thirteen patients treated with anti-Programmed Death (PD-1) drugs (pembrolizumab, nivolumab, and cemiplimab) were selected. The data collected include the general history of the patient and the type of anticancer treatment. The sample was then analyzed by recording the alterations found on the mucous membranes of the oral cavity and on the skin. Finally, the average time that elapsed between the start of immunotherapy and the onset of lesions was analyzed. Results: Patients often had multiple lesions at the same time. Hyperkeratosis was found in three patients, candidiasis (pseudomembranous and median rhomboid glossitis) in two patients, epithelial atrophy in four patients, and ulcerative areas in two patients. One patient reported xerostomia with dysphagia. The anatomical areas most involved were the dorsal tongue and palate. Skin irAEs included skin rash erythema (n = 7) with diffuse redness, the presence of small bubbles with a crusty outcome, and dryness of the skin in the affected areas. Discussion: In the literature, there are few studies that analyze how irAEs affect the mucous membranes of the oral cavity in patients treated with ICI drugs. The most frequently described lesions are lichenoid reactions and xerostomia. Moreover, the development of mucositis, generally of low grade, has been reported. The present study has confirmed the data from the literature and, in addition, reports two cases of candidiasis, an adverse event that has never been shown in the literature. Conclusions: irAEs have the potential to affect any organ. The only way to avoid the occurrence of serious events that is currently available is early interception, which is only possible through the knowledge of these manifestations. It is therefore considered necessary to deepen our knowledge of oral irAEs and their correlation with dermatological toxicities, allowing for a multidisciplinary classification of the patient and a timely diagnosis of any adverse event and avoiding progression to more advanced stages, which could lead to the temporary or permanent suspension of anticancer drugs.

Characterization of tongue dorsum microbiome in wine tasters

Taste plays a paramount role in food and beverage choice, with recent studies pointing to a potential influence of the microorganisms from the tongue dorsum - particularly bacteria - on flavor perception. Thus, the association between tongue dorsum biofilm and taste is a fundamental prerequisite for a better understanding of the role played by these bacteria in wine tasting. To study this impact, we have analyzed the microbiomes from 58 samples of the tongue dorsum surface from professional wine tasters and 30 samples from non professional wine tasters. The microbiome of each sample was characterized through metagenome sequencing of the 16S rRNA gene for taxonomic discrimination of bacteria. A total of 497 taxa were identified in the tongue dorsum, and significant differences in diversity were observed between the wine taster and the control group. The comparison of bacterial diversity between samples collected before and after wine tasting along with the presence of new bacterial taxa indicates a direct effect of wine on the microbiome of frequent wine tasters, particularly in those tasting sparkling wines.

A genetic association study reveals the relationship between the oral microbiome and anxiety and depression symptoms.

Growing evidence supports that alterations in the gut microbiota play an essential role in the etiology of anxiety, depression, and other psychiatric disorders. However, the potential effect of oral microbiota on mental health has received little attention. Using the latest genome-wide association study (GWAS) summary data of the oral microbiome, polygenic risk scores (PRSs) of 285 salivary microbiomes and 309 tongue dorsum microbiomes were conducted. Logistic and linear regression models were applied to evaluate the relationship between salivary-tongue dorsum microbiome interactions with anxiety and depression. Two-sample Mendelian randomization (MR) was utilized to compute the causal effects between the oral microbiome, anxiety, and depression. We observed significant salivary-tongue dorsum microbiome interactions related to anxiety and depression traits. Significantly, one common interaction was observed to be associated with both anxiety score and depression score, Centipeda periodontii SGB 224 × Granulicatella uSGB 3289 (P depressionscore = 1.41 × 10-8, P anxietyscore = 5.10 × 10-8). Furthermore, we detected causal effects between the oral microbiome and anxiety and depression. Importantly, we identified one salivary microbiome associated with both anxiety and depression in both the UKB database and the Finngen public database, Eggerthia (P IVW - majordepression - UKB = 2.99 × 10-6, P IVW - Self - reportedanxiety/panicattacks - UKB = 3.06 × 10-59, P IVW - depression - Finngen = 3.16 × 10 P IVW - anxiety - Finngen = 1.14 × 10-115). This study systematically explored the relationship between the oral microbiome and anxiety and depression, which could help improve our understanding of disease pathogenesis and propose new diagnostic targets and early intervention strategies.

Impact of Age and Sex on Electrical Impedance Values in Healthy Oral Mucosa.

Background: Electrical impedance (EI) is a property of all living tissues and represents the resistance to the electric current flow through a living tissue. EI depends on the structure and chemical composition of the tissue. The aim of this study was to determine the influence of age, sex, and electrode pressure on the EI values of healthy oral mucosa. The study involved 101 participants with healthy oral mucosa who were divided into three age groups. EI was measured in seven anatomical regions. Results: Significant differences between different age groups were found. Younger participants (20–40 years) had significantly higher EI values than the older participants (60+). Significantly higher EI values were found in women at all localisations at all measured frequencies, except on the hard palate. EI values measured with higher sub-pressure were significantly lower than values measured with lower sub-pressure at all frequencies and localisations, except the tongue dorsum, tongue border, and sublingual mucosa. Conclusions: This study found that EI values in healthy oral mucosa depend on age and sex and may also depend on the pressure of the measuring device. These factors should be kept in mind when EI is used as a diagnostic method for different oral lesions.

Hairy Tongue and Associated Risk Factors among Outpatients in Faculty Dentistry of Damascus University: A Cross-Sectional Study

Aim: The term hairy tongue was first coined by Amatus Lusitanus in the year 1557 as self-renewing hairs on the tongue. It is characterized by the presence of elongated filiform papillae of the dorsum of the tongue, which gives a hairy appearance, depends on two components: elongated filiform papillae and discoloration of the dorsal tongue as the result of both extrinsic and intrinsic factors. The hair-like projections in hairy tongue are thought to develop from a lack of adequate desquamation on the dorsal tongue. This prevents the breakdown of keratin layers on the dorsal tongue leads to their accumulation, known as hyperkeratosis. This occurs on the tips of the filiform papillae and leads to their elongation to be a suitable environment for bacterial growth by trapping microscopic food particles and bacteria themselves to thrive on the fermentation of amino acids and produce porphyrins, resulting in a black or brown color.Materials and Methods: The study design was case - control sample, among patients attending the Department of Oral Medicine at the Faculty of Dentistry at Damascus University during the period from February 2021 to January 2022.Patients (n = 20). Individuals with hairy tongue were included in the study. Tongue examination was performed according to WHO clinically without biopsy, then data were collected through the attached questionnaire in both case and control groups. It included demographic information and complete history of the patients. Results: We found that the prevalence of hairy tongue increased with male gender, and was more common with fissured tongue 15%, we reported 70% of hairy tongue patients had the lesion in the posterior third of the tongue. There was a true statistically significant correlation between the hairy tongue and predisposing as 70% smoking, 80% poor oral hygiene, 20% use oxidizing mouthwashes, 45% xerostomia and 30% use antibiotics for a long time. Although we reported 90% of hairy tongue patients had no pain, but we recorded 35% had a metallic taste and tickling sensations, 25% had burning sensation, and 55% had halitosis. There was not real statistically significant correlation between the colour of the hairy tongue and gender but on the other hand we showed that 30% black hairy tongue patients were smokers, 45% brown hairy tongue patients drank large amount of tea and coffee, and 25% creamy hairy tongue patients used medications.Conclusion: To conclude, hairy tongue is an asymptomatic condition involving the posterior third of the tongue, which can be easily diagnosed by clinical examination and triggered by predisposing factors. A thorough detailed history is always necessary to obtain an accurate diagnosis to investigate the risk factors for establishing the successful treatment of hairy tongue.

Site-tropism of streptococci in the oral microbiome.

A detailed understanding of wherebacteria localize is necessary to advance microbial ecology and microbiome-based therapeutics. The site-specialist hypothesis predicts that most microbes in the human oral cavity have a primary habitat type within the mouth where they are most abundant. We asked whether this hypothesis accurately describes the distribution of the members of the genus Streptococcus, a clinically relevant taxon that dominates most oral sites. Prior analysis of 16S rRNA gene sequencing data indicated that some oral Streptococcus clades are site-specialists while others may be generalists. However, within complex microbial populations composed of numerous closely related species and strains, such as the oral streptococci, genome-scale analysis is necessary to provide the resolution to discriminate closely related taxa with distinct functional roles. Here, we assess whether individual species within this genus are specialists using publicly available genomic sequence data that provide species-level resolution. We chose a set of high-quality representative genomes for human oral Streptococcus species. Onto these genomes, we mapped shotgun metagenomic sequencing reads from supragingival plaque, tongue dorsum, and other sites in the oral cavity. We found that every abundant Streptococcus species in the healthy human oral cavity showed strong site-tropism and that even closely related species such as S.mitis, S.oralis, and S. infantis specialized in different sites. These findings indicate that closely related bacteria can have distinct habitat distributions in the absence of dispersal limitation and under similar environmental conditions and immune regimes. Substantial overlap between the core genes of these three species suggests that site-specialization is determined by subtle differences in genomic content.

A comparison between tongue dorsum configurations during vowel production in hypernasal speech vs typical speech

Appropriate nasalization is important for intelligible speech production and can be impacted by various disorders, including a cleft palate. Nasalization is achieved primarily through coupling the nasal and oral cavities by opening the velopharyngeal (VP) port, which introduces a variety of acoustic features. Although VP control has the primary role in nasalization, evidence suggests articulatory changes such as lip rounding (constriction) enhances acoustic features of nasality, while a downward and forward movement of the tongue dorsum in high vowels could attenuate perceptions of nasality in individuals with competent VP function. There is yet scant evidence to indicate whether such systematic changes occur in the case of VP opening. In an attempt to further understand the clinical aspect of this concept, we evaluated the tongue height and forwardness using ultrasound in three speakers with VP insufficiency (VPI) and three speakers with typical VP function to investigate the tongue configuration across two conditions. Tongue dorsum excursion and tongue positioning index were captured using Assistive Articulation Assessment (AAA) software during the production of vowels /a/ and /i/ across VCV contexts. Further results will be discussed in the meeting.

Two cases with cleft lip and palate of improvement palatalized articulations by performing dentition expansion in the deciduous dentition stage

AbstractBackgroundPalatalized articulation (PA), which is a common occurrence in children who have undergone cleft lip and palate surgery, is thought to be influenced by palate morphology. To help patients acquire normal articulation, it is better to improve the palate morphology earlier.Case PresentationIn these two cases, dentition expansion was performed during the deciduous dentition stage and resulted in improved articulatory performance.ConclusionDuring speech therapy for PA, if the patient still produces incorrect sounds even after their abnormal tongue dorsum raising has eliminated, it is important to investigate the possibility of improving articulation through improving the palate morphology.

Describing the Acoustic and Vocal Production Characteristics of the Irrintzi: Feasibility of Its Use for the Treatment of Voice Disorders.

The aims of this study were to analyze and characterize the irrintzi (a folkloric shout emitted in a single breath used by the Basque people) acoustically and to describe the mechanism by which it is emitted. Thirty-six sound samples of 12 female volunteers were analyzed. Acoustic analysis included primarily fundamental frequency (f o), spectral analysis in the time domain with a narrowband filter, and the use of linear predictive coding (LPC). Laryngeal and pharyngeal movements while emitting an irrintzi were studied by fiberoptic nasal endoscopy. Postural and mandible movements were observed and video recorded. Movements of the larynx and the vocal tract were also studied by lateral pharyngo-laryngeal radioscopy. The central part of an irrintzi spectrogram contains a peculiar, repeated M-shaped motif unseen in the spectrogram of any other human vocal emission, and intensity was over 90 dB SPL in all cases. f o was very high (1487 Hz) especially at the end of the irrintzi. Fiberoptic nasal endoscopy consistently revealed considerable elevation of the glottis, with the larynx swinging forward and retraction of the ventricular bands. Lateral radioscopy showed a very high larynx and a high tongue dorsum. The irrintzi is a sound emitted in a single breath and characterized by its shrillness and loudness, qualities that make it audible in noisy environments and over large distances and the vocal technique observed when it is produced can be explained by the Estill voice model (Steinhauer et al., 2017). The use of this technique may help in the treatment of voice disorders and improve efficiency in singers, teachers, actors, and people who use their voice at high volume or at high frequency. https://doi.org/10.23641/asha.20779405.

Corncob structures in dental plaque reveal microhabitat taxon specificity

BackgroundThe human mouth is a natural laboratory for studying how bacterial communities differ across habitats. Different bacteria colonize different surfaces in the mouth—teeth, tongue dorsum, and keratinized and non-keratinized epithelia—despite the short physical distance between these habitats and their connection through saliva. We sought to determine whether more tightly defined microhabitats might have more tightly defined sets of resident bacteria. A microhabitat may be characterized, for example, as the space adjacent to a particular species of bacterium. Corncob structures of dental plaque, consisting of coccoid bacteria bound to filaments of Corynebacterium cells, present an opportunity to analyze the community structure of one such well-defined microhabitat within a complex natural biofilm. Here, we investigate by fluorescence in situ hybridization and spectral imaging the composition of the cocci decorating the filaments.ResultsThe range of taxa observed in corncobs was limited to a small subset of the taxa present in dental plaque. Among four major groups of dental plaque streptococci, two were the major constituents of corncobs, including one that was the most abundant Streptococcus species in corncobs despite being relatively rare in dental plaque overall. Images showed both Streptococcus types in corncobs in all individual donors, suggesting that the taxa have different ecological roles or that mechanisms exist for stabilizing the persistence of functionally redundant taxa in the population. Direct taxon-taxon interactions were observed not only between the Streptococcus cells and the central corncob filament but also between Streptococcus cells and the limited subset of other plaque bacteria detected in the corncobs, indicating species ensembles involving these taxa as well.ConclusionsThe spatial organization we observed in corncobs suggests that each of the microbial participants can interact with multiple, albeit limited, potential partners, a feature that may encourage the long-term stability of the community. Additionally, our results suggest the general principle that a precisely defined microhabitat will be inhabited by a small and well-defined set of microbial taxa. Thus, our results are important for understanding the structure and organizing principles of natural biofilms and lay the groundwork for future work to modulate and control biofilms for human health.DJxteJ7vGqLvWEg9EZAKHDVideo

