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The oral inflammatory dermatoses is a term used to describe a number of predominantly immune-mediated disorders: lichen planus (LP), erythema multiforme (EM), the vesiculobullous diseases pemphigoid (MMP), pemphigus (PV) and epidermolysis bullosa acquisita (EBA). These conditions are characterized by frequent involvement of the oral mucosa and often associated with extraoral manifestations, particularly of the skin, but can involve the eyes, both the conjunctiva and sclera, the nasal and pharyngeal mucosa, as well as the genitals. Given their frequent, and sometimes initial involvement of the oral mucosa, oral health professionals need to be both familiar with the clinical features and presentations of these conditions, and appreciate their critical role in management.This paper reviews the clinical features and presentation of the oral dermatoses, provides guidance as to the appropriate investigations needed to differentiate and correctly diagnose these conditions, details the aetio-pathology of these diseases and discusses their management.Keywords: Autoimmune, blister, bullae, corticosteroids, dermatoses, desquamative, erosion, immune-mediated, immunosuppression, steroid-sparing, vesicles, vesiculobullous, ulcers.Abbreviations and acronyms: ADCC = antibody dependent cellular cytotoxicity; BMZ = basement membrane zone; CDC = complement dependent cytotoxicity; cGVHD = chronic graft-versus-host disease; DIF = direct immuno-fluorescence; DLE = discoid lupus erythematosus; EB = epidermolysis bullosa; EBA = epidermolysis bullosa acquisita; EM = erythema multiforme; c-IFN = gammainterferon; MMP = mucous membrane pemphigoid; OCP = ocular cicatricial pemphigoid; OLCL = oral lichenoid contact lesions; OLDR = oral lichenoid drug reactions; OLP = oral lichen planus; OMMP = oral mucous membrane pemphigoid; PUVA = psoralen ultraviolet A light; PV = pemphigus vulgaris; SJS = Stevens Johnson syndrome; TEN = toxic epidermal necrolysis; TNF-a = tumour necrosis factor alpha. ORAL LICHEN PLANUSLichen planus is a chronic systemic disease of established immune-mediated pathogenesis.1 It most commonly, and most protractedly, involves the mucosa of the oral cavity, hence it is of interest and concern to dentists, but it can involve other sites, namely the skin, the scalp (with inflammation around and affecting the hair follicles resulting in alopecia), the nails as well as the genital area -the vulval and vaginal mucosa, and the glans penis. There are six recognized oral presentations of lichen planus: (1) reticular; (2) papular; and (3) plaque-form; and the (4) atrophic; (5) ulcerative (erosive) and rare (6) bullous form. These latter three forms can be associated with significant discomfort requiring either topical and ⁄ or systemic immunosuppressive therapy.

Background: Osteomyelitis of the maxillofacial skeleton is rare in developed countries such as Australia. This case report describes the successful surgical treatment of chronic suppurative osteomyelitis (CSO) of the mandible in a 75 year old man. The precipitant factor was thought to be a retained tooth root in the (right) posterior body of the mandible. Methods: Treatment included a pre-surgical course of antibiotics (clindamycin 300mg, p.o. q.i.d. for two weeks) followed by removal of the retained root, surgical débridement of the affected bone, the intra-oral draining sinus, and resection of the cutaneous sinus tract. Specimens were taken for bacterial cultures and antibiotic sensitivity testing, and the resected tissue sent for histopathological review. Results: On clinical and radiographic review at three months, the patient was well, completely symptom free and the osteomyelitis had fully resolved. Conclusion: This case report demonstrates the typical features of CSO. The combination of antibiotic therapy and surgical débridement was effective in the treatment of chronic suppurative osteomyelitis of the mandible utilizing intravenous sedation, and so averting the need for a general anaesthetic.Key words: Osteomyelitis, chronic, surgery, clindamycin, débridement.Abbreviations and acronyms: CSO = chronic suppurative osteomyelitis; p.o. = per oral (by mouth); q.i.d. = quarter in die (four times a day).

Crohn's disease is a heterogeneous, inflammatory condition that can affect any location of the gastrointestinal tract. Proximal gastrointestinal involvement occurs in 0.5-16% of patients, and it is usually diagnosed after recognition of intestinal disease. Symptoms are often mild and nonspecific; however, upper gastrointestinal disease predicts a more severe Crohn's phenotype with a greater frequency of complications such as obstruction and perforation. Gastroscopy and biopsy is the most sensitive diagnostic investigation. There is a paucity of data examining the treatment of this condition. Management principles are similar to those for intestinal disease, commencing with topical therapy where appropriate, progressing to systemic therapy such as glucocorticoids, 5-aminosalicylic acid, immunomodulators, and biologics. Acid suppression therapy has symptomatic but no anti-inflammatory benefit for gastroduodenal and esophageal involvement. Surgical intervention with bypass, strictureplasty, or less frequently, endoscopic balloon dilation may be required for complications or failed medical therapy.

Background Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures. Objectives To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes. Methods A single‐center, prospective, cohort study was performed to compare 7‐day bleeding outcomes between patients who continued their DOAC, and patients on warfarin with an International Normalized Ratio (INR) between 2.0 and 4.0. Blood tests including oral anticoagulant drug levels were measured immediately prior to extraction. The gauze used to apply pressure to the socket was weighed before and after extraction to estimate blood loss. Patients were contacted by phone 2 and 7 days after extraction. Results Eighty‐six patients on a DOAC had a total of 145 teeth extracted, and 21 patients on warfarin had 50 teeth extracted. There were no major bleeding events. The rate of minor plus clinically relevant nonmajor bleeding was comparable between the DOAC and warfarin cohorts (36% and 43%, respectively; odds ratio, 0.75; 95% confidence interval, 0.29‐1.98). Preextraction apixaban and dabigatran levels were comparable between bleeders and nonbleeders, while rivaroxaban levels were higher in those who bled. The weight change of gauze used to tamponade the socket was similar between the 2 cohorts. Conclusion Dental extractions on patients continuing DOACs led to bleeding rates similar to patients on warfarin with an INR between 2.0 and 4.0. There is no need to adjust DOAC dosing prior to dental extractions.

The immunohistochemical detection of epithelial p53 protein expression in oral lichen planus (OLP) biopsies was supplemented with molecular analysis for mutations of the p53 gene using the polymerase chain reaction ‐ single stranded conformational polymorphism (PCR‐SSCP) technique. p53 protein expression, in the basal epithelial cell layer, as detected by the DO7 and 1801 antibodies, was significantly more frequent in OLP compared with other oral keratoses and normal mucosa, as was the growth fraction. The 10 OLP biopsies that had the most frequent p53 staining (plus a case of OLP found in continuity with a SCC) were screened by the PCR‐SSCP technique, but no mutations were detected in the p53 gene (exons 5–9). The p53 overexpression in the OLP samples may be a physiological response to the hyper‐proliferative state, as revealed by the growth fraction determination. This may usefully serve to protect against mutagenesis, and so be a factor in the low incidence of carcinoma associated with OLP.