Jair Carneiro Leão

Desquamative gingivitis: Retrospective analysis of disease associations of a large cohort

BACKGROUND Desquamative gingivitis (DG) is usually a manifestation of immunologically mediated mucocutaneous disorders, although it was previously suggested to be hormonally related. METHODS One hundred and eighty-seven Caucasian UK residents with clinical features of DG (126 female, median age of 51 years, range 23-93 years) were retrospectively evaluated. RESULTS It was established that, in this population, the largest cohort yet reported, oral lichen planus was most common (70.5%) while mucous membrane pemphigoid (14%), pemphigus vulgaris (13%), linear IgA disease (1.6%), dermatomyositis (0.5%) and mixed connective tissue disease (0.5%) were less common. CONCLUSION Oral lichen planus is the main disorder associated with DG. However, DG may be a feature of bullous disease and connective tissue disease.

Email for distance diagnosis of oral diseases: a preliminary study of teledentistry

We examined the feasibility of distance diagnosis of oral diseases, using transmission of digital images by email. Twenty-five cases of oral lesions were documented during a 12-month study in a primary care public health clinic in Paraná in Southern Brazil. Clinical electronic charts and images were produced and sent by email to two oral medicine specialists with a median of 10 years experience in the field. The consultants provided a maximum of two clinical hypotheses for each case. In 15 of the 25 cases (60%) both consultants made a correct diagnosis; in seven cases (28%) only one consultant made a correct diagnosis; and in three cases (12%) neither consultant made a correct diagnosis. Thus in 88% of cases, at least one consultant was able to provide the correct diagnosis. The results suggest that distant diagnosis can be an effective alternative in the diagnosis of oral lesions and that the using two distant consultants improves diagnostic accuracy. Primary care public health clinics may benefit from the use of email and digital cameras for telehealth in remote areas where oral medicine specialists are not available.

Oral complications of HIV disease

Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

Focal epithelial hyperplasia – an update

Focal epithelial hyperplasia (FEH) is an asymptomatic benign mucosal disease, which is mostly observed in specific groups in certain geographical regions. FEH is usually a disease of childhood and adolescence and is generally associated with people who live in poverty and of low socioeconomic status. Clinically, FEH is typically characterized by multiple, painless, soft, sessile papules, plaques or nodules, which may coalesce to give rise to larger lesions. Human papillomavirus (HPV), especially genotypes 13 and 32, have been associated and detected in the majority of FEH lesions. The clinical examination and social history often allow diagnosis, but histopathological examination of lesional tissue is usually required to confirm the exact diagnosis. FEH sometimes resolves spontaneously however, treatment is often indicated as a consequence of aesthetic effects or any interference with occlusion. There remains no specific therapy for FEH, although surgical removal, laser excision or possibly topical antiviral agents may be of benefit. There remains no evidence that FEH is potentially malignant.

Impact of ageing and drug consumption on oral health

The impact of ageing on oral health and salivary flow is usually over-estimated possibly because of the high frequency of polypharmacy observed in this subset of patients. Understanding the physiological changes and treatment-related oral complications of older patients is essential to promote accurate management of symptoms and improve their quality of life. The current paper reviews age-related physiological chances in salivary glands and the effect of polypharmacy on oral health, focusing on xerostomia and hyposalivation.

Wegener's granulomatosis: a review of clinical features and an update in diagnosis and treatment.

Wegeners granulomatosis (WG) is an idiopathic, systemic inflammatory disease characterized by necrotizing granulomatous inflammation and pauci-immune small-vessel vasculitis of upper and lower respiratory tract and kidneys. The condition affects both genders equally, although some inconsistent gender differences have been observed. The aetiology of WG remains unknown although a number of exogenous factors have been suggested to be of aetiological relevance. Most clinical characteristics of this disease are non-specific, making clinical diagnosis challenging. Histopathological examination of lesional and peritoneal tissue is not pathognomonic, but is an essential investigation to confirm the presence of disease and exclude other disorders. At present, despite the increasingly wide range of potential therapies, cyclophosphamide plus corticosteroids remain the most recognized and effective means of inducing and sustaining remission of WG.

