Evaluation of the Effect of Photobiomodulation on Radiation-Induced Xerostomia in Head and Neck Cancer Patients: A Randomized Clinical Trial

Introduction: Radiotherapy-induced xerostomia is an important side effect of head and neck cancer (HNC) treatment. Photobiomodulation (PBM) is one of the new emerging methods for preventing or reducing this problem. The aim of this study is to evaluate the effect of PBM on radiation-induced xerostomia in HNC patients. Methods: Thirty-seven patients with HNC who were referred for radiotherapy to Mashhad cancer center. In the case group, an infrared diode laser was used in contact mode on 16 points (covering minor and major salivary glands). The device emitted a wavelength of 810 nm and operated at the power of 200 mW and continuous wave mode. Each area was irradiated for 4 seconds in contact mode with gentle pressure, and the laser energy was 0.8 J with an energy density of 2.85 J/cm2 at the surface of the probe (spot size, 0.28 cm2 ). The total dose was 45.6 J/cm2. The power density was 714.2 w/cm2. In the control group, the sham laser device was used. Subjective xerostomia was evaluated through the LENT SOMA scale (LSS). Stimulated and unstimulated saliva was also assessed. Data were analyzed with SPSS ver22 statistical software. Results: The study included 26 men and 11 women with a mean age of 55.6±15.3 years. In the sixth week, the case group produced more stimulated saliva than the control group (P=0.006). They also had less subjective xerostomia than the control group in weeks four to six. Conclusion: In the present study, PBM had a preventive effect on stimulated saliva and subjective xerostomia and can be recommended as an adjunctive treatment. Further studies with a higher sample size and the use of a low-level laser in more sessions are needed for definitive comment.

Correlation of glycemic control with salivary oxidative markers in subjects with prediabetes and diabetes: A cross-sectional study

Background and aims

Rising levels of oxidative stress play an important role in the pathogenesis of type 2 diabetes mellitus. This study aimed to some assess salivary antioxidants in patients with type 2 diabetes, prediabetes, and healthy control. We also assessed the potential clinical relevance of salivary antioxidants with glycemic control.

Methods

This cross-sectional study included 30 prediabetes, 31 type 2 diabetes, and 39 sex-matched normoglycemic individuals. To assess the salivary oxidative status, we measured the levels of malondialdehyde (MDA), superoxide dismutase (SOD), the total antioxidant capacity (TAC), and uric acid (UA) by spectrophotometry.

Results

Salivary MDA levels were significantly higher in individuals with diabetes compared to prediabetes, and control groups (p = 0.001). MDA and SOD were significantly correlated with fasting blood sugar (FBS) and HbA1C (p < 0.001, r = 0.43, p < 0.001, r = 0.34, and p = 0.003, r = 0.29 p = 0.01, r = 0.23 respectively). Salivary TAC was also significantly correlated with FBS (p = 0.02, r = 0.23). Furthermore, salivary MDA was an independent determinant of type 2 diabetic patients compared to healthy subjects (p = 0.04). According to the cutoff point in the ROC curve, the MDA index was below 2.8 in 82.1% of the controls (specificity), and it was above 2.8 in 64.2% of the Individuals with diabetes (sensitivity).

Conclusion

The simultaneous assessment of salivary oxidative and antioxidant factors, revealed weak but a significant positive association between MDA and glycemic status in diabetes. However, further investigations are required to confirm our results.

Sarcoidosis and its oral manifestations: A case report study

A patient was referred to the oral medicine department with redness and swelling of the lips and cheek, and an intra-oral lesion. Biopsy and laboratory investigations suggested a diagnosis of sarcoidosis. In this study we discuss oral findings associated with sarcoidosis.

Evaluation of Risk Factors in Patients with Head and Neck Cancer: A Case Control Study

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is one of the most common types of cancer worldwide. Since there are many factors that influence the development of cancer, identifying risk factors plays an important role in cancer prevention. The aim of this study was therefore to identify the risk factors for HNSCC in Mashhad, Iran.

