Ronald S. Brown

Erythema Multiforme Major Following Treatment with Infliximab

BACKGROUND The growth in the use of anti-tumor necrosis factor α (TNF-α) agents for treatment of inflammatory conditions has led to increased recognition of the side effects associated with this class of drugs. CASE DESCRIPTION We report a case of a patient who developed erythema multiforme (EM) major with characteristic oral and cutaneous lesions following treatment with the anti-TNF-α medication infliximab therapy for Crohns disease (CD). CLINICAL IMPLICATIONS To our knowledge, this is the first reported case of infliximab-induced EM secondary to the treatment of CD. It is important for dental clinicians evaluating patients using anti-TNF-α agents to be aware of this possible complication.

Topical tacrolimus with custom trays in the treatment of severe oral chronic graft-versus-host disease refractory to a potent topical steroid therapy: a case report.

BACKGROUND The authors present a case demonstrating the success of topical tacrolimus (TAC) therapy with custom trays in the treatment of oral chronic graft-versus-host disease (cGVHD). The 41-year-old male patient initially responded to topical steroid therapy (clobetasol propionate 0.05% ointment) applied both topically and with flexible carrier trays, but later became refractory to this potent topical agent. Topical TAC therapy with flexible carrier trays and systemic prednisone therapy was initiated. RESULTS The patient responded favorably with the change to topical TAC therapy with custom trays (and oral prednisone). His oral cGVHD lesions resolved within a period of 4 weeks. The improvement has remained stable at 14 months of follow-up. CLINICAL IMPLICATIONS This is the first case reported with regard to the successful resolution of steroid recalcitrant cGVHD successfully treated with topical TAC with custom trays.

Bilateral bone loss of the maxilla.

CLINICAL PRESENTATION A 34-year-old woman reported to her general dentist in April 1994 with a chief complaint of “painful oral ulcer, upper left.” A clinical and radiographic examination revealed a vertical bony defect measuring approximately 4 to 5 mm on the mesial aspect of the left maxillary second molar. The patient had been seen regularly for 15 years, had always demonstrated excellent oral hygiene, and had no history or evidence of periodontal disease. She practiced as a physical therapist, and it was noted that she had treated many patients with human immunodeficiency virus (HIV). In May 1994, the patient began experiencing symptoms of chronic nonproductive cough, hectic fever, and general malaise. A purified protein derivative (PPD) tuberculin test and chest radiograph were ordered by her physician. The PPD test result was positive ( 22 mm); however, her chest film was negative. She presented to an oral and maxillofacial surgeon in June 1994. He performed gingival curettage of the left maxillary posterior area and discarded the tissue. Later that month, another positive PPD test result was obtained ( 12 mm) and the patient was placed on a 6-month course of isoniazid (300 mg daily) despite 2 negative sputum cultures. In July 1994, a similar pattern of focal periodontal bone loss was detected in the right maxillary posterior quadrant (Fig 1). Later that month, the oral surgeon performed curettage of this area, with the tissue again discarded. Shortly thereafter, the left maxillary second molar was extracted because of extensive local bone loss. In August 1994, an endodontic procedure was performed on the right maxillary second bicuspid and the right maxillary second molar was extracted. In September 1994, the patient was referred to a second oral surgeon, who performed an incisional biopsy of the right maxillary posterior gingival tissues. The differential diagnoses at the time included periodontal disease, oral tuberculosis (TB), and possible HIV-related periodontitis. A histopathologic evaluation of the tissue revealed the presence of multiple well-formed granulomas with minimal central necrosis (Fig 2, A and B). No foreign material was seen, and no microorganisms were identified through the use of acid-fast, periodic acid–Schiff, and Gomori’s methenamine silver staining. The diagnosis was noncaseating granulomatous inflammation.

A topical imiquimod-induced oral mucosal lichenoid reaction: A case report

BACKGROUND Imiquimod (IMI) is a topical immune response modifier used in the treatment of actinic keratosis and cheilitis. Actinic cheilitis is a potentially premalignant condition that requires therapeutic intervention. IMI therapy is noted for producing cutaneous and mucosal adverse effects. The authors report the case of an 88-year-old woman who was treated for actinic cheilitis of the upper lip with IMI and who consequently experienced an oral mucosal lichenoid reaction of the lower lip and right buccal mucosa. RESULTS The patient was treated successfully with high-dose steroid therapy, and the oral lesions resolved in 17 days. CONCLUSIONS To our knowledge, this is the first case report regarding an IMI-induced oral mucosal lichenoid reaction. Clinicians should be aware of the potential of IMI to cause lichenoid reactions. PRACTICAL IMPLICATIONS IMI is an efficacious therapeutic agent when used in the treatment of actinic cheilitis, but it is prone to cause oral mucosal side effects such as lichenoid reactions. Therefore, it is important for dentists to be knowledgeable concerning potential mucosal IMI side effects.

Inflammatory reaction of the anterior dorsal tongue presumably to sodium lauryl sulfate within toothpastes: a triple case report

BACKGROUND Sodium lauryl sulfate (SLS), a popular surface active agent ingredient within toothpastes, is known for its foaming action. Surface active agents increase the effectiveness of toothpastes with respect to dental plaque removal. SLS is a known irritant and also has allergenic potential. The authors report 3 patients with oral pain secondary to inflammation of the dorsal anterior tongue. These patients were all using toothpastes with SLS as an ingredient. RESULTS The dorsal tongue lesions and oral pain resolved upon switching to toothpastes without SLS as an ingredient. CONCLUSIONS Clinicians should be aware of the potential of SLS within toothpastes to cause oral mucosal inflammatory reactions of the anterior dorsal tongue. To our knowledge, these are the first case reports of oral mucosal inflammatory reactions of the anterior dorsal tongue associated with SLS containing toothpastes.

On Emerging Clinical Dental Specialties and Recognition

C l i n M e d International Library Citation: Brown RS (2015) On Emerging Clinical Dental Specialties and Recognition. Int J Pathol Clin Res 1:006 Received: June 16, 2015: Accepted: July 20, 2015: Published: July 24, 2015 Copyright:

Antifibrinolytic Drugs (Aminocaproic Acid and Tranexamic Acid): Treatment Perspectives for Dental Surgery

The purpose of the review was to evaluate the risks and benefits of antifibrinolytic drugs, aminocaproic acid and tranexamic acid, with respect to dental surgery. The literature supports the utilization of antifibrinolytic drugs particularly with regard to hemophilia and other bleeding dyscrasias. Systemic therapy has potential risks, although blood studies allow for the safe utilization of antifibrinolytics. The use of topical antifibrinolytic drugs demonstrates benefit without significant risk.

Orofacial pain due to trigeminal autonomic cephalgia with features of short-lasting neuralgiform headache attacks with conjunctival injection and tearing: a case report.

BACKGROUND We present a case of a 64-year-old woman with a presumptive diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome with telangiectasia. Dental procedures were not successful in alleviating the condition. RESULTS The patients symptoms of short unilateral severe pain episodes abated after geographic relocation, although orofacial pain continued. Sphenoid sinus surgery further decreased the patients chronic pain complaints. The patients current pain condition is controlled with gabapentin therapy. CLINICAL IMPLICATIONS Diagnostic, etiologic, and therapeutic issues related to SUNCT syndrome are discussed. This case represents the first case report of trigeminal autonomic cephalgia with SUNCT syndrome-like features illustrating possible problematic dental therapies. It is only the third SUNCT case report in the dental literature, and the third case reporting a correlation between SUNCT syndrome and sinusitis.