Treatment of Oral Diseases. George Laskaris

diagnosis is based on the history and the clinical features.

      

Differential Diagnosis

      •Amalgam contact stomatitis

      •Chronic biting

      •Leukoedema

      •Lichen planus

      •Leukoplakia

      •Candidiasis

      •Hairy leukoplakia

      •Plasma cell stomatitis

      •Uremic stomatitis

      •Lupus erythematosus

      •Epithelial peeling

      

Treatment

      Basic Guidelines

      •High level of oral hygiene should be maintained.

      •Change or avoid any product which contains cinnamon.

      •Avoid antibacterial mouthwashes as these worsen the symptoms.

      •If the cinnamon products are reused usually the signs and symptoms soon recur.

      Suggested Therapies

      •Discontinuation of any cinnamon product improves the condition and the signs and symptoms disappear in approximately 2 weeks time.

      •In cases of severe and extended erosions, corticosteroids in the form of topical ointment or low doses of oral prednisone, e.g., 10-15 mg/day for 1 week, help the lesions to heal soon.

      •Topical rinses with chamomile four to five times daily improve the symptoms.

      References

      Allen CM, Blozis GG. Oral mucosal reactions to cinnamon-flavored chewing gum. JADA 1988;116:664–667.

      Le Sueur BW, Yiannias JA. Contact stomatitis. Dermatol Clin 2003;21:105–114.

      Miller R, Gould A, Berstein M. Cinnamon-induced stomatitis venenata. Oral Surg Oral Med Oral Pathol 1992;73:708–716.

      Samio EL, Kanerva L, Contact allergens in toothpastes and a review of their hypersensitivity. Contact Dermatitis 1995;33:100–105.

      Coccidioidomycosis

      

Definition

      Coccidioidomycosis is a chronic systemic mycosis, endemic in the USA. Central America, and South America.

      

Etiology

      Coccidioides immitis, a dimorphic fungus, is the causative organism.

      

Main Clinical Features

      There are five clinical forms of the disease: a) acute pulmonary, b) chronic pulmonary, c) disseminated focal, d) disseminated widespread, and e) meningitis. Oral lesions develop in disseminated infection, which commonly occurs in patients with AIDS or in immunocompromised patients.

      Oral Lesions

      These present as vegetating ulcers with irregular peripheries. The palate, tongue, and gingiva are more frequently affected.

      Disseminated Widespread Form

      Fever, malaise, anorexia, cough, chest pain, weight loss, and lymphadenopathy are common signs and symptoms. With time, lesions develop in the bone, joints, skin, subcutaneous tissues, meninges, and other sites.

      

Diagnosis

      Smear, culture, and biopsy are very useful diagnostic tools. Serologic tests are also helpful.

      

Differential Diagnosis

      •Paracoccidioidomycosis

      •Other systemic mycoses

      •Squamous cell carcinoma

      •Tuberculosis

      •Syphilis

      •Non-Hodgkin lymphoma

      •Leishmaniasis

      

Treatment

      Basic Guidelines

      These are as for the other systemic mycoses.

      Suggested Therapies

      •Itraconazole 100-400 mg/day for 12 months or more is useful in the treatment of coccidioidomycosis.

      •Ketoconazole 200-400 mg/day for 12 months or more has resulted in improvement in patients with lung, skin, bone, and joint lesions.

      •Fluconazole 100-300 mg/day may be useful.

      •Amphotericin B 0.5-0.7 mg/kg per day for about 12-14 weeks is recommended in severe disease, particularly in patients with meningitis.

      Future Therapies

      Voriconazole has been shown to have in-vitro activity against C. immitis.

      References

      Diaz M, Puente R, de Hoyos LA, Cruz S. Itraconazole in the treatment of coccidioidomycosis. Chest 1991;100:682–684.

      Drutz DJ. Amphotericin B in the treatment of coccidioidomycosis. Drugs 1983;26:337–341.

      Ghannoum MA, Kuhn DM. Voriconazole: Better changes for patients with invasive mycoses. Eur J Med Res 2002;7:242–256.

      Graybill JR, Stevens DA, Galgiani JN, et al. Itraconazole treatment of coccidioidomycosis. Am J Med 1990;89:282–290.

      Condyloma Acuminatum

      

Definition

      Condyloma acuminatum or anogenital wart is a common benign viral-induced lesion.

      

Etiology

      Types 6 and 11 human papilloma virus (HPV) are the main causative organisms of the disease.

      

Main Clinical Features

      The lesions are usually found on the anogenital area and rarely in the oral mucosa. Oral condyloma acuminatum may result from autoinoculation from anogenital lesions or during orogenital contact.

      Oral Lesions

      •Single or multiple small sessile or pedunculated painless nodules with cauliflower surface

      •The lesions have normal or whitish color

      •Lip and buccal mucosa, gingiva, and palate are the sites of predilection

      Anogenital Lesions

      •Discrete or multiple, sessile or pedunculated. exophytic, small nodules with cauliflower-like appearance

      •Lesions may have whitish or brown color

      •Size varies from 1-5 mm to several cm in diameter

      

Diagnosis

      Biopsy and histopathologic