METHODS

In this case-control study, 76 patients with HNSCC were included as the case and 91 healthy people as the control group. A checklist of risk factors was completed for each participant and the two groups were compared for the presence of risk factors. Chi-square, t test, and Mann-Whitney tests were used to compare the data. Odds ratios (ORs) for several factors have also been determined.

FINDINGS

The educational level and body mass index (BMI) of the patients in the case group were significantly lower than in the control group (P<0.001). Moreover, there were significant differences between the two groups in terms of risk factors such as tobacco smoking, the number of cigarettes smoked per day, and its duration (P=0.001, P<0.001, P=0.05), as well as the duration of hookah smoking, opium consumed per day and use of alcohol (P=0.023, P<0.001, P=0.015).

CONCLUSION

There was a direct relationship between HNSCC and risk factors such as cigarette smoking, number of cigarettes smoked per day, duration of cigarette consumption and hookah, opium consumed per day, and alcohol use. However, extensive studies with larger sample sizes are needed to better assess the impact of these factors and generalize the results.

Analyzing the relationship between tissue color observed in VELscope examination and histopathological factors in OSCC patients

OBJECTIVE

Early detection of OSCC is a crucial step towards improving OSCC prognosis. In recent years, novel diagnostic aids such as light-based detection systems have been introduced for early diagnosis. VELscope is one such light-based device which is used to examine tissue fluorescence. Based on different studies, VELscope has a sensitivity of 90% in the diagnosis of oral premalignant and malignant lesions. Tumor depth of invasion and invasive front have recently been proposed as influential factors in OSCC prognosis. Therefore, the aim of this study was to assess the relationship between tissue color seen through this device and tumor depth of invasion.

METHODS & MATERIALS

20 histopathologically approved OSCCs were included in this study. Conventional oral examination was carried out followed by an assessment of the lesion using VELscope. The H&E slides prepared following the final OSCC surgeries were then examined by an oral pathologist to assess tumor depth of invasion (interpreted as low-risk/high-risk), invasivefront (low-risk/high-risk) and perivascular and perineural invasions. Data was transferred to SPSS 16 software. The association between color changes and histopathological factors was analyzed using the fisher's exact and chi-square tests.

RESULTS

The mean age of the patients was 51/5+/-16/74, 60% of which were men. Most lesions were exophytic and the most common color seen during VELscope examination was red. 55% and 50% of the OSCCs showed high-risk tumor depths and high-risk invasive fronts respectively. Perivascular and perineural invasion was seen in 55% and 35% of the samples respectively. Statistical analysis showed that 72/2% of the lesions with high tumor depths and 70% with high-risk invasive fronts were seen as red, although these associations were not significant (P>0/05). Tumor depth was significantly correlated with invasive front (P<0/05).

CONCLUSION

There was no significant relationship between the type of color seen through VELscope and tumor depth of invasion, however most cases with high-risk depth of invasions were red.

Cathepsin-B and caveolin-1 gene expressions in oral lichen planus and oral squamous cell carcinoma

BACKGROUND

Given the importance of the role of cellular changes in the prognosis and diagnosis of malignancies of the head and neck, we examined in this study the gene expressions of cathepsin-B (Cat-B) and caveolin-1 (Cav-1) which are in cell membranes structures involved in carcinogenesis, in oral squamous cell carcinoma (OSCC) and oral lichen planus (OLP) and compared them to controls. We also investigated their relationship to clinicopathological indices.

METHODS AND RESULTS

In this case-control study, 29 paraffin blocks of OLP patients were compared to 29 paraffin blocks of OSCC samples as well as 28 paraffin blocks of normal oral tissue. Real-time quantitative PCR was performed to determine gene expressions and results were analyzed for their relationship to clinical data using chi-square, Kruskal-Wallis and Mann-Whitney tests.

RESULTS

The mean age of OSCC and OLP patients were 59.24 ± 15.04 and 48.79 ± 14.17 years, respectively. The Cat-B and Cav-1 expressions were significantly higher in OSCC and OLP samples compared to control (p < 0.001). The highest expression was found in OSCC samples. The difference between OLP and control samples for Cat-B and Cav-1 expression was significant. There was no association between the gene expression and age, gender, duration of disease, Thongprasom score, smoking and cutaneous lichen planus. However, the expressions were related to the grade and stage of OSCC samples (P = 0.01, P = 0.02).

CONCLUSION

The gene expressions of Cat-B and Cav-1 in OSCC were associated with the stage and grade of lesions. Therefore, they appear to be useful in predicting the biological behavior of OSCC and malignant transformation of OLP, although this process is multi factorial and more investigations are needed.

Effects of diode low-level laser therapy on healing of tooth extraction sockets: a histopathological study in diabetic rats

Diabetes mellitus is mostly interrelated to deficiency in wound healing. Low-level laser therapy has been shown to exert reliable effects on the acceleration of wound healing process. This study aimed to determine the potential influence of low-level laser therapy (LLLT) on the healing of extraction sockets in diabetic rats. A total of 24 healthy male Wistar rats were selected for this study. After diabetes induction, the maxillary first molars of all rats were extracted bilaterally. Then, the animals were subjected either to Ga-Al-As laser at 808 nm or to Al-Ga-In-P laser at 660 nm at the right extracted socket every day for the next 14 days. The left sockets served as controls. Rats were sacrificed on the 3rd, 5th, 7th, and 14th days after tooth extraction. The samples were examined by a pathologist. LLLT at 808 nm was able to significantly repress inflammation, improve osteoid formation, and promote vascularization in comparison to the non-treated sockets. LLLT at 660 nm significantly suppressed inflammation and developed vascularization in comparison to the non-treated sockets, but failed to improve osteoid formation in the treated sockets. This study suggests that LLLT could be considered as a reliable treatment for wound healing in diabetic experimental rats.

Evaluation of desmoglein 1 and 3 autoantibodies in pemphigus vulgaris: correlation with disease severity

Background

Pemphigus is an autoimmune blistering disease of the skin and mucous membranes caused by autoantibodies against desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3). Pemphigus vulgaris (PV) is the most common form of pemphigus. The aim of this study was to assess the correlation between the levels of anti-desmoglein 1 and 3 autoantibodies and the severity of PV disease.

Material and Methods

Nineteen newly diagnosed patients with pemphigus vulgaris were enrolled in this study. The titers of Dsg in subjects by using enzyme-linked immunosorbent assay (ELISA) were done at diagnosis time-point, 4th and 8th weeks after the initiation of treatment, and the correlation of antibodies with the oral and skin disease severity was evaluated.

Results

The severity of cutaneous lesions was significantly correlated with anti-Dsg1 titer in all visits and the severity of mucosal lesions was correlated with the titer of Dsg3 in the third visit (<0.001, 0.001, 0.016 and 0.015 P value, respectively).

Conclusions

Anti-Dsg-1 autoantibodies titers seem to be more useful in showing the extent of the disease and activity in pemphigus with mucocutaneous lesions.

Key words:Pemphigus vulgaris, Desmoglein (Dsg), Enzyme-linked immunosorbent assay (ELISA).

The diagnostic value of the native fluorescence visualization device for early detection of premalignant/malignant lesions of the oral cavity

PURPOSE

The present study aimed to determine the diagnostic value of a native fluorescence visualization device in the identification of oral malignant/dysplastic lesions.

METHODS

This study involved 45 patients who had oral lesions that were suspected to be malignant, potentially malignant, or benign. The patients visited the Oral Medicine Department of the Mashhad Dental School. The sensitivity, specificity, positive and negative predictive values, and likelihood ratio of this device were determined.