Effect of Low-Level Laser Therapy in the Treatment of Burning Mouth Syndrome: A Case Series

OBJECTIVE The aim of this study was evaluate the effect of low-level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS) patients. BACKGROUND DATA BMS is a clinical condition characterized by a burning sensation in a morphologically normal oral mucosa, without association with systemic disorders. METHODS Ten patients with oral burning sensation were included in the study. After careful evaluation of medical history and oral examination, the diagnosis of BMS was established. All patients were submitted to one weekly session of LLLT for 10 weeks. A continuous wavelength of 660 nm, power 40 mW, 20 J/cm(2), 0.8 J/point, with each point irradiated for 10 sec. In all sessions the burning intensity was evaluated with a 10-cm visual analogue scale (VAS), with 0 indicating no symptoms and 10 indicating the worst burning possible. The burning intensity evaluation by VAS was performed immediately before (VAS baseline) and immediately after each LLLT session. The nonparametric Wilcoxon test was used for statistical analysis, considering significance of 5%. RESULTS All patients reported improvement in all sessions, with reduction in VAS scores by up to 58% in the tenth session. When only the VAS baseline of the first session was compared with the other sessions, there was a statistically significant reduction in VAS scores in the fourth (p=0.03), fifth (p=0.03), sixth (p=0.009), seventh (p=0.003), eighth, ninth, and tenth (all p=0.002) sessions. CONCLUSIONS LLLT may be an alternative treatment for the relief of oral burning in patients with BMS.

Teledentistry: Distant Diagnosis of Oral Disease Using E-Mails

OBJECTIVE The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail. SUBJECTS AND METHODS The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard. RESULTS In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574). CONCLUSIONS The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Sarcoidosis – a clinically orientated review

Sarcoidosis is a multisystem disease of unknown cause. Sarcoidosis can affect all individuals with any race, sex, or age but commonly affects young- and middle-aged adults and usually presents with bilateral hilar lymphadenopathy, pulmonary infiltration, skin and ocular lesions. Other organs can also be affected. Diagnosis is established when clinical and radiological findings are supported by the presence of non-caseating epithelioid cell granulomas, however, local sarcoid reactions and granulomas of known cause should be excluded. The optimal management has not been well defined yet, although corticosteroids remain the mainstay of treatment, there is little evidence on which to base the indications for treatment including dosage and duration of therapy. Certain clinical features are helpful in the prognosis of the condition that can vary from a self-limiting course to progressive life-threatening fibrosis of the vital organs.

Salivary shedding of HHV-8 in people infected or not by human immunodeficiency virus 1

BACKGROUND Human herpesvirus 8 (HHV-8), the main agent involved in the etiopathogenesis of Kaposis sarcoma (KS) is primarily transmitted through sexual contact. The potential of saliva as a source of HHV-8 transmission remains unclear. The purpose of this work was to determine the frequency of HHV-8 detection in saliva of HIV-infected individuals and their family contacts. METHODS The study group comprised 210 individuals. Group 1: 35 HIV-infected patients; group 2: 35 non-HIV individuals; group 3: two siblings for each patient from group 1; group 4: two siblings for each individual from group 2. Each participant had non-stimulated whole saliva collected and DNA was extracted. HHV-8-DNA amplification from ORF-26 was performed using a nested PCR protocol. RESULTS HHV-8 DNA was detected in saliva from 14/35 (40%) HIV-infected individuals and 4/35 (11.4%) non-HIV-infected individuals (OR = 5.16, CI [1.49-17.88], P = 0.006). It was also possible to amplify HHV-8 DNA in 11/70 (15.7%) relatives of HIV-infected participants and 4/70 (5.71%) relatives of non-HIV-infected individuals(P = 0.041). Among the 14 group 1 patients with HHV-8 DNA detected in saliva, eight (57.1%) had a household member in whom HHV-8 DNA was also amplified (OR = 8, CI [1.58-40.29] P = 0.007). CONCLUSIONS HHV-8 DNA is frequently found in saliva. HIV-infected individuals showed a higher frequency of detection of HHV-8 than healthy controls. HHV-8 DNA was significantly amplified in saliva of household members of HIV/HHV-8 co-infected individuals.