Osteonecrosis of the jaw (ONJ) is a well-known pathological condition in oncology derived from the use of bisphosphonates (BPs) and denosumab. Many molecular and immunological targets have been introduced for daily use in cancer treatment in recent years; consequently, new cases of ONJ have been reported in association with these drugs, especially if administered with BPs and denosumab. When the drugs are administered alone, ONJ is rarely seen. The objective of our study was to analyze the recent literature relative to the association of ONJ with these new drugs highlighting the pathogenic, clinical and therapeutic aspects. The close collaboration between maxillofacial surgeon, oncologist, dentist, and dental hygienist remains the most important aspect for the prevention, prompt recognition, and treatment of this pathology.
Angiogenesis Modulating Agents ; Cooperative Behavior ; Denosumab ; Dental Hygienists ; Dentists ; Diphosphonates ; Humans ; Immunomodulation ; Immunotherapy ; Jaw ; Oral and Maxillofacial Surgeons ; Oral Manifestations ; Osteonecrosis ; Pathology

Mucopolysaccharidosis (MPS) is an inherited metabolic disorder caused by a deficiency in enzymes that participate in the degradation of glycosaminoglycans (GAGs) such as heparin sulfate and dermatan sulfate. Left untreated, patients show progressive mental and physical deterioration due to deposition of GAGs in organs. Death often occurs due to cardiac or respiratory failure before patients reach their early twenties. MPS has several oral and dental manifestations. An enlarged head, short neck, and open mouth associated with a large tongue are major characteristics of MPS patients. Dental complications can be severe, including unerupted dentition, dentigerous cyst-like follicles, malocclusions, condylar defects, and gingival hyperplasia. A 21-year-old female patient with MPS was described in this article, with special emphasis on oral manifestations and dental treatment.
Dental Pulp Cavity ; Dentition ; Dermatan Sulfate ; Female ; Gingival Hyperplasia ; Glycosaminoglycans ; Head ; Heparin ; Humans ; Malocclusion ; Mouth ; Mucopolysaccharidoses ; Neck ; Oral Manifestations ; Respiratory Insufficiency ; Root Canal Therapy ; Tongue ; Young Adult

Leukemia is a hematological malignant disease with various clinical symptoms. Due to the fatal nature of the disease, early detection is important. Oral manifestations include ulcers and gingival enlargement with bleeding. Moreover, myeloid sarcoma or opportunistic infections may also occur. This report introduces a 31-year-old male presenting with generalized gingival enlargement with bleeding and another 81-year-old female with neoplasm on the left retromolar area. Both were diagnosed as acute monocytic leukemia. These cases implicate that gingival enlargement or mucosal lesion in the oral cavity may represent underlying systemic diseases. Related to this, it has to be reminded that making timely diagnosis and referral according to the clinical findings is crucial.
Adult ; Aged, 80 and over ; Diagnosis ; Female ; Hemorrhage ; Humans ; Leukemia ; Leukemia, Monocytic, Acute ; Male ; Mouth ; Opportunistic Infections ; Oral Manifestations ; Referral and Consultation ; Sarcoma, Myeloid ; Ulcer

Dyke-Davidoff-Masson syndrome is a non-inherited rare condition that presents during childhood and is characterized by seizures, hemiplegia, mental retardation, cerebral hemiatrophy, calvarial thickening, and hyperpneumatization of the frontal sinuses. The present article highlights a case of a 12-year-old male child with additional clinical findings of café-au-late pigmentation and ocular lipodermoid. This is the first case report of Dyke-Davidoff-Masson syndrome to describe oral manifestations, such as unilateral delayed eruption of teeth, hypoplasia, and taurodontism, which could be unique and characteristic of this condition. Oral health care providers and physicians should be aware of these oral observations as dental referrals could warrant early dental prophylactic care and can be useful in diagnosing the possible time of injury and type of Dyke-Davidoff-Masson syndrome.
Child ; Dental Enamel Hypoplasia ; Frontal Sinus ; Hemiplegia ; Humans ; Intellectual Disability ; Male ; Open Bite ; Oral Health ; Oral Manifestations* ; Pigmentation ; Referral and Consultation ; Seizures ; Tooth

No abstract available.
CD4 Lymphocyte Count* ; Humans ; Oral Manifestations*

OBJECTIVES: The objective of this study was to investigate the presence of oral lesions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in a descriptive cross-sectional study, and to establish their presence according to levels of CD4+ cells (including the CD4+/CD8+ cell ratio). MATERIALS AND METHODS: A total of 75 patients infected with HIV were included. Oral lesions were observed and classified using World Health Organization classification guidelines. Potential correlations between the presence and severity of oral lesions and CD4+ cells, including the CD4+/CD8+ cell ratio, were studied. RESULTS: The most frequent oral lesion detected was oral pseudomembranous candidiasis (80.0%), followed by periodontal disease (40.0%), herpetic lesions (16.0%), hairy leukoplakia (16.0%), gingivitis (20.0%), oral ulceration (12.0%), Kaposi's sarcoma (8.0%), and non-Hodgkin's lymphoma (4.0%). The CD4+ count was <200 cells/mm³ in 45 cases (60.0%), between 200–500 cells/mm³ in 18 cases (24.0%), and >500 cells/mm³ in 12 cases (16.0%). The mean CD4+ count was 182.18 cells/mm³. The mean ratio of CD4+/CD8+ cells was 0.26. All patients showed at least one oral manifestation. CONCLUSION: There was no correlation between the CD4+/CD8+ cell ratio and the presence of oral lesions. The severity of the lesions was more pronounced when the CD4+ cell count was less than 200 cells/mm³.
Acquired Immunodeficiency Syndrome ; Adult* ; Candidiasis ; CD4 Lymphocyte Count ; Classification ; Clinical Study* ; Cross-Sectional Studies ; Gingivitis ; HIV* ; Humans* ; Leukoplakia, Hairy ; Lymphoma, Non-Hodgkin ; Oral Manifestations ; Oral Ulcer ; Periodontal Diseases ; Sarcoma, Kaposi ; World Health Organization

