Francesco Spadari

Oral lichen planus and malignant transformation: a longitudinal cohort study.

OBJECTIVE Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults. STUDY DESIGN Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period. RESULTS During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%. CONCLUSIONS OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months.

Different therapeutic strategies for burning mouth syndrome: preliminary data.

BACKGROUND To compare different therapeutic supportive approaches in patients with burning mouth syndrome. A prospective study was carried out for this purpose. MATERIALS AND METHODS The study involved 56 patients with burning mouth syndrome. They were randomly assigned to treatment with capsaicin, alpha-lipoic acid or lysozyme-lactoperoxidase (test drugs) or boric acid (control group). Symptoms were scored after 60 days treatment and 60 days after drug discontinuation. RESULTS At the end of the treatment period, there was a significant reduction in the symptom scores of all of the patients who received the test drugs (P<0.01), and at the end of the follow-up period in the test groups as a whole (P<0.01); the reduction was not significant when considering each test group separately after the treatment period. All of the treatments were more effective than boric acid and there was no significant difference in the symptom scores of the control group at either of the study time-points. CONCLUSIONS Our results demonstrate the similar effectiveness of capsaicin and alpha-lipoic acid in controlling the symptoms of burning mouth syndrome. Lysozyme-lactoperoxidase may be effective in the supportive care of BMS patients with xerostomia. The transitory effect observed after discontinuing drug administration justifies the use of prolonged therapy in chronically affected patients.

Burning mouth syndrome: the role of contact hypersensitivity

BACKGROUND Burning mouth syndrome is a burning sensation or stinging disorder affecting the oral mucosa in the absence of any clinical signs or mucosal lesions. Some studies have suggested that burning mouth syndrome could be caused by the metals used in dental prostheses, as well as by acrylate monomers, additives and flavouring agents, although others have not found any aetiologic role for hypersensitivity to dental materials. OBJECTIVE To evaluate the extent and severity of adverse reactions to dental materials in a group of patients with burning mouth syndrome, and investigate the possible role of contact allergy in its pathogenesis. MATERIALS AND METHODS We prospectively studied 124 consecutive patients with burning mouth syndrome (108 males; mean age 57 years, range 41-83), all of whom underwent allergen patch testing between 2004 and 2007. RESULTS Sixteen patients (13%) showed positive patch test reactions and were classified as having burning mouth syndrome type 3 or secondary burning mouth syndrome (Lameys and Scalas classifications). CONCLUSION Although we did not find any significant association between the patients and positive patch test reactions, it would be advisable to include hypersensitivity to dental components when evaluating patients experiencing intermittent oral burning without any clinical signs.

Allergological and Toxicological Aspects in a Multiple Chemical Sensitivity Cohort

Background. Multiple chemical sensitivity (MCS) is a chronic condition characterized by an exaggerated response to toxicants. We ascertained the prevalence of allergy to metals and toxicological aspects in MCS patients. Methods. We conducted a retrospective review of medical records of 41 patients with MCS. We performed patch testing (n = 21) for dental series and did lymphocyte transformation test (n = 18) for metals. We measured mercury in samples of blood (n = 19), urine (n = 19), saliva (n = 20), and scalp hair (n = 17) to investigate the association between mercury levels and cases of MCS. Results. The prevalence of metal immune hypersensitivity in a subset of 26 patients was 92.3 percent. Elevations of mercury occurred in 81.2 percent (26 of 32). The mean (±SD) in blood concentrations of mercury was 7.6 ± 13.6 μg/L; mean in urine was 1.9 ± 2.5 μg/L; mean in scalp hair was 2.2 ± 2.5 μg/g; mean in saliva was 38.1 ± 52.1 μg/L. Subgroup analyses showed that elevation of mercury levels in biological matrices were associated with mercury amalgams in patients with MCS (22 patients), compared with controls (8 patients) (odds ratio 11 : 95 percent confidence interval 1.5 to 81.6; P = 0.023). Conclusions. Our data show an increased prevalence of metal allergy and elevation of mercury levels in bioindicators among patients with MCS.

Photodynamic therapy to treat periimplantitis.

Aim: Periimplantitis is a bacterial complication after dental implants implantation. Photodynamic therapy (PDT) implies the use of low-power laser in combination with appropriate photosensitizer to increase the detoxification of the implant surfaces. Little information exists about PDT in the treatment of periimplantitis. A randomized comparative case-control study has been conducted with 20 patients and 20 controls to compare the efficacy of antimicrobial PDT versus surgical therapy in patients with periimplantitis, who have received dental implants with rough surfaces. Materials and Methods: In the surgery group, mucoperiosteal flap surgery was used with scaling on implant surfaces and debridement of granulation tissue. Microbiologic testing was evaluated before and after intervention treatment, at 12 and 24 weeks in the study subjects. Discussion: Total anaerobic counts of bacteria did not differ significantly between patients assigned to receive PDT and those assigned to receive surgical therapy (mean, 95.2% and 80.85%, respectively). PDT was associated with a significant decrease in bleeding scores (P = 0.02) as well as inflammatory exudation (P = 0.001). Conclusion: Treatment with PDT in patients with periimplantitis was not associated with major reduction of total anaerobic bacteria on the rough surfaces of dental implants as compared with surgical therapy. A significantly lower proinflammatory index of periimplantitis was observed in the PDT group at 24 weeks of follow-up.

Black hairy tongue associated with long-term oral erythromycin use.

