Skin Lesion on the Cheek of a Child after Dentist Appointment

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Oral and maxillofacial metastasis of breast cancer: a case report and literature review

Objective: Oral metastases are relatively rare. In women, the most common oral metastases originate from breast cancer, most diagnosed malignancy and the second leading cause of death. The aim of this study was to review the literature regarding oral metastases from breast cancer with the help of a case report, with a focus on clinical and radiographical features and differential diagnosis. Materials and Methods: The English-language literature between 1980 and 2020 was searched for cases of metastatic lesions to the oral cavity, including bone and soft tissue. Clinical and histopathological data were collected from selected articles. Results: 81 studies were included in the analysis, with a total of 191 affected patients. 97% were women (mean age 54.6) and the remaining 3% were men (mean age 65.2). Adenocarcinoma was the most frequent histotype (33%) followed by ductal carcinoma (17%). In 102 patients (51.5 %), oral metastases were intra-osseous and the remaining 96 patients (48.5%) showed metastases to soft tissues. The primary breast tumor was already known before the onset of the oral metastatic lesion (76.4%). The average time between primary tumor diagnosis and appearance of the oral metastases was 3.8 years. 73% of the patients died, the mean survival time from oral metastasis diagnosis was 21.6 months. Conclusions: Oral metastases can present both clinically and radiographically very similar to other benign lesions frequently encountered in clinical dental practice. In most cases, the patient has developed the primary neoplasm before oral metastasis, therefore, a complete anamnesis is decisive. Once the diagnostic hypothesis and the differential diagnosis have been established, the histopathological examination is fundamental; therefore, it must always be performed

Oral manifestations of monkeypox and potential tools for their management

Since May 2022, cases of monkeypox have been reported in around 70 countries where the disease is not endemic. The World Health Organization (WHO) has declared the 2022 monkeypox outbreak a Public Health Emergency of International Concern. The monkey poxvirus, like that of smallpox, is a member of the Orthopoxvirus group. There are two distinct strains (or clades, i.e., groups of similar microorganisms that are descended from a common ancestor) of monkeypox: the West African strain and the Congo Basin strain [1]. Particularly, all cases associated with the 2022 global outbreak are caused by the West African strain. Despite the name, nonhuman primates are not a reservoir for the virus. Although the reservoir is unknown, the main candidates are small rodents (eg, squirrels) of African rainforests, mainly in western and central Africa. Dentists and oral pathologists should be aware of the clinical manifestations of the new monkeypox virus. Even if this last is transmitted through large respiratory droplets and typically requires prolonged close contact (in contrast to the current SARS-CoV-2 infection), the possibility of transmission through saliva splashes during dental procedures is concret

Extended erosive oral lichen planus treated with a very low-level laser therapy: A case report

Background: Oral lichen planus is a chronic idiopathic inflammatory disease that affects the skin and mucous membrane and involves about 1-2% of the population. The management of this pathology aims to control symptoms. Clinically, it can appear as a plaque, in reticular form, or an erythematous/atrophic form. The treatment options include different classes of drugs and non-drug therapies such as a laser. In addition, most drug treatments include numerous side effects. Objective: The aim of this work is to evaluate the clinical effectiveness of a particular type of very Low-Level-Laser Therapy for the management of an erosive oral lichen planus case. Methods: An extensive form of erosive Oral Lichen Planus was treated using a Low-Level Laser Therapy with a 660 nm diode laser. The treatment was performed once per week for two sessions of five minutes each. Different outcome variables were examined: the size of lesions, evolution of pain symptoms, and presence of side effects and stability of the therapeutic results in the follow-up period. Results: After a week, the lesion appeared more homogenous, and the erythematous areas underwent a reduction with a simultaneous decrease in symptoms. After two weeks, the lesion seemed completely healed with the disappearance of pain. The follow-up continued for the other four months, and no relapse was reported. No adverse effects were observed during the study. Conclusion: This study suggests that Low-Level Laser Therapy with very low power parameters could be a safe and successful treatment for extended oral erosive lichen planus lesions

Oral HSV Infections: Molecular biology and photodynamic therapy as new diagnostic and therapeutic tools

Globally, it has been estimated that 3.7 billion people are Herpes simplex 1 (HSV) seropositive. In addition, numerous studies highlight the presence of HSV-1 and 2 (HSV-2) in the oral cavity of asymptomatic patients. The rate of asymptomatic shedding of both HSV-1 and HSV-2, the re-exacerbation following dental treatments and finally the professional risk, and new techniques to improve the diagnosis and treatment of this widespread pathology, will discussed. In particular the effectiveness of photodynamic therapy (PDT) in combination with molecular biology (Polymerase Chain reaction, PCR) tested on a cohort of patients will presented. PDT was performed by diode laser light at 660 nm and 100 mWatt of power (Helbo, Bredent Medical, Senden, Germany), combined with photosensitizer phenothiazine chloride at 1%. The results show that the main HSV spread mode is asymptomatic. Particularly, HSV-1 is statistically more detectable in HIV positive and oncological patients than in immunocompetent ones (p<0,01) but not in transplant patients (p>0,01). HSV-2 is more detectable in HIV positive patients than healthy ones (p<0,01) but not in cancer and transplant patients (p>0,01). Regarding the exacerbation of HVS-1 after dental treatments, studies in the literature are discordant. Finally, for the occupational risk, dentistry team appears to be more exposed than the general population. Extremely interesting data emerged from PDT applied in patients with herpetic lesion. The PCR in fact, besides being decisive in some doubtful clinical cases, has shown a statistically significant reduction of the viral load 100 and 150 times the first and the second cycle of PDT. Clinically PDT has proven effective in immediately reducing symptoms and healing, also increasing the recurrence interval. Therefore, it could be a powerful aid in patients with herpetic manifestations to be applied before carrying out any treatments in order to decrease the viral spread

Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option

Background: Drug-induced gingival overgrowth is associated with the intake of three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. It is clinically characterized by hyperplasia of the gingival connective tissue which appears edematous, bloody, and purplish-red in color. In more severe cases, drug-induced gingival hyperplasia negatively affects the patient’s quality of life, making it difficult to eat and practice good oral hygiene. Drug-induced gingival overgrowth therapy is controversial and, in fact, no studies in the literature highlight a well-defined therapeutic protocol. The therapies that are described provide primarily for non-surgical periodontal treatment and second-line surgical treatment. The aim of this work is to highlight a case of drug-induced gingival hyperplasia which was completely resolved thanks to photodynamic therapy which is completely free from side effects. Design and Methods: Photodynamic therapy was performed on an 18year-old female patient with LEDs at a power of 450–470nm and 5500mW/cm2+7500mW/cm2, combined with a Curcuma longa-based photosensitizer. A single session was performed, with applications of approximately 30s for each interdental papilla. Results: The patient improved markedly after only one cycle of PDT. There was an absence of clinically detectable inflammation, edema, and rubor of the involved dental papillae. At the 4, 6, and 12week follow-ups there were no recurrences. Conclusions: This case report highlights the first case of drug-induced gingival hypertrophy entirely treated with photodynamic therapy to be described in the literature. Therefore, although it is only a case report, this therapy which is free from side effects should be investigated as an alternative to current therapies

Melkersson–Rosenthal syndrome: A case report

Melkersson–Rosenthal syndrome (MRS) is a rare disorder with a still unknown etiology. It is defined by three main symptoms, which are orofacial granulomatosis (OFG), facial palsy, and fissured tongue. It generally presents in young people, during the second or third decade, and its incidence in the entire population is about 1%. We focus our attention on a 69-year-old man who came to us with an important swelling of the upper lip. His anamnesis revealed that he suffered from a facial palsy four times in his life and at the physical examination we attested the presence of scrotal tongue. We suspected a misdiagnosed MRS and we searched the web in order to give him a diagnosis and a therapy. We found that OFG is the most common symptom of MRS and that it can show as a non complete form, where the three main symptoms cannot occur simultaneously. We also prescribed a therapy based on the use of topic steroids and antiviral, according to literature. After the positive response to the therapy and according to data found in the most recent literature, we can assume that our patient suffers from a misdiagnosed MRS for about 40 years

Polarized Light as an Adjuvant to Drug Therapy for the Treatment of Refrectory Oral Erosive Lichen Planus: A Case Report

Oral lichen planus is a chronic inflammatory disease of unknown etiology, associated with a malignant transformation in 1.2% of cases. It can be predominantly white and therefore almost always asymptomatic, or with the presence of large erosions in different areas of the oral cavity. In this case the pathology can be disabling, causing severe chewing difficulties and compromising the patient's quality of life. The gold standard for the treatment of this pathology is the use of topical cortisones combined with nystatin. The use of photodynamic therapy for the treatment of these lesions is also documented in the scientific literature. Polarized light is a light with a very wide wavelength variability, created for the treatment of erosive and ulcerative skin lesions and then also introduced in other fields, such as in oral medicine. It has an excellent analgesic and bio stimulating effect. We propose a case of erosive lichen planus refractory to systemic cortisone therapy, present for 4 years without remission, successfully treated with 6 15-minute sessions of phototherapy with polarized light, using a Bioptron device at 25 watts of power. After an important improvement, the therapy was concluded with gel based on ozonated olive oil (Ialozon, Gemavip, Cagliari, Italy) and topical cortisone, due to the impossibility of continuing the therapies in the study (lockdown). Polarized light is very easy to use, has no side effects, does not require special eye protection and has proven to be very effective in the clinical resolution of refractory lesions to drug therapy

PHOTODYNAMIC THERAPY AS SUPPORT OF PHARMACOLOGICAL THERAPY IN A CASE OF PARTICULAR REFRACTORY ORAL LICHEN PLANUS: A CASE REPORT.

Aim: Lichen planus (LP) is a chronic autoimmune mucocutaneous condition, primarily affecting the oral and genital mucous membrane, skin, nails, and scalp. The oral lichen planus (OLP) affects approximately 2% of the population. OLP, in general, may arise in > 70% of persons with skin lesions. The frequency of malignant change ranges from 0.4% to 3.3%. OLP is seen worldwide, mostly in the fifth to sixth decades of life, and is twice as prevalent in women as in men. OLP has demonstrated numerous systemic connotations such as diabetes mellitus (DM), hypertension, metabolic syndrome (MS), thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The treatment options for OLP are numerous and include topical and systemic agents. Topical corticosteroids remain the mainstay of therapy. Case report: A 62-year-old woman came to our observation for a lesion present for about 1 year extended to the hard palate and the upper vestibular gingival mucosa. In the anamnesis she reported osteoporosis and gastro-esophageal reflux. On objective examination there were erosion areas of different width and depth interspersed with erythematous and rare areas white patterns. The patient also reported the formation of bubbles that in a very short time exploded. The negative Nickolsky sign on physical examination did not testify for a diagnosis of vesicular-bullous disease. An incisional biopsy was performed in the palatine area. The subsequent histological evaluation and immunofluorescence were significant for the diagnosis of lichen planus bullous. Topical therapy prescribed with Clobetasol 0.05% 2 times a day and topical Nystatin (100.000 ul/ ml) 3-4 times a day for 3 weeks brought an evident improvement; however an erosive lesion persisted in the area 22-23. It was decided to proceed with a photodynamic support therapy with 460 nm diode light, 4 watts (FlashMax P4 CSM Dental, Copenhagen, Denmark) and 3% hydrogen peroxide. Mucous surface was wetted with hydrogen peroxide then illuminated with diode light 20 times for 3 seconds, subsequently the hydrogen peroxide was removed with a sterile gauze. This treatment was repeated 3 times every 7 days. Results: One week later there was an important clinical improvement, the subsequent therapeutic sessions allowed an almost complete remission of the lesion unresponsive to corticosteroid treatment. Numerous invasive and non- invasive therapeutic methods including local and systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested. Extended use of corticosteroids for chronic OLP may have certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes. To surmount the side effects of steroid therapy, photodynamic therapy (PDT) has been proposed as an alternative treatment strategy for OLP. PDT uses a photosensitizing agent which, when activated by the energy of light, creates a photodynamic reaction that is cytotoxic. A systematic review of the literature assessed the effectiveness of PDT in the management of OLP. PDT also showed an increase in the bactericidal activity of hydrogen peroxide in a case of refractory hairy tongue. Conclusions: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with standardized PDT parameters are needed

Microbiota of the Tongue and Systemic Connections: The Examination of the Tongue as an Integrated Approach in Oral Medicine

The tongue is able to quickly reflect the state of health or disease of the human body. Tongue inspection is an important diagnostic approach. It is a unique method that allows to explore the pathogenesis of diseases based on the guiding principles of the holistic concept that involves the observation of changes in the lining of the tongue in order to understand the physiological functions and pathological changes of the body. It is a potential method of screening and early detection of cancer. However, the subjective inspection of the tongue has a low reliability index, and therefore computerized systems of acquisition of diagnostic bioinformation have been developed to analyze the lining of the tongue. Next-generation sequencing technology is used to determine the V2–V4 hypervariable regions of 16S rRNA to study the microbiota. A lot of neoplasms are identified only at an advanced phase, while in the early stages, many subjects remain in an asymptomatic form. On the contrary, the early diagnosis is able to increase the prognosis of cancer and improve the survival rates of subjects. Evidently, it is necessary to develop new strategies in oral medicine for the early diagnosis of diseases, and the diagnosis of the tongue as a minimally invasive method is certainly one of them