Stevens-Johnson syndrome (SJS) is characterized by mucocutaneous tenderness and typical hemorrhagic erosions, erythema and epidermal detachment presenting as blisters and areas of denuded skin. SJS is often observed after drug use as well as after bacterial or viral infections. Several drugs are at high risk of inducing SJS, but there are no cases in the English literature regarding anabolic steroid use triggering SJS. In our paper, we describe a case in which use of anabolic androgenic steroids (AAS) was associated with SJS. The patient participated in competitive body-building and regularly took variable doses of AAS. Initial symptoms (headache, weakness, pharyngodynia, and fever) were ignored. After a week he presented to the Emergency Department with a burning sensation on the mouth, lips, and eyes. Painful, erythematous, maculopapular, and vesicular lesions appeared all over the body, including on the genitals. During hospitalization, he also developed a cardiac complication. The patient had not taken any drugs except AAS.
Anabolic Agents ; Blister ; Burns ; Emergency Service, Hospital ; Erythema ; Hospitalization ; Humans ; Lip ; Mouth ; Oral Manifestations ; Sensation ; Skin ; Steroids* ; Stevens-Johnson Syndrome* ; Stomatitis

OBJECTIVES: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana. MATERIALS AND METHODS: A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance. RESULTS: Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions. CONCLUSION: From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.
Acquired Immunodeficiency Syndrome ; Candidiasis, Oral ; CD4 Lymphocyte Count* ; Cell Count ; Classification ; Cross-Sectional Studies ; Diagnosis ; European Union ; Female ; Ghana* ; Gingivitis ; HIV ; Hospitals, Teaching ; Humans ; Hyperpigmentation ; Immune System ; Immunosuppression ; Leukoplakia, Hairy ; Male ; Medical Records ; Opportunistic Infections ; Oral Manifestations* ; Periodontitis ; Prospective Studies ; Statistics as Topic ; Xerostomia

PURPOSE: Methimazole is an anti-thyroid drug that can cause life-threatening neutropenia in rare situations. The aim of this case report is to describe a set of oral complications associated with methimazole-induced neutropenia and the healing of the gingiva after proper treatment. METHODS: A 31-year-old female patient hospitalized for systemic symptoms of sore throat and fever and showing extensive gingival necrosis with pain was referred to the Department of Periodontics from the Department of Endocrinology. Methimazole-induced neutropenia was diagnosed based on blood test results and her medical history. Methimazole was discontinued and a range of treatments was administered, including the injection of granulocyte colony stimulating factor. RESULTS: After systemic treatment, the gingiva began to heal as the neutrophil count increased. Approximately one year later, the gingiva had returned to a normal appearance. Twenty-one months after treatment, sequestra of the alveolar bone that had broken through the gingiva were removed. Periodic supportive periodontal treatment has been continued uneventfully. CONCLUSIONS: The oral manifestations of gingival necrosis and ulcerations, in combination with systemic symptoms such as fever and sore throat, are the critical signs presented in the early stages of drug-induced neutropenia. Therefore, dentists need to be aware of these oral complications in order to make an accurate diagnosis and to ensure that prompt medical intervention is provided.
Adult ; Colony-Stimulating Factors ; Dentists ; Diagnosis ; Endocrinology ; Female ; Fever ; Follow-Up Studies* ; Gingiva ; Granulocytes ; Hematologic Tests ; Humans ; Hyperthyroidism ; Methimazole ; Necrosis* ; Neutropenia* ; Neutrophils ; Oral Manifestations ; Periodontics ; Pharyngitis ; Ulcer

Treating patients with severely worn dentition often requires comprehensive prosthetic treatments. Oral rehabilitation and long-term stability could be achieved by analyzing the cause of the wear and changing vertical dimension. The temporary restoration procedure is executed and patient's adaptation is evaluated by long-term observation when treatment is accompanied with increasing vertical dimension. In this case, 54 year-old male presented with worn dentition and esthetic dissatisfaction. In oral manifestations, severely worn dentition with attrition and erosion is diagnosed. To evaluate change of vertical dimension, interocclusal rest space, facial appearance, pronunciation, clinical crown length, distance from incisor edge to labial vestibule are evaluated. Consequently, 2.5 mm increase of vertical dimension that based on articulator incisal pin is determined. After 8 weeks stabilization period with temporary prostheses, definitive prostheses are fabricated. After 6 months follow up period, satisfactory outcomes were achieved both in functional and esthetic aspects through this procedure.
Crowns ; Dental Articulators ; Dentition* ; Follow-Up Studies ; Humans ; Incisor ; Male ; Mouth Rehabilitation* ; Oral Manifestations ; Prostheses and Implants ; Rehabilitation ; Tooth Wear ; Vertical Dimension*