Prevalence of Candida spp., xerostomia, and hyposalivation in oral lichen planus--a controlled study

OBJECTIVE

To determine the frequency of Candida spp., xerostomia, and salivary flow rate (SFR) in three different groups: patients with OLP (OLP group), patients with oral mucosal lesions other than OLP (non-OLP group), and subjects without oral mucosal lesions (control group).

MATERIAL AND METHODS

Xerostomia as well as SFR was investigated in the three groups. Samples for isolation of Candida spp. were collected from OLP lesions (38 patients), non-OLP lesions (28 patients), and healthy subjects (32 subjects).

RESULTS

There was no statistically significant difference regarding the frequency of xerostomia and hyposalivation among the three groups (P > 0.05). A higher prevalence for colonization by Candida spp. was found in the healthy subject as compared to that of patients with OLP (P = 0.03) and non-OLP (P = 0.02) groups. Low SFR was not a factor for colonization by Candida spp.

CONCLUSIONS

Xerostomia and hyposalivation occur with similar frequency in subjects with and without oral lesions; also, the presence of oral lesions does not increase the susceptibility to colonization by Candida spp. It seems that any study implicating Candida spp. in the malignant transformation of oral lesions should be carried out mostly on a biochemical basis, that is, by testing the capability of Candida spp. to produce carcinogenic enzyme.

Psychological profile (anxiety and depression) in patients with oral lichen planus: a controlled study

AIM

The influence of psychological disturbances in oral lichen planus (OLP) still bears some controversy. This study aimed at assessing levels of anxiety and depression in OLP patients and control subjects, using a self-report scale questionnaire.

METHODS

This cross-sectional study comprised 91 consecutive OLP patients (71 female and 20 male; mean age 52.9 years) and 87 subjects as a control group (69 female and 18 male; mean age 52.7 years). Data collected of both groups included age, sex, race, medical records and systemic disease. Anxiety and depression levels were assessed using, respectively, the State-Trait Anxiety Inventory (STAI-T) and Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed by Chi-square and Fisher's exact tests as appropriate, and by Logistic regression analysis.

RESULTS

No statistically significant difference was found when the level of anxiety and depression was compared between the OLP and control using Chi-square and Fisher's tests (P>0.05). Logistic regression analysis showed that the score in 2 out of 20 items of the STAI-T scale (but none of the CES-D) was significantly higher in OLP patients (P<0.05). The analysis by gender showed that the female and male OLP patients presented a significantly higher score for one item in the STAI-T scale (respectively question 4 and 20) but none in the CES-D scale, as compared with that of the control group (P<0.05).

CONCLUSION

Our findings do not support that either anxiety or depression has any role in the development of OLP lesions.

Diagnosing oral lichenoid contact reaction: clinical judgment versus skin-patch test

AIM

Objective of this study was to compare the skin-patch test with the clinical diagnosis of oral lichenoid contact reaction (OLCR) as indicators for amalgam replacement.

METHODS

Of 53 patients (38 female and 15 male; mean age 48.7) with oral lichen planus (OLP), 26 were identified as having OLCR, and clinically graded according to the proximity of their lesions with amalgam fillings: class I (weak association), class II (moderate association), and class III (strong association). All OLCR patients were skin-patch tested for both standard (Brazilian) and specific allergens (TROLAB, Germany). Patients were considered skin-patch positive only if they developed positive skin reactions for thimerosal and/or amalgam components. Amalgam replacement was indicated in all class II and III patients. For class-I patients, amalgam replacement was indicated only if they were skin-patch test positive. Readings for the skin-patch test were made at 48h and 96h.

RESULTS

Of the 26 patients with OLCR, two missed the follow-up and were excluded, leaving 24 cases. Of these, four were class-I, and all were negative for the skin-patch test. Twelve were class-II, of whom seven were skin-patch positive. Eight were class-III, of whom six were skin-patch positive. Following amalgam replacement in the 12 class-II patients, six showed improvement and six had complete resolution, while in the eight class-III patients, two showed improvement and six a complete resolution.

CONCLUSION

Clinical diagnosis of OLCR lesions is a more reliable indicator for the question of amalgam replacement than is the skin-patch test.

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion

Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.

Orofacial granulomatosis of the lip: a report of 2 cases with histological and immunohistochemical analyses and intralesional corticotherapy

Orofacial granulomatosis is a generic term applied to manifestations of several diseases including sarcoidosis, Crohn's disease, Melkersson-Rosenthal syndrome, cheilitis granulomatosa of Miescher, tuberculosis and foreign-body reactions. What bonds these diseases together is the presence of noncaseating granulomas. A typical clinical manifestation of orofacial granulomatosis is recurrent labial swellings that eventually persist. This article describes 2 cases of OG diagnosed with the aid of immunohistochemical analysis and successfully treated with intralesional steroids.

The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia

AIM

This study evaluated the effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia.

