Cleonice Hitomi Watashi Hirata

Treatment of recurrent aphthous stomatitis with clofazimine

OBJECTIVE The aim was to investigate the safety and efficacy of clofazimine for the treatment of recurrent aphthous stomatitis. STUDY DESIGN In this randomized controlled partially blind study, 23 patients received clofazimine 100 mg daily for 30 days and then 100 mg every other day. Twenty-three patients received colchicine 0.5 mg 3 times daily. Twenty patients received 1 placebo pill 2 times daily. All subjects received medications for 6 months. The chi-squared or Fisher exact tests were used to assess drug efficacy with respect to objective findings and symptoms. RESULTS A greater percentage of individuals in the clofazimine group had no further aphthous episodes (17%-44% compared with <or=6% in the other groups). A significantly greater percentage of treatment interruption occurred in the colchicine group because of gastrointestinal effects (23%-45%). Individuals in the clofazimine group who continued to suffer from aphthous stomatitis presented with better results for the evaluated variables. CONCLUSION Clofazimine should be considered for the treatment of recurrent aphthous stomatitis.

The oral mucosa in leprosy: a clinical and histopathological study

INTRODUCTION Multibacillary leprosy may involve the oral mucosa, with or without apparent lesions. There are few studies that deal with this issue in the era of multidrug therapy. AIM To assess the frequency of oral mucosa involvement in multibacillary leprosy patients. PATIENTS AND METHODS A transversal study with twenty non-treated multibacillary leprosy patients. The patients were treated in Dracena, São Paulo, between 2000 and 2002. Clinical examination of the oral mucosa was carried out. All patients were submitted to jugal mucosa, soft palate and tongue biopsies, in altered or in pre-established sites. The cross-sections were stained by techniques of hematoxilin-eosin and Ziehl-Neelsen. Granuloma and alcohol-acid-resistant bacilli findings determined the specific histopathological involvement. RESULTS The study involved 19 patients with an average of 2.5 years of disease progression. Specific histopathological involvement occurred in the tongue and soft palate of one lepromatous patient with an apparently normal oral mucosa. CONCLUSIONS (1) Clinical alterations in the oral mucosa does not imply disease involvement, it is necessary to have histopathological confirmation. (2) Apparent specific clinical alterations are rare. (3) The clinically normal oral mucosa can show specific histopathological involvement.

Actinic cheilitis adjacent to squamous carcinoma of the lips as an indicator of prognosis

UNLABELLED Many studies have shown an association between actinic cheilitis and squamous carcinoma of the lips. AIM The aim of the study was to observe the relation between actinic cheilitis and the prognosis of squamous carcinoma of the lips. MATERIALS AND METHODS This is a retrospective cross-sectional cohort study of squamous carcinoma of the lips. Histological sections of squamous carcinoma tumors done at the the Department of Pathology of the Sao Paulo Federal University between 1993 and 2000 were reviewed for evidence of actinic cheilitis in the lip vermillion adjacent to the tumor. Patient reports were reviewed to find information about exposure to sun, metastases and relapses. The occurrence or absence of relapses and metastases was correlated with the presence or absence of actinic cheilitis in the lip vermillion. Data was analyzed by Fishers Exact test. RESULTS Of the 31 selected patients, most were caucasian, males and with lower lip involvement. Statistical analysis demonstrated independence between the occurrence of metastases and relapse and gender, skin color and site (lower or upper lips). There was dependence between actinic cheilitis and solar elastosis, and between the absence of actinic cheilitis and the occurrence of metastases. There was no dependence between the absence of actinic cheilitis and the occurrence of relapses. CONCLUSION It may be concluded that tumors originating from actinic cheilitis have a better prognosis.

Levamisol não previne lesões de estomatite aftosa recorrente: um ensaio clínico randomizado, duplo-cego e controlado por placebo

OBJECTIVE: to utilize a double-blind protocol to provide clarification about the safety and effectiveness of levamisole in the treatment of recurrent aphthous stomatitis. METHODS: Fourteen patients took a decreasing dose of oral levamisole for six months (initial dose 150mg three times a week) and ten others were placebo control patients. All were evaluated monthly. RESULTS: The number of crises had a tendency to decrease in both groups, but without a difference between groups. The number of lesions diminished significantly in the two groups, but upon comparison the difference was not significant. Duration of the lesions diminished significantly in the placebo, however when compared to the levamisole group, difference was not significant during treatment. The intensity of pain was significantly lower in the two groups, but upon comparison, pain was significantly lower in the placebo group. The final global evaluation showed improvement in 50% of patients of the levamisole group and in 70% of the placebo, without a significant difference between treatments. No difference in the frequency of collateral effects was observed between groups. CONCLUSIONS: Levamisole, as used in this protocol, is a safe drug. When compared with the placebo, levamisole is not effective in the prophylactic treatment of recurrent aphthous stomatitis. The placebo effect is important in diseases where emotional factors affect recurrence or expression of symptoms.