Editor In May 2007, a 40-year-old man presented to our department because of tongue discoloration in association with burning mouth symptoms. Examination of the oral mucosa revealed a pronounced black-brownish pigmentation of the dorsal tongue. The filiform papillae appeared elongated (fig. 1). Moreover, the posterior palatine arch displayed detached mucosa, bilaterally. In these sites, the oral mucosa could easily be rubbed off by instruments. The patient did not have odynophagia or glossodynia, but burning tongue was exacerbated by eating. We performed extensive laboratory tests to exclude other coexisting conditions such as immunodeficiency, autoimmune conditions, sarcoidosis and nutrient deficiencies, but there was no evidence of other disorders. Culture of tongue swab specimen grew for Saccharomyces cerevisiae. A second, confirmatory, scraping swab specimen on the left anterior palatine arch yielded growth of S. cerevisae. No lymphoadenopaty was found. He smokes 10 cigarettes per day, moderately drinks alcohol and coffee (2 cups per day) and he does not eat candies. He was admitted 30 months earlier because of an episode of burning mouth syndrome. He did not have previous dental work in the past year. He did not undergo whitening to bleaching treatment as well as bicarbonate or hydrogen peroxide and clorexidine mouth rinse treatment. He was not allergic to any dental materials, which was evaluated by patch testing. Three days before admission, he tried to brush his tongue by using his toothbrush, but the condition did not ameliorate. At the age of 20, he had a history of ulcerative colitis, and in recent years, he has suffered from depression. Black hairy tongue (also termed lingua villosa nigra) is characterized by an overgrowth of filiform papilles. Patients with black hairy tongue tend to have an excessive length of filiform papillae, which confer a typically villous aspect to the dorsal tongue. The long projections of these filiform papillae reach lengths of over 15 to 20 mm, as reported in the present case. The width may be 2 mm. Histologically, the filiform papillae may show hyperkeratosis. Inappropriately, the patient had been taking oral erythromycin for 5 months (800–1200 mg given daily) due to a borderline positive single-sample serologic testing for Bordetella pertussis IgM in the absence of a history of spasmodic coughing. Moreover, before the start of antibiotic therapy, there was no evidence to suggest any bacterial infections or complications linked to Bordetella species. We also noted a consistent relation between the start of erythromycin course and the developing of nail discoloration, particularly the nail on his right fifth finger (fig. 2). After erythromycin was discontinued, the patient’s clinical condition gradually improved. Cases of antibiotic therapy-related black hairy tongue have been reported previously. In addition, bacteria and fungal pathogens have been considered to be related to black hairy tongue. Another cause of black discoloration of the tongue – with no ‘hairy’ tongue – is chlorexidine mouth rinse, which has been linked to Enterobacter cloacae. It is interesting to note that some neurological conditions, such as trigeminal neuropathy, might be associated with black hairy tongue. This case documents that an inappropriate as well as inadvisable long-term treatment with oral antibiotic therapy may cause black hairy tongue.

Effect of thimerosal, methylmercury, and mercuric chloride in Jurkat T Cell Line

ABSTRACT Mercury is a ubiquitous environmental toxicant that causes a wide range of adverse health effects in humans. Three forms of mercury exist: elemental, inorganic and organic. Each of them has its own profile of toxicity. The aim of the present study was to determine the effect of thimerosal, a topical antiseptic and preservative in vaccines routinely given to children, methyl mercury, and mercuric chloride on cellular viability measured by MTT in Jurkat T cells, a human T leukemia cell line. The treatment of Jurkat T cells with thimerosal caused a significant decrease in cellular viability at 1 μM (25%, p<0.05; IC50: 10 μM). Methyl mercury exhibited a significant decrease in cellular viability at 50 μM (33%, p<0.01; IC50: 65 μM). Mercuric chloride (HgCl2) did not show any significant change in cellular survival. Our findings showed that contrary to thimerosal and methyl mercury, mercuric chloride did not modify Jurkat T cell viability.

Exfoliative cheilitis associated with titanium dental implants and mercury amalgam

Exfoliative cheilitis is an uncommon chronic inflammatory condition that generally affects the vermilion of the lips. Its cause is still largely unknown an there is no effective treatment. Here we report of a case of exfoliative cheilitis possibly caused by mercury-containing dental amalgam in close proximity to dental titanium implant in a 41-year-old woman. By patch-testing, she was tested positive to thimerosal, palladium, gold, nickel, and copper. There was a strong temporal relation between last titanium dental implant and the onset of exfoliative cheilitis. Clinicians should be aware that exfoliative cheilitis might be associated with an allergy to intraoral dental metals and that titanium dental implant should not be implanted in the vicinity of the mercury-containing dental amalgam filling, even in presence of mercury amalgam as rootend filling material.

Diode Laser therapy for Heck's disease associated with HPV13 infection

© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation

Mucosa-associated lymphatic tissue lymphoma of the lower lip in a child☆,☆☆

Mucosa-associated lymphatic tissue lymphoma of the lip in a child is a very rare clinical entity whose cause is poorly understood. We describe an 11-year-old boy who presented with a 5-month history of an asymptomatic nodule on the lower lip with the clinical appearance of a benign mucocele. After surgical excision of the lower lip lesion, lymphocyte phenotypic analysis and histologic examination of the specimen disclosed an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue type of the buccal minor salivary glands. Mucosa-associated lymphatic tissue lymphoma of the lip may clinically resemble a large mucocele. To prevent a delayed detection of lip mucosa-associated lymphatic tissue lymphoma, an incisional biopsy of large mucous cysts of the oral mucosa before marsupialization is recommended.