METHODS

Twelve patients with severe xerostomia were treated with acupuncture after radiation therapy. The baseline data were obtained preceding acupuncture treatment, and used as reference values. Acupuncture was performed in 12 sessions, 20 min each, twice a week, during a 6-week period. Clinical response was evaluated objectively by saliva collection measuring resting and stimulated whole salivary flow rates, and subjectively by a visual analogue scale patients' self-evaluation questionnaire. Statistical analyses were performed with a repeated-measures analysis of variance by using a mixed-effect modeling procedure.

RESULTS

The results showed a statistically significant improvement for salivary flow rates on both objective and subjective evaluations (P<0.05). On objective evaluation there was an increase for resting salivary flow of 142.2% (mean=0.04 mL/min to 0.12 mL/min) and of 73.5% (mean=0.09 mL/min to 0.21 mL/min) for stimulated salivary flow. On subjective evaluation, visual analogue scale raised 36 points (mean=18.4 to 53.8) for sensation of more saliva production.

CONCLUSION

According to the results of the present study, acupuncture showed a significant effect on saliva production, suggesting this therapy as a useful treatment for patients suffering from radiation-induced xerostomia.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus and hepatitis C virus infection

OBJECTIVE

This investigation was conducted to determine the possible association between oral lichen planus (OLP) and hepatitis C virus infection (HCV) in the population of São Paulo (Brazil).

MATERIALS AND METHODS

Three groups of patients were studied: group 1 was composed of 68 patients with OLP lesions; group 2 had 126 patients with HCV infection; and the control group consisted of 898 individuals seeking dental treatment at our school, used to determine the prevalence of lichen planus in the general population. The prevalence of HCV in group 1 was determined and compared with that of the population of São Paulo (Focaccia et al (1998) Brazilian J Infect Dis 2: 269), while the prevalence of OLP in group 2 was determined and compared with that of the control group.

RESULTS

The results showed that the frequency of HCV in OLP patients was 8.8%, significantly higher than in the general population of São Paulo, which is 1.4% (P = 0.002), and the frequency of OLP in HCV patients (4.7%) was also significantly higher (P = 0.0003) than that of the control group (0.6%).

CONCLUSION

These data suggest that, at least in São Paulo, there is an association between OLP and HCV infection.

Traumatic bone cyst: report of two cases and review of the literature

Traumatic bone cysts usually are found in young individuals and most frequently have the radiographic appearance of well-circumscribed radiolucent lesions with a tendency to scallop between the roots of the teeth. Two well-documented cases of traumatic bone cysts are presented in which some differences related to their radiographic features were observed. The possible explanations for these differences are discussed and a brief review of the literature regarding the main characteristics of traumatic bone cyst lesions also is provided.

Hard palate perforation: an unusual finding in paracoccidioidomycosis

A 36-year-old black man presented to his dermatologist in May 1996 complaining of mucosal lesions in the mouth, as well as perforation of the hard palate. The lesions had started approximately 7 months before and had worsened gradually. Other complaints included odynophagia, dysphagia, mild dyspnea, and dry cough. The patient was in good general health, but reported a 3 kg weight loss over the previous semester. The hard and soft palate presented erythematous ulcers with a finely granulated base and irregular, but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate was seen in the center of the ulcerated region (Fig. 1). Direct examination of 10% KOH cleared specimens showed typical double-walled, multiple budding yeast structures. Paracoccidioidomycosis (PCM) serologic reactions tested positive for double immunodiffusion (DI), complement fixation (CF) 1 : 256 and counterimmunoelectrophoresis (CIE) 1 : 128. Hematoxylin and eosin-stained sections of oral lesions showed an ulcer covered by a fibrous leukocytic crust, with a lymphoplasmacytic infiltrate, as well as multinuclear giant cells containing round bodies with a double membrane. Gomori-Grocott staining showed budding and blastoconidia suggestive of PCM. Lung computed tomography (CT) exhibited findings consistent with pulmonary PCM. Diagnosis of the chronic multifocal form of PCM with oral and pulmonary manifestations was established. Drug therapy was initiated with ketoconazole (KCZ) 200 mg twice daily, which led to clinical cure in approximately 2 months. Serum antibody values rose 30 days after institution of therapy (CIE 1 : 256; CF 1 : 512), peaking at day 60 (CIE 1 : 1024; CF 1 : 1024). Three months later the daily dose was reduced to 200 mg and titers declined slowly. The diameter of the perforation remained unchanged (Fig. 2). The hard palate perforation was corrected with a palatoplasty 27 months after initiation of drug therapy (Fig. 3). KCZ was discontinued when serologic cure was achieved after 34 months of treatment (DI weakly positive; CIE 1 : 8; CF not measurable). The patient was discharged 46 months after the first visit.

Periodontal aspects of the juvenile form of paracoccidioidomycosis

Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erythematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestations.