Rosa María López-Pintor

Comparison of oral lesion prevalence in renal transplant patients under immunosuppressive therapy and healthy controls.

OBJECTIVE The aim of this study was to analyse the prevalence of oral lesions in a group of renal transplant patients (RTPs) compared with healthy controls (HCs). SUBJECTS AND METHODS The study included 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HCs (314 men, 187 women, mean age 52.25 years). Demographic and pharmacologic data were recorded for all subjects. RESULTS Forty percent of the RTPs presented with oral lesions compared to 23.4% of HCs. The most frequent lesion was candidiasis (7.4% in RTPs, 4.19% in HCs). Lip herpes simplex lesions were observed in 2.6% of RTPs and 2.2% of HCs; aphthae were observed in 2.2% of RTPs and 1% of HCs. Xerostomia prevalence was significantly greater in RTPs than HCs (1.4%vs 0.2%). Lichen planus appeared in 0.6% of RTPs, and one RTP suffered from hairy leukoplakia. CONCLUSIONS We report a lower prevalence of oral candidiasis and hairy leukoplakia in RTPs than previous reports and describe other oral conditions not presented before in prevalence studies of RTPs, such as xerostomia, aphthous ulcers and lichen planus. These oral lesion changes in RTPs and the risk of malignancy emphasize the importance of regular oral screening in these patients.

Oral ulcers during the course of cytomegalovirus infection in renal transplant recipients.

BACKGROUND Cytomegalovirus (CMV) infection is frequent in kidney transplant recipients. Although involvement of the gastrointestinal tract with CMV has been described, intra-oral localization is rare. The aim of this study was to analyze the incidence, clinical characteristics, treatment, and outcome of renal transplant recipients with oral lesions due to CMV. PATIENTS AND METHODS We analyzed the records of 453 patients who underwent kidney transplantation between February 1989 and March 2007. Incident cases and characteristics of CMV oral lesions were ascertained retrospectively in the outpatient records. RESULTS The cumulative incidence of 6 cases with oral ulcerations was 1.32%. The median follow-up (n = 453) was 61.84 +/- 50.68 months. The interval for the incidence of CMV oral ulcers after renal transplantation was 12.83 +/- 23.51 months. The affected oral locations included the buccal mucosa, hard palate, soft palate, tongue, and floor of the mouth. CMV cases showed no significant difference with regard to gender distribution, age at renal transplantation, renal transplant indication, type of immunosuppressive treatment, and donor/recipient CMV serological status before transplantation. The number of acute rejection episodes was significantly greater and time since transplantation was significantly shorter in CMV cases. CONCLUSION CMV infection, which is common in renal transplant recipients, only rarely affects the mouth. Herein we have reported 6 patients who suffered oral ulcers due to CMV infection. An early diagnosis of these lesions is important to a successful outcome for these patients.

Clinical Outcomes of Peri-Implant Peripheral Giant Cell Granuloma: A Report of Three Cases

BACKGROUND Peripheral giant cell granuloma (PGCG) is a reactive lesion that occurs on the gingiva or alveolar mucosa and contains numerous giant cells. Its recurrence rate is 10%. Only five cases associated with dental implants have been reported. This case report describes three additional cases with clinical courses and outcomes. METHODS Three women presented with a chief complaint of a gingival mass around the implants. The lesions were surgically excised under local anesthesia. RESULTS The initial diagnosis at presentation was pyogenic granuloma. Radiography showed marginal bone loss accompanying the lesions. Histopathology confirmed the diagnosis of PGCG. In two cases, several recurrences resulted in explantation of the fixture. One case healed uneventfully. CONCLUSIONS Despite its usually benign clinical behavior, peri-implant PGCG may follow an aggressive course. Treatment planning for this condition should take into account the presence of recurrences to evaluate the necessity of an aggressive surgical approach that may involve advanced bone loss and explantation. Further research on the origin of this implant-associated condition with a larger series of cases is necessary to provide a basis for adequate management.

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.

Amlodipine and Nifedipine Used With Cyclosporine Induce Different Effects on Gingival Enlargement

BACKGROUND Gingival enlargement (GE) is a frequent side effect associated with the administration of cyclosporine (CsA) and the calcium channel blockers (CCB). The aims of this study were to determine and compare GE prevalence and severity in 3 groups of renal transplant recipients who had been medicated with CsA versus CsA in combination with nifedipine versus CsA in combination with amlodipine. PATIENTS AND METHODS A cohort of 93 patients included 31 medicated with CsA, 31 with CsA plus nifedipine, and 31 with CsA plus amlodipine. The presence and severity of GE were assessed using the index developed by Harris and Ewart. RESULTS There were significant differences in GE prevalence and GE severity among the 3 groups. A greater proportion (90.3%) of the CsA-nifedipine group was categorized as having GE compared with the CsA-amlodipine group (58.1%) or the CsA group (51.6%). A greater percentage of subjects in the CsA-nifedipine group displayed severe GE (22.6%) when compared with the CsA (0%) or the CsA-amlodipine group (16.1%). CONCLUSION The prevalence and severity of GE in subjects maintained on CsA-nifedipine was significantly greater than that among subjects treated with CsA-amlodipine or CsA only. The GE prevalence and severity was greater in the CsA-amlodipine group than the CsA group. This observation should lead clinicians to avoid the use of these drugs together with CsA or to choose amlodipine instead of nifedipine.

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.

Afectación oral en el paciente con síndrome de Sjögren primario. Manejo multidisciplinar entre odontólogos y reumatólogos

Primary Sjögrens syndrome is a chronic systemic autoimmune disease that causes destruction of lacrimal and salivary glands. The most common and earliest symptoms are oral and ocular dryness. Dry mouth makes talking difficult, tasting and chewing properly, impairing quality of life of these patients. The most common oral signs and symptoms are hyposialia with or without xerostomia, tooth decay, fungal infections, traumatic oral lesions, dysphagia, dysgeusia, and inflammation of salivary glands. There are different therapeutic strategies, depending on the severity of each case, and the increase in the amount of saliva, to reduce the number of cavities and oral infections. It is particularly important to establish a close relationship between the dentist and the rheumatologist in order to make an early and correct diagnosis, promoting appropriate dietary and hygiene measures, as well as to treat and prevent potential oral complications.

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.

Oral lesions in Sjogren’s syndrome: A systematic review

Background Sjögren’s syndrome (SS) is an autoimmune disease related to two common symptoms: dry mouth and eyes. Although, xerostomia and hyposialia have been frequently reported in these patients, not many studies have evaluated other oral manifestations. The aim of this systematic review was to investigate prevalence rates of oral lesions (OL) in SS patients and to compare it to a control group (CG), when available. Material and Methods An exhaustive search of the published literature of the Pubmed, Scopus, Web of Science and the Cochrane Library databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) for relevant studies that met our eligibility criteria (up to September 1st 2017). Results Seventeen cross-sectional studies and one cohort study were finally included. The results showed that SS patients presented more OL compared to non-SS patients. The most frequent types of OL registered in primary and secondary SS were angular cheilitis, atrophic glossitis, recurrent oral ulcerations and grooves or fissurations of the tongue, also when compared to a CG. Conclusions OL are common and more frequent in SS patients when compared to a CG. This may be a consequence of low levels of saliva. More studies where these OL and all the possible cofounding factors are taken into account are needed. Key words:Sjögren’s syndrome, oral lesions, oral diseases, oral manifestations, oral disorders, systematic review.