Lorenzo Arriba

Rapid progression from oral leukoplakia to carcinoma in an immunosuppressed liver transplant recipient

Immunosuppression used to avoid graft rejection in solid organ transplantation recipients leads to a variety of side-effects, and an increased rate of infections and de novo malignancies. Oral conditions usually associated with immunosuppressive drugs include fungal and viral infection, and lip lesions, but intra-oral carcinoma has not been reported as having a high incidence. This report deals with a male liver transplant recipient receiving FK506 (5 mg/day) and prednisone (20 mg/day) who was diagnosed with a homogeneous leukoplakia on the floor of the mouth 4 months after transplantation, and 4 months later with a squamous cell carcinoma growth at the site of this lesion. The rapid transformation of the lesion suggests that in patients who display oral premalignant conditions, immunosuppression must be considered as an important risk factor for oral cancer.

Implant treatment in patients with oral lichen planus: a prospective‐controlled study

OBJECTIVES The main aim of this prospective-controlled study was to evaluate the implant survival rate in patients diagnosed with oral lichen planus (OLP). The secondary goals were to analyze the presence of implant- and patient-dependent variables. MATERIAL AND METHODS Two groups, including 18 patients diagnosed with OLP and 18 controls, received 56 and 62 implants during the years 2003-2008. Pain and wound healing were evaluated after the procedure. After a mean follow-up of 53.5 and 52.3 months, clinical and radiographic assessments were used to evaluate implant survival and patient- and implant-dependent parameters. RESULTS The implant survival rate was 100% for the OLP group. Immediate postsurgical complications were similar in both groups. Peri-implant mucositis (PIM) was detected in 44.6% of the implants and 66.6% of the patients with OLP. The presence of desquamative gingivitis (DG) was associated with a higher rate of PIM on those implants of the OLP group (P=0.004). Peri-implantitis (PI) appeared in 10.7% of the implants and 27.7% of the patients with OLP (P=NS). CONCLUSION Despite the limitations of the small sample size, it seems that lichen planus is not a prominent local player in the genesis of implant failure. Patients with DG should be carefully examined during follow-up care.

Lip cancer in renal transplant patients

The aims of this study were to establish the incidence of lip cancer (LC) in a population of renal transplant patients (RTPs), identifying possible risk factors and predictable variables, and to describe the clinical appearance, treatment, and course of LC in this group. The study included 500 patients (307 men, 193 women; mean age 53.63±13.42 years, range 19-95 years; mean period since transplant 59.66±55.81 months, range 4-330 months). Incident cases of LC were ascertained retrospectively from outpatient records. All LC lesions were sampled by biopsy and examined histopathologically. Six of the men (1.2%) suffered lower LC, and LC cases showed significant differences on univariate analysis for tobacco habit, tobacco consumption, and sun exposure. All patients who had LC were taking prednisolone and cyclosporine A (CsA) at the time of LC diagnosis. The median interval for LC incidence after renal transplant was 80.50±31.25 months. Five of six LCs were squamous cell carcinomas. Multiple logistic regression showed that the LCs were not significantly associated with any independent risk factor. The results show that the appearance of LC in RTPs is associated with immunosuppressant treatment, sun exposure, and tobacco and indicate that these patients should avoid unprotected exposure to sunlight and smoking. Because of the high incidence of LC in RTPs, periodic checking of the lips is important to ensure prompt diagnosis and correct management of LC. Our data suggest that the clinical profile of LC in this patient group is similar to that of the general population.

Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients

The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%–53.5% versus 0–30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG) is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%). In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection.

Oral candidiasis in patients with renal transplants

Objectives: Oral candidiasis (OC) is a frequent oral lesion in renal transplant patients (RTPs). Despite the increased prevalence of OC in RTPs, no study has examined related risk factors. The aims of this study were to analyze the prevalence of and risk factors for OC in RTPs compared with age- and gender-matched healthy control group (HC) as well as determine the incidence of OC after transplantation. Study Design: We analyzed the prevalence and risk factors of OC in a group of 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HC subjects (314 men, 187 women, mean age 52.25 years). Demographic and pharmacological data were recorded for all subjects. Incident cases of OC were ascertained retrospectively from outpatient clinical records only in the RTP group. Results: The prevalence of OC was 7.4% in RTPs compared with 4.19% in HC (P<0.03). The most frequent type of OC in the two groups was denture stomatitis. Statistical association was found between OC and age, mycophenolate mofetil dose and blood levels, dentures and tobacco. The multiple logistic regression model only chose for denture variable. According to the outpatient clinical records, 24 RTPs suffered OC during the first moth post-transplant. Severe lesions affecting the oral cavity and pharynx appeared in 79% of the OC cases. Conclusions: This study shows a lower prevalence of OC in RTPs than previous reports. Denture stomatitis was the most frequent OC prevalence form described in RTPs. Severe candidiasis is more frequent in the immediate posttransplant period. The presence of denture is an important risk factor of OC. These results emphasise the importance of adequate pre- and post-transplant oral health and denture cleaning and adjustment is recommended for these subjects to prevent this infection. Key words:Oral candidiasis, immunosuppressive therapy, renal transplantation.

Successful treatment of oral pemphigus vulgaris in an insulin-dependant geriatric patient

OBJECTIVE To present a clinical report of a patient treated with corticosteroids for oral pemphigus vulgaris (PV) lesions. BACKGROUND PV is the type of pemphigus that most often affects the oral mucosa and tends not to appear in elderly people. METHODS Two biopsies were needed for diagnosis. She was treated with oral prednisone and topically with 0.05% clobetasol propionate. CONCLUSION An early diagnosis and treatment is needed for a good prognosis, especially in elderly patients with multiple systemic pathology.

Surgical Treatment of a Peripheral Ossifying Fibroma and Reconstruction with a Porcine Collagen Matrix: A Case Report

A 35-year-old woman was referred to the Department of Oral Medicine and Orofacial Surgery after several recurrences of an ossifying fibroma (OF) that affected the free and attached gingiva of the maxillary right central incisor. Surgery was performed with a complete excision of the lesion together with the surrounding healthy tissue up to the bone. To guide the healing of the anterior esthetic framework and the excised tissues, a porcine collagen matrix as an alternative to connective tissue graft was used. After an 18-month follow-up, the lesion had not recurred and keratinized gingiva had formed around the area.