RESULTS

The histopathological assessment of samples showed 9 cases of oral squamous cell carcinoma and 12 lesions with dysplasia. Ten samples of dysplastic lesions and all malignant lesions appeared dark or red/orange when examined with the native fluorescence visualization device. In 90% of the dysplastic/malignant lesions, the label-free fluorescence results were positive. The sensitivity, specificity, and positive and negative predictive values of this device were 90%, 15%, 40%, and 71%, respectively.

CONCLUSIONS

The native fluorescence visualization device can be used in specialized centers as an adjunctive device to increase the sensitivity of a clinical examination, but is not capable of distinguishing benign lesions from malignant and dysplastic ones due to its low specificity.

Evaluation of the Cytotoxic Activity of Crocin and Safranal, Constituents of Saffron, in Oral Squamous Cell Carcinoma (KB Cell Line)

Crocin and safranal are active ingredients in the saffron. Some studies have demonstrated antitumor activities of saffron ingredients. The aim of this study was to evaluate cytotoxic effects of crocin and safranal in oral squamous cell carcinoma (KB cells) and NIH 3T3 cell line as nonmalignant cells. The cells were incubated with crocin and safranal at 37°C for 24, 48, and 72 h, and cell viability was quantitated by MTT assay. Apoptotic cells, cell cycle distribution, and sub-G1 fraction were determined using propidium iodide staining of DNA fragmentation by flow cytometry. Crocin (0.05-4 mM) and safranal (0.2-3.2 mM) significantly inhibited the growth of KB cells (the inhibitory growth effects of all concentrations for both were >50% after 72 h), while they had less inhibitory effects on NIH 3T3 cells viability. The IC₅₀ values of crocin and safranal against NIH 3T3 cells after 72 h were determined as 2.8 and 0.3 mM, respectively. Crocin and safranal induced a sub-G1 peak in the flow cytometry histogram of treated cells compared to control cells indicating that apoptotic cell death is involved in the toxicity of crocin and safranal. Apoptotic effects of crocin and safranal in tumor cells were more than normal cells. Neither crocin nor safranal affected the cell cycle progression. Crocin and safranal exerted apoptotic effects in KB cell line.

Extranodal NK/T Cell Lymphoma with Destruction of the Uvulae: A Case Report

INTRODUCTION

Extranodal Natural Killer (NK)/T-cell lymphoma (NKTCL) nasal type is a rare but well-known disease with poor prognosis. NKTCL is more prevalent in Asia and comprises about 7-10% of all non-Hodgkin lymphoma cases in this region. The characteristic clinical pattern of NKTCL is the destruction of the midline structures of the mid-face.

CASE REPORT

The present study examines a case of NKTCL in a 23-year-old man with a destructive ulcer of the palate and uvulae. Based on immunohistochemical results, after three months of delay, the definitive diagnosis was revealed to be Extranodal NK/T cell lymphoma. Following the third cycle of chemotherapy, the patient died due to sepsis and infection.

CONCLUSION

It is very common to misdiagnose NKTCL with other clinical conditions such as necrotizing stomatitis, deep fungal ulcers, Wegener's Granulomatosis disease, etc. Delay in diagnosis can worsen the course of the disease and its prognosis.

Evaluation of the Efficacy of Curcumin in the Treatment of Oral Lichen Planus: A Randomized Controlled Trial

INTRODUCTION

Oral Lichen Planus (OLP) is a chronic immunological, mucocutaneous disease with a wide range of clinical appearances. The treatment of oral lichen planus is often difficult and disappointing.

AIM

We have studied the efficacy of curcumin, a low molecular weight flavonoid with anti-inflammatory and anti-oxidant activities, in the treatment of OLP.

MATERIALS AND METHODS

In this study, a randomized, double-blind, placebo-controlled trial was conducted with a total of 20 OLP patients. The patients were randomly divided into two groups, each treated with curcumin tablets at a dose of 2000 mg/day or placebo for a period of four weeks. Furthermore, the patients of both groups received routine treatment for OLP (i.e. Mouthwash Dexamethasone 0.5 mg and suspension Nystatin 100,000 Units). The baseline data were recorded for each patient. Patients were evaluated on day 14 and after completing the course of treatment. Pain and burning sensation were measured based on the Visual Analogue Scale, and the Thongprasom Index was used for clinical improvement and healing. Mann-Whitney and independent t-test were used to compare the responses between the two groups, p-value < 0.05 was considered statistically significant.

