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Orofacial granulomatosis is an uncommon clinicopathological entity describing patients who have oral lesions characterized by persistent and/or recurrent labial enlargement, oral ulcers and a variety of other orofacial features, who on lesional biopsy have lymphoedema and non-caseating granulomas. The aetiology of oral lesions with non-caseating granulomas includes oral Crohn's disease (some patients with oral lesions will develop typical bowel symptoms of Crohn's disease in ensuing months to years), tooth-associated infections, sarcoidosis and food or contact allergies. Treatment of orofacial granulomatosis is not reliably effective and may not be always necessary, although most patients do require some medical intervention.

The possible malignant potential of oral lichen planus (OLP) is still controversial. We present three new oral lichen planus (OLP) patients who developed oral squamous-cell carcinoma (OSCC). In all cases, were analyzed variables like sex, age, clinical type, localization, extension, follow-up study and treatment, moreover were considered the patient's habits, localization, stage and treatment of cancer. The average age was 59 years and both of them were non smoker or with no alcohol habits. The follow-up period was greater than two years and the malignant lesion developed after mean of nine years, after the diagnosis of OLP had been established. Oral squamous-cell carcinoma (OSCC) arose on lesions previously diagnosed clinically and histologically as atrophic and erosive oral lichen planus in two of our patients and on a plaque lesion LP in a patient. All of them had been using topical corticoids before the cancer was diagnosed. The appearance of new cases of OLP malignization framed inside the established approaches, suggests the realization of new researches in order to determine the factors involved in this process.

Pyostomatitis vegetans is a rare oral disorder often associated with gastrointestinal and/or cutaneous diseases and sometimes with other disorders. The association of pyostomatitis vegetans with inflammatory bowel disease, particularly ulcerative colitis, is well known and in most cases bowel disease precedes the onset of oral lesions by months or years. A peripheral eosinophilia has been observed in most reported cases. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. Histopathologically, it is characterized by intraepithelial and/or subepithelial abscesses containing large numbers of eosinophils. The pathogenesis is as yet unknown although immunological and microbial factors have been suggested as possible aetiological factors. Management of pyostomatitis vegetans consists mainly of immunosuppression using topical or systemic corticosteroids with medical and/or surgical treatment of any underlying inflammatory bowel disease.

To identify drugs associated with the complaint of dry mouth.MEDLINE was searched for papers 1980-2002 using keywords, oral, mouth, salivary, drugs, dry mouth and xerostomia, and relevant secondary references were hand-searched.Evidence was forthcoming for a number of xerogenic drugs, especially antimuscarinic agents, some sympathomimetic agents, and agents affecting serotonin and noradrenaline uptake, as well as a miscellany of other drugs such as appetite suppressants, protease inhibitors and cytokines.Dry mouth has a variety of possible causes but drugs--especially those with anticholinergic activity against the M3 muscarinic receptor--are the most common cause of reduced salivation.

The dilemma in managing patients with potentially malignant oral lesions and field change is of deciding which mucosal lesions or areas will progress to carcinoma. Although dysplasia may be predictive, this is not invariable, and there can be considerable inter- and intraexaminer variation in that diagnosis. Recent data on molecular and DNA changes in potentially malignant lesions suggest that it is now feasible to identify those lesions that are truly potentially malignant.

To evaluate the degree and causes of underdiagnosis of incisional biopsy in oral potentially malignant lesions (PML).Cross-sectional retrospective study.All pathology slides (incisional biopsy and resection specimen) from 46 patients with oral PML were reviewed and scored blind. The provisional diagnosis was considered in order to provide underdiagnosis or overdiagnosis according to whether this score was lower or higher than the final diagnosis.Concordance between the scores for provisional and final diagnoses was compared for reviewed and unreviewed assessments.Upon review, underdiagnosis significantly decreased from 23.9% to 4.4% (P=0.016, chi-square with the Yates' correction). As the underdiagnosis ratio was not significantly influenced by intra- or inter-observer variability, it is likely to be related to pathologists' interpretation difficulties when examining incisional biopsy specimens.The good quality of incisional biopsy samples was demonstrated, but clinicians should be conscious of the possible underdiagnosis by incisional biopsy when planning therapy in suspected early oral squamous cell carcinoma lesions.

There are many causes of recurrent oral mucosal ulceration, particularly gastrointestinal, mucocutaneous, and hematologic disease. The present report details the features of a patient with recurrent oral ulceration caused by autoimmune neutropenia.

Lichen sclerosus et atrophicus (LSA) is a chronic mucocutaneous inflammatory disorder of uncertain aetiology that is clinically characterized by the appearance of well delimited white plaques or papules, preferentially affecting the skin and genitals, and more rarely the oral cavity. We present the case of a woman with LSA limited to the oral cavity in the form of a well delimited, flat whitish lesion affecting the vestibular gingiva of the right upper incisors and left central incisor, and extending towards the vestibular fundus and frenulum of the upper lip. Widening of the periodontal space was observed, with gingival recession and attachment loss limited to these teeth. Local corticosteroid injections caused the mucosal lesion but not the periodontal alterations to resolve. Emphasis is placed on the importance of knowledge of this condition in relation to establishing a diagnosis, and on its periodontal repercussions.

The paper describes predictive load balancing schemes designed for use with parallel adaptive finite element methods. We provide an overview of data structures suitable for distributed storage of finite element mesh data as well as software designed for mesh adaptation and load balancing. During the course of a parallel computation, processor load imbalances are introduced at adaptive enrichment steps. The predictive load balancing methods described here use a priori estimates of work load for adaptive refinement and subsequent computation to improve enrichment efficiency and reduce total balancing time. An analysis code developed with these components for solving compressible flow problems is used to obtain predictive load balancing results on an IBM SP2 computer. Our test problem involves the transient solution of the three dimensional Euler equations of compressible flow inside a perforated shock tube. We also present a message passing library extension in development which allows for automated packing of messages to improve communication efficiency.

Infections by Candida spp. have increased in medical importance over the past few decades. Our understanding of species identification, commensalisms, pathogenicity, person-to-person spread, and the development of antifungal resistance within specific strains has been greatly enhanced by the utilization of molecular epidemiological methodology. The aim of the current research was to assess the quantity, species and molecular characterization of oral yeast isolates from well-defined cohorts of immunocompetent patients from a diverse range of clinical settings. Oral rinse samples were assessed for the growth of yeast and degree of colonization. Isolates were defined to the species level by both phenotypic and molecular methods and strains were further genotypically subtyped. Significant variation was shown to exist in the number, species and genotypic subgroups of yeast isolated from the oral cavity in different patient groups. This variation could be attributed to the local oral conditions unique to these patient groups.

Objective To investigate changes in the oral healthcare of adults with learning disability after transference from long stay hospital care to community-based care. Subjects Adults with learning disability who were former residents of a single long stay hospital and who had been resettled into the community during the period April1995 to April 1998. Design Structured questionnaire with a covering letter sent to community-based carers. Hospital notes were reviewed to assess oral healthcare received as in-patients. Results There was a 68% response rate to the questionnaire from community-based carers with details obtained from 106 out of a possible 157 subjects. As residents in the hospital, all subjects were examined regularly by a dentist – yearly for edentulous and six-monthly for dentate individuals. However, attendance patterns were less regular as residents in the community. In the community, individuals were also less likely to receive operative dental treatment. Although oral hygiene regimes were generally on a daily basis only 37% of the subjects and/or their carers had received oral health education from dental professionals in the community. Conclusion Changes from institutional living to community-based housing for adults with learning disability may be associated with changes in dental attendance and treatment patterns.

This paper summarises some of the oral adverse effects of antiretroviral agents. Some are related to bone marrow suppression which may also predispose to mouth ulcers. Erythema multiforme and toxic epidermal necrolysis are especially well recognized in HIV disease, particularly as reactions to sulphonamides and to antiretroviral agents. Oral lichenoid reactions have been described in HIV disease often relating to zidovudine use. Didanosine has also produced erythema multiforme and not unusually induces xerostomia, again by an unknown mechanism. Xerostomia may be seen in up to one-third of patients taking didanosine. Taste abnormalities are common with the protease inhibitors and oral and perioral paraesthesia can be a disturbing adverse effect. Ritonavir in particular can give rise to circumoral paraesthesia in over 25% of patients. Indinavir can also produce cheilitis.

Alpha-lipoic acid (ALA), is a potent antioxidant mitochondrial coenzyme, the trometamol salt of thioctic acid that has been shown in clinical studies to be neuroprotective. This study examined the effect of ALA on the symptomatology of Burning mouth syndrome (BMS).Forty-two patients with BMS and no clinical or laboratory evidence of organic oral disease were divided into two groups (Test and Control) each of 21 subjects, matched for age and sex. The Test group were given ALA (thioctic acid; Tiobec) for 30 days, as 600 mg per day orally for 20 days followed by 200 mg per day for 10 days. The Control group were given cellulose starch 100 mg per day as placebo for 30 days. All BMS patients were reviewed at 10-day intervals and scored for changes in symptomatology.Significant improvements were shown in the symptomatology of BMS in up to two-thirds of patients with BMS receiving alpha-lipoic acid, in about 15% of those using placebo and also in up to two-thirds of those who, having tried placebo, were switched to ALA.

Parotid salivary flow rates and amylase concentrations were measured in three groups of eight subjects each (normal control, non-neuropathic diabetic, and neuropathic diabetic). Flow rates were significantly reduced in neuropathic diabetic patients as compared with normal controls (p less than 0.001) and non-neuropathic diabetic patients (p less than 0.02). Amylase concentrations were similar. These data are consistent with parasympathetic denervation of the parotid gland in diabetic neuropathy and provide evidence for a widespread distribution of autonomic denervation in diabetes.

Most oral involvement in the mucocutaneous diseases is related mainly to disorders with a prominent immunological component, especially lichen planus and pemphigoid. However, less common conditions such as pemphigus, dermatitis herpetiformis, linear IgA disease, erythema multiforme, chronic ulcerative stomatitis and other conditions may need to be excluded. Diagnosis is initially clinical, based on a full history, general, and oral examination but precise diagnosis can be difficult without further data and therefore biopsy and immunological studies are invariably required to confirm the specific diagnosis. Apart from improving oral hygiene, immunosuppressive therapy is typically required to control many of these conditions.

In the light of nurses' increasing role in the assessment and diagnosis of leg ulcers, this article looks at leg ulcer management, focusing on increased aetiological factors, improved assessment techniques and treatment.

The increasingly ageing population, advances in medical and surgical sciences, and the advent of new diseases such as infection with the human immunodeficiency virus (HIV) have highlighted the importance of orofacial diseases. This article begins a new series on current thinking in the areas of orofacial medicine most relevant to the dental care team.

Adenosquamous carcinoma is a rare tumour in the oral cavity and is characterised histologically by carcinomatous change in surface epithelium, in association with adenocarcinoma affecting the ducts of minor salivary glands. Only a dozen cases have previously been reported in the oral cavity, but all have shown an aggressive course with 60% of patients dying of disease. We report three further cases and review the literature, which suggests that this lesion should be regarded as a high-grade variant of squamous cell carcinoma.

Histoplasmosis is a deep mycosis which is increasingly seen in HIV disease. It has emerged as a relatively common infection in Argentina, mainly in HIV-infected and other immunocompromised persons, and is often disseminated (DH).The aim of this study was to describe 32 HIV-I-seropositive patients with AIDS who had DH, 21 of whom presented orofacial manifestations, and their treatment.A retrospective study of 876 HIV-seropositive patients revealed 32 with a clinical diagnosis of DH confirmed by special stains on histopathologic specimens, or by culture.Thirty-two HIV-infected patients had DH. Two-thirds (21 patients) had oral lesions of histoplasmosis, of which six presented with oral cavity (OC) lesions as the sole orofacial manifestation of disease, nine patients presented oral and facial (OF) lesions and six presented facial lesions only. A unique case of submandibular histoplasmosis is also reported. Antifungal therapy cleared more than 90% of the orofacial and disseminated lesions of histoplasmosis. Over the 7-year period there was a mortality of 85%.DH should be considered as a possible diagnosis in HIV patients with chronic ulcerative or nodular orofacial or oral lesions. Itraconazole is an effective and acceptable therapy.

Deletions on chromosome arm 8p, as defined by allelic imbalance, are a frequent event in many different types of malignant tumors, including those of the head and neck. These regions are thought to harbor tumor suppressor genes. In order to define a high-density deletion map of this chromosomal arm in oral and oropharyngeal squamous cell carcinomas, we have tested for allelic imbalance in 35 such tumors with 22 short tandem-repeat polymorphisms. Overall, 21 (60%) of the 35 tumors showed allelic imbalance at one or more loci on chromosome arm 8p. Interstitial deletions defined three discrete areas of deletion: at 8p23, 8p22, and 8p12-p21. Tumors of TNM stages II-IV showed a significantly higher frequency of allelic imbalance on 8p than did TNM stage I tumors. Our data suggest that there are least three tumor suppressor loci on chromosome arm 8p that may be implicated in oral carcinogenesis. Furthermore, inactivation of such genes may be associated with high-grade tumors.

Aim: To examine the subjective efficacy of proprietary agents for aphthous stomatitis. Design: A simple open study. Setting: Hospital out-patients in the UK in 1993. Subjects: 50 consecutive patients with aphthae. Outcome: Patients assessed agent efficacy as very effective, possibly effective or not effective at relieving symptoms. Results: 38 of 54 available agents were used. Difflam Oral Rinse (benzydamine hydrochloride) appeared to give most control of pain. Overall, Corsodyl mouthwash (chlorhexidine gluconate) gave most beneficial effect. Conclusions: Difflam and Corsodyl appear to give some symptomatic relief to aphthous victims

This paper reports on a patient who developed oral hyperpigmentation and the literature on drug-induced oral hyperpigmentation is reviewed.

We have demonstrated previously a loss of constitutional heterozygosity on the short arm of chromosome 3 in approximately 50% of oral squamous cell carcinomas. In the present study, we have investigated 30 oral dysplastic lesions (DLs), presenting clinically as either erythroplakias or leukoplakias with histopathological features of either severe epithelial dysplasia or carcinoma in situ, for LOH on chromosome 3p using 15 microsatellite markers. Thirteen of the 30 LDs (approximately 43%) showed allelic imbalance at one or more loci. The pattern of loss in these lesions defined three noncontiguous regions of interstitial deletions that overlap with those defined for oral squamous cell carcinomas. These data indicate that the alteration of tumor suppressor genes on chromosome 3p is probably an early event in oral carcinogenesis. Additionally, 7 of the 30 DLs showed microsatellite instability. However, the frequency of loci showing microsatellite instability per lesion was low.

There is no doubt that, when the oncology team includes a dentist, the risks of development of serious complications such as osteoradionecrosis are significantly reduced for the cancer patient [15,157,158]. Ideally, all patients should be rendered dentally fit before the commencement of cancer therapy. Those receiving radiotherapy should then be seen weekly by the dentist during the course of radiotherapy and approximately every 1–2 weeks during the intensive phases of treatment, if receiving chemotherapy or surgery. All patients should be carefully followed up after cancer therapy in order to minimize orofacial complications and be in a position to intervene at an early stage, when therapy is likely to be easier and more rapidly effective.

The past decade has seen intense and increasing interest in the oral health care consequences of viral infection, particularly the possible relationships between viruses and oral diseases — especially malignant neoplasms, the possible infectivity of saliva and oral secretions and, latterly, the oral consequences of infection with the human immunodeficiency viruses (HIV).