A mucosa oral na hanseníase: um estudo clínico e histopatológico

INTRODUCAO: a anseniase multibacilar pode causar comprometimento da mucosa oral, com ou sem lesoes aparentes. Ha poucos estudos que tratam deste assunto na era da multidrogaterapia. OBJETIVO: Verificar a frequencia do comprometimento da mucosa oral em pacientes de hanseniase multibacilar. CASUISTICA E METODOS: Foi realizado um estudo transversal em vinte pacientes de hanseniase multibacilar, nao-tratados, atendidos consecutivamente em Dracena, Sao Paulo, entre o periodo de 2000 e 2002. Foi realizado exame clinico completo da mucosa oral. Os pacientes foram submetidos a biopsias na mucosa jugal, na lingua e no palato mole, em alteracao ou em pontos pre-estabelecidos. Os cortes foram corados pelas tecnicas da hematoxilina-eosina e Ziehl-Neelsen. O encontro de granuloma e bacilos alcool-acido-resistentes ao exame histopatologico determinou o comprometimento especifico. RESULTADOS: O estudo envolveu 19 pacientes multibacilares com tempo medio de evolucao de 2,5 anos. Ocorreu comprometimento histopatologico especifico em apenas um paciente virchowiano, com mucosa oral clinicamente normal, na lingua e no palato mole. CONCLUSOES: 1. Alteracao clinica na mucosa oral nao implica em comprometimento pela doenca, e necessario confirmacao histopatologica. 2. Alteracoes clinicas especificas aparentes sao raras. 3. A mucosa oral clinicamente normal pode exibir comprometimento histopatologico especifico.

Histological and ultrastructural aspects of the tongue in undernourished rats.

UNLABELLED There are few published studies on the effects of protein-caloric undernourishment on the oral mucosa. OBJECTIVES The objective of this study is to verify the histological and ultrastructural aspects of the tongue mucosa in protein-caloric undernourished adult rats. MATERIAL AND METHODS A clinical experimental study was done in thirty Wistar rats, 15 controls and 15 with protein-caloric undernourishment. The last group received ration in small amounts, with a reduced casein content, during 45 days. Rats were weighed every 3 days, from the first (90 days of life) to the last day of a 45-day dietary period, when they were sacrificed. Plasma was used for protein electrophoresis and their tongues were prepared for light and scanning electron microscopy. Analyses of variance and Students t-test were used for statistical analysis. RESULTS A significant decrease in weight and in plasma proteins was found in protein-caloric undernourished rats compared to the control group. Histological findings revealed no differences between the two groups and there were no statistically significant differences in the filiform papilla count under the scanning electron microscopy. CONCLUSION Protein-caloric undernourishment does not cause alterations in the tongue mucosa of adult rats.

Presence of oral lesions in leprosy patients does not imply involvement by Mycobacterium leprae

6. Huang GT-J, Yamaza T, Shea L, Djouad F, Kuhn N, Tuan R, Shi S. Stem/progenitor cell–mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model. Tissue Eng A. Epub ahead of print November 19, 2009. 7. Huang GT-J, Gronthos S, Shi S. Mesenchymal stem cells derived from dental tissues vs. those from other sources: their biology and role in regenerative medicine. J Dent Res 2009;88:792-806.

Oral manifestations in AIDS

I m A a l a e d a i c owadays, patients with AIDS can live a life with considerble quality in relation to oral health, being healthy enough o tolerate most surgical and dental procedures. Furtherore, several studies have shown that patients with HIV isease are not more susceptible to complications, regardess of CD4-cell counts. There are no oral lesions that are specific to HIV patients. ll lesions found among HIV-positive patients also occur in ther diseases associated with immunosuppression. Thus, e conclude that there is a clear correlation between the nset of oral lesions and decreases in the immune system. everal lesions, such as oral thrush, hairy leukoplakia, ulcertive necrotizing periodontal disease and Kaposi’s sarcoma re strongly suggestive of impaired immune response, with D4 counts below 200 cells/mm3. If we consider oral lesions s markers of immunosuppression and progression of AIDS, t may play a role in intervention strategies and treatment. We can cite as major oral lesions of patients with HIV:

Effect of Symbiotic Treatment in Patients with Recurrent Aphthous Stomatitis

Objectives: The recurrent aphthous stomatitis (RAS) is a chronic oral inflammatory disease and it still poses as a clinical problem without satisfactory treatment. The aims of the study were: (1) Evaluate the clinical outcome of RAS patients towards the use of symbiotic Lactofos/Simbioflora, analyzing symptoms, seizure frequency, number, duration, and size of the lesions. (2) Compare the immune profile of RAS patients through cytokine levels with each other and controls before and after treatment. Methods: We conducted double blind randomized clinical trial placebo controlled study with 60 patients with RAS and 30 controls in a period of 2 years (2011-2012). Results: The symbiotic group showed improvement in pain compared with placebo (P = .027), with no statistical difference for the other clinical variables assessed. The side effects observed were similar in both groups, but flatulence (P = .003) and diarrhea (P = .04) were significant for the symbiotic group. Significant differences were found in cytokine IFN-Y, IL-4, and IL-6 in serum of peripheral blood mononuclear cells (PBMCs) of patients when compared with control and RAS groups. Regarding treatment over time we observed that IFN-Y (P = .023), IL-4 (P = .045), IL-10 (P = .000), and IL-12p70 (P = .027) showed significant difference or between treatments or during the time line. Conclusions: The symbiotic was effective in improving pain compared with placebo. Patients with RAS have a mixed profile of Th1/Th2 immune response when compared with the control group at baseline. The symbiotic induced Th1 and Th2 responses by increasing IL-12 and IFN-Y and IL-4 and IL-10, respectively.

Filiform papillae do not have taste buds: reply

1 M.Sc; Graduate student. 2 Full Professor Department of Otorhinolaryngology and Head and Neck Surgery. 3 PhD. Head of the Stomatology Sector. Federal University of Sao Paulo. Send correspondence to: Marilda Aparecida Milanez Morgado de Abreu. Rua Brasil, 1599. Centro. Dracena SP. CEP: 17900-000. Tel: (18) 3821-4630. Fax: (18) 3821-2276. E-mail: marildaderma@bol.com.br Paper submitted to the BJORL-SGP (Publishing Management System Brazilian Journal of Otorhinolaryngology) on February 24, 2008; and accepted on March 7, 2008. cod. 5731. LETTER TO THE EDITOR Braz J Otorhinolaryngol. 2012;78(4):8. BJORL.org