RESULTS

Our analyses demonstrated no significant difference between the curcumin and placebo treated groups.

CONCLUSION

In conclusion, curcumin had no detectable effect in the treatment of OLP. However, a higher dose of curcumin administration and other forms of curcumin with improved bioavailability may be considered in future studies.

Preventing and Therapeutic Effect of Propolis in Radiotherapy Induced Mucositis of Head and Neck Cancers: A Triple-Blind, Randomized, Placebo-Controlled Trial

BACKGROUND

Mucositis is one of the acute complications of radiotherapy which can ulcerate oral mucosa and cause severe pain and discomfort which can affect oral normal function. Propolis is a natural source of flavenoid which has antiulcer, antibacterial, antifungal, healing and anti-inflammatory effects. Using such an affordable compound without any bad smell or taste that has reasonable price can help the radiotherapy undergoing patients.

OBJECTIVES

Our goal is assessing the preventing and therapeutic effect of propolis in radiotherapy induced mucositis in patients with head and neck cancer.

PATIENTS AND METHODS

In a randomized triple blind clinical trial, 20 patient were selected randomly to swish and swallow 15 ml of water based extract of propolis mouth wash 3 times a day in the case group (n = 10) and 15 ml placebo mouth wash in control group (n = 10). we use NIC-CTC scale for determining mucositis grading.

RESULTS

We use T-test, Man-Whitney, Chi-square, and Friedman as analyzing tests. Case group had significantly (P < 0.05) lower grade of mucositis in all of the follow-ups, but xerostomia is not significantly different in two groups (P > 0.05).

CONCLUSIONS

This is a pilot study which shows water based extract of propolis efficiently prevents and heals radiotherapy induced mucositis.

Human T-Lymphotropic Virus-1 Associated with Adult T-Cell Lymphoma/ Leukemia and Generalized Expansion of Palatal and Jaw Bones: A Rare Case Report

Human T-lymphotropic virus-1 (HTLV-1) can cause adult T-cell leukemia/ lymphoma (ATL/L), which is a rare and aggressive type of blood cancer. Herein, we report a case of ATL/L in a middle-aged man with unusual jaw presentations. The patient presented with mandibular, maxillary and palatal bony hard expansion, accompanied by generalized tooth mobility six months prior to admission to the Department of Oral Medicine. The panoramic radiograph showed generalized rarefaction of jaw bones. After laboratory examinations and bone marrow aspiration, ATL/L was diagnosed in association with HTLV-1. The patient underwent chemotherapy. Although the majority of infections associated with HTLV-1 are asymptomatic, some patients may develop blood diseases such as ATL/L and neurological disorders, mainly HTLV-1 associated myelopathy and tropical spastic paraparesis. ATL/L is a rare hematological malignancy in oral cavity that should be included in the differential diagnosis of cases with jaw swelling or generalized demineralization. Serum levels of anti-HTLV-1 antibodies should be examined in suspicious patients, particularly in endemic regions.

Secondary Involvement of the Mandible due to Basal Cell Carcinoma: A Case Report

Basal cell carcinoma (BCC) is the most common cutaneous malignancy among Caucasians. Rare examples of aggressive and neglected BCC have been reported. Here we report a unique case of a neglected BCC with significant jaw involvement. A 50-year-old female, referred by an otorhinologist, presented with a large ulcer on her chin, which was extended to her mandibular vestibule. The ulcer was 9×5.5 cm in size, and tissue destruction, necrosis was observed in the central portion, and the mandibular bone was exposed. On intraoral examination, tooth mobility and severe bone loss were evident. Due to the primary cutaneous origin of the lesion, BCC was considered as preliminary diagnosis. Biopsy was performed and diagnosis of BCC was confirmed. The diseased mandibular bone was resected and reconstructed with a surgical plate. The soft tissue defect was reconstructed with deltopectoral flap. The patient refused secondary stage plastic surgery. Although BCC is not a lethal malignancy, if left untreated and neglected, it can result in severe destruction, disfigurement, and even mortality.