GRANULAR CELL TUMOR: CASE REPORT

The granular cell tumor is a benign soft tissue neoplasm, considered an unusual pathology. The aim of this study is to report the case of a 43-year-old brown-skinned female patient who attended the stomatology service reporting “a lump on her tongue.” In the history of the current disease, the patient reported a 6-month-old lesion with swelling and painlessness. On intraoral examination, a submucosal nodule on the dorsum of tongue, with a smooth surface, yellowish color, sharp boundaries, oval and firm consistency, unique and measuring 0.5 × 0.5 × 0.2 cm, was observed. An excisional biopsy was performed with clinical suspicion of granular cell tumor, a neoplasm of mesenchymal origin composed of granular cells, histologically confirmed by hematoxylin and eosin,. The patient is being followed up and has no sign of recurrence. This case reinforces the importance of the stomatologist in elucidating the diagnosis of submucosal lesions in the oral cavity, which should be biopsied to eliminate the possibility of malignant nature. The granular cell tumor is a benign soft tissue neoplasm, considered an unusual pathology. The aim of this study is to report the case of a 43-year-old brown-skinned female patient who attended the stomatology service reporting “a lump on her tongue.” In the history of the current disease, the patient reported a 6-month-old lesion with swelling and painlessness. On intraoral examination, a submucosal nodule on the dorsum of tongue, with a smooth surface, yellowish color, sharp boundaries, oval and firm consistency, unique and measuring 0.5 × 0.5 × 0.2 cm, was observed. An excisional biopsy was performed with clinical suspicion of granular cell tumor, a neoplasm of mesenchymal origin composed of granular cells, histologically confirmed by hematoxylin and eosin,. The patient is being followed up and has no sign of recurrence. This case reinforces the importance of the stomatologist in elucidating the diagnosis of submucosal lesions in the oral cavity, which should be biopsied to eliminate the possibility of malignant nature.

MULTIPLE LESIONS OF PEMPHIGUS VULGARIS IN MOUTH: CASE REPORT

A 54-year-old female patient attended the stomatology unit reporting painful symptoms in the mouth. In the anamnesis, the patient reported having pemphigus vulgaris and that she had been under medical supervision in a hospital for 2 years. The patient used dapsone 100 mg once a day for the disease and had biopsy-confirmed lesions of pemphigus vulgaris in the mouth. The examination revealed an ulcer on the lower lip and multiple ulcers that bleed to the touch, located on the hard palate, gums, tongue dorsum and sides, and bilateral buccal mucosa, most of which were covered by a pseudomembrane. The initial treatment was the prescription of 0.05% clobetasol and 100.000 IU nystatin. After 15 days, there was an improvement, and there was no need to continue the medications previously prescribed. Two months later, an interocclusal device was made to protect the surrounding mucosa, and the patient is in follow-up.

RAPID TEST FOR SYPHILIS: IS IT RELIABLE?

Syphilis is a sexually transmitted infection caused by a bacterium (<i>Treponema pallidum</i>) that may present oral manifestations. A 26-year-old male patient presented with a 2-month history of a painful ulcer on the tongue. Medical history revealed low levels of hemoglobin and hematocrit. Intraoral examination showed an ulcer with well-defined borders on the tip of the tongue, measuring 1 cm in diameter. Moreover, erosive lesions with typical characteristics of benign migratory glossitis were seen in the tongue dorsum. The hypotheses for the ulcerated lesion were primary syphilis or ulceration related to anemia. Rapid tests for human immunodeficiency virus and syphilis were negative. A teleconsultation was required, and the oral medicine teleconsultant recommended Venereal Disease Research Laboratory and fluorescent treponemal antibody absorption exams, which confirmed the diagnosis of primary syphilis. The treatment included penicillin G benzathine (2,400,000 UI once a week for 3 weeks). Cases showing features suggesting syphilis require serological tests when rapid tests are negative.