A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus

Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP.

Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (Trial Registration Number: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5.

Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported.

Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.

Oral manifestations of human immunodeficiency virus-infected patients

INTRODUCTION

Oral lesions are among the earliest clinical manifestations of human immunodeficiency (HIV) infection and are important in early diagnosis and for monitoring the progression to acquired immunodeficiency syndrome (AIDS). The purpose of this study was to determine the prevalence of oral lesions and their relationship with a number of factors in HIV/AIDS patients attending an HIV center.

MATERIALS AND METHODS

A total of 110 HIV-positive patients were examined to investigate the prevalence of oral lesions according to the criteria established by the European Community Clearing House on Oral Problems Related to HIV Infection. An independent T-test was used for correlation of oral lesions with CD4+ count and a χ2 test was used for analysis of the relationship of co-infection with hepatitis B virus (HBV), sexual contact, route of transmission, history of drug abuse, and history of incarceration.

RESULTS

Most of the cases were male patients (82.7%). The mean age across all participants was 36.2±8.1 years. Rampant carries, severe periodontitis and oral candidiasis were the most notable oral lesions. Oral lesions were more prevalent in patients between 26-35 years of age. There was a significant difference between patients with and without pseudomembranous candidiasis and angular cheilitis according to mean level of CD4+.

CONCLUSION

The most common oral presentations were severe periodontitis, pseudomembranous candidiasis and xerostomia.

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran

OBJECTIVE

The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran.

BACKGROUND

This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly.

METHODS

In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis.

RESULTS

The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected.

DISCUSSION

These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer

OBJECTIVES

To determine diagnostic value of modified Liquid Based Brush Biopsy technique.

STUDY DESIGN

26 oral premalignant and malignant lesions in 25 patients (12 females; 54.23+/-19.77 years and 13 males; 53.77+/-15.43 years) underwent Modified (Liquid Based) Brush Biopsy and scalpel biopsy simultaneously from the same area.

RESULTS

There were 16 positive and 10 negative brush biopsy results, with no inadequate readings. Histological findings were compatible with oral leukoplakia (n=5) with dysplasia, Oral lichen planus and lichenoid reaction (n=7) (with or without dysplasia) oral squamous cell carcinoma (n=11),verrucous carcinoma (n=1) and granular cell tumors (n=2). Sensitivity, specificity, positive predictive value, negative predictive value, positive diagnostic likelihood ratio (LR+) and negative diagnostic likelihood ratio (LR-) were 88.8%, 100%, 100%, 80%, infinity and 0.11 respectively (no false positive results).

CONCLUSION

It is the first attempt to do LBC with a specialized oral brush. Our results show that modified technique is a useful tool for screening of oral premalignant and malignant lesions.

Comparison of colchicine versus prednisolone in recurrent aphthous stomatitis: A double-blind randomized clinical trial

PURPOSE

Recurrent aphthous stomatitis (RAS) is one of the most common ulcers of the oral cavity with a reported prevalence of 5- 50%. There is still no definitive treatment for RAS; however, immunosuppressive and immunomodulant agents have been proposed. In this study, we compared the therapeutic effects of 5 mg/d prednisolone with 0.5 mg/d colchicine in the treatment of RAS.

METHODS

In a double-blind randomized clinical trial, 34 patients with RAS were randomly divided into two groups for treatment with prednisolone or colchicine. All patients took the medication for three months and were assessed at two weeks intervals. The groups were compared for size and number of lesions, severity of pain and burning sensation, duration of pain-free episodes and any side effects of the prescribed medicines. Both colchicine and prednisolone treatments significantly reduced RAS (p < 0.001). No significant differences in size and number of lesions, recurrence and severity of pain and duration of pain-free period were seen between the two treatment groups. Colchicine (52.9%) had significantly more side effects than prednisolone (11.8%).

CONCLUSION

Low dose prednisolone and colchicine were both effective in treating RAS. Given that the two therapies had similar efficacy, yet colchicine was associated with more side effects, , 5mg/d of prednisolone seems to be a better alternative in reducing the signs and symptoms of the disease.

Detection of human papilloma virus DNA in seven cases of focal epithelial hyperplasia in Iran

BACKGROUND

Focal epithelial hyperplasia (FEH), also known as Heck's disease, is a very rare disease of the oral cavity especially in Asia. It is a disease of children and young adults. Various causes have been implicated but in majority of cases FEH is caused by some subtypes of human papilloma virus (HPV) especially 13 and 32. Polymerase chain reaction (PCR) is a useful tool to identify HPV in FEH as it is a rapid and sensitive method.

OBJECTIVE

This study was designed to determine special HPV subtypes in seven cases of Heck's disease referring to our department by using PCR analysis.

METHOD

Paraffin sections of seven patients clinically diagnosed as FEH with compatible histhopathological features underwent DNA extraction procedures for PCR examination. Initially, all specimens were tested for presence of HPV virus followed by specific PCR testing for 16, 18, 13, and 32 subtypes in positive samples.

RESULTS

Human papilloma virus was found in all samples. In five cases HPV13 and in one case HPV32 was positive. One case showed strong reactivity for HPV but none of tested subtypes were positive. All cases were negative for HPV 16 and 18.

CONCLUSIONS

Similar with other studies about FEH, most of our cases were associated with HPV 13 but other subtypes may also be implicated.

Oral Squamous cell carcinoma with an unusual clinical manifestation: a case report

Introduction

Squamous cell carcinoma is the most common malignant tumor of the oral cavity and one of the 10th most common causes of death. It arises from dysplastic oral squamous epithelium. By considering the pathogenesis of squamous cell carcinoma, the smooth and intact surface for this lesion is not usual.

Case presentation

A painful nodular lesion with smooth surface on the left buccal mucosa of a 75-year-old female patient was observed. She noticed it 2 weeks ago. Histopathological examination revealed oral squamous cell carcinoma.

Conclusion

In this paper, we report an unusual clinical presentation of oral squamous cell carcinoma in buccal mucosa which is very rare.

Squamous cell carcinoma arising from an odontogenic keratocyst: a case report

Squamous cell carcinoma (SCC) derived from keratocystic odontogenic tumor is an extremely rare tumor that is limited to the jaws. Most intraosseous carcinomas originate from the epithelial lining of odontogenic cysts, so they are called odontogenic carcinomas. They occur more frequently in men and the mean age of patients is 57 years. The following report describes an extremely rare case of an odontogenic carcinoma derived from a keratocystic odontogenic tumor in a 20-year-old man. The patient presented with an exophytic lesion in the retromolar region of the mandible which was first noticed by the patient 25 days earlier. In panoramic radiograph a well-defined radiolucency around the impacted 3rd molar was observed. Clinical and radiographic diagnosis was odontogenic SCC. Surgical resection was performed and histhopathologic examination of the lesion confirmed the diagnosis of SCC in the wall of a keratocystic odontogenic tumor.

Oral Squamous Cell Car-cinoma with an Unusual Clinical Manifestation: A Case Report

Squamous cell carcinoma (SCC) is the most com-mon malignant tumor of the oral cavity and one of the ten most common causes of death. It arises from dysplastic oral squamous epithelium. Considering the pathogenesis of SCC, a smooth and intact surface in this lesion is not a usual finding. In this paper, we report an extremely rare case of oral SCC in buccal mucosa presenting as an exo-phytic lesion with smooth and intact surface, very unusual for oral SCC.