Background: Traumatic ulcers represent the most common oral mucosal lesions that can be differentiated from oral squamous cell carcinoma (OSCC) by their clinical appearance. From a clinical perspective, OSCC may resemble a chronic traumatic ulcer (CTU) because the base of the CTU that is healing is filled with reddish-pink granulated tissue, similar to that in OSCC. Purpose: The aim of this case report is to provide information about the oral management of a CTU case that imitates OSCC. Case: A 30-year old female presented with a major, painful, non-healing ulcer located on the right lateral of the tongue for the previous two months. Approximately two years before, she had experienced a similar lesion on the tongue. Intra oral examination showed a 10mm x 5mm yellowish ulcer with a fibrous center, erythematous irregular-induration margin and concave yellow base. The 15th, 44th and 47th teeth were sharp and on occlusion caused trauma to the right lateral border of the tongue. Case management: Based on the clinical features, the lesion was imitating OSCC. After a case history review, clinical examination and appropriate investigation, the patient was diagnosed as suffering from a chronic traumatic ulcer. The primary treatment of traumatic ulcers involves eliminating etiological factors. As pharmacological therapy, a mixture of triamcinolone acetonide and 1mg dexamethasone tablet was administered in addition to folic acid and vitamin B12. Conclusion: Clinical presentation of traumatic lesions varies significantly and may, at times, be ambigous. It is important to immediately establish a correct diagnosis and implement prompt treatment of CTU lesions because they play a role at the oral carcinogenesis promotion stage.
Oral Leukoplakia (OL) is white plaque lesion in oral mucosa thatcannot be scraped and one of Oral Potentially Malignant Disorder(OPMD) with incidence about 2.5% of all populations in the world.The most case of oral squamous cell carcinoma are preceded byOPMD. The aim of this case report is to understand the importance ofdetection oral lesion that could potentially become malignancy. A 28-year-old male patient complained of sores on his tongue that had nothealed for 2 months. Intraoral examination obtained red and whitelesion on the left lateral tongue: shallow reddish ulcer with irregularborder in region 35-36, followed by unscrapable white plaque lesionwith slight induration in region 37-38. Hematological examinationshowed normal range. According anamnesis and clinical examination,diagnosis of traumatic ulcer and OL were made. Patients were treatedwith multivitamins and antiseptic mouthwash. Histopathologicalexamination results from lesion biopsies show a hyperplastic mass,parakeratosis and a tissue with polymorphic form, a hyperchromaticnucleus of cells associated with histopathologic criteria of squamouscell carcinomas with well differentiation. The patient was referred tothe Hemato-oncology Department for chemotherapy. There are twoimportant parameters should be considered when evaluating thepotential for malignant change of OL that is when finding white lesionswith or without red lesions should always be suspected as OPMD andalways confirm it by histopathological examination as early aspossible. Accurate examination and histopathologic examination isessential to obtain a good prognosis in OPMD.
Background: Human immunodeficiency virus (HIV) infection increases vulnerability to opportunistic viral infection, including Human cytomegalovirus (HCMV) infection, that has been detected in saliva. The HCMV envelope glycoprotein B (gB) is highly immunogenic and has been associated with HCMV-related diseases. Purpose: The purpose of this study is to assess the prevalence of HCMV and gB-1 genotype in the saliva of HIV/AIDS patients and to analyse their relationship with xerostomia and salivary flow rate (SFR). Methods: This cross-sectional study involved 34 HIV/AIDS patients. Saliva was tested for the presence of HCMV DNA using PCR microarrays, and nested PCR for gB-1 genotype detection. Xerostomia was measured using a Fox’s questionnaire. Unstimulated whole saliva flow rate was measured by means of the spitting method. Results: The composition of the research population consisting of 73.5% males and 26.5% females with HIV/AIDS. HCMV was found in 64.7% of HIV/AIDS patients, while gB-1 genotype was detected in 59.1%. Xerostomia was closely associated with the presence of HCMV in saliva (p<0.05), but not with gB-1. There was no significant relationship between xerostomia and SFR rates in the research subjects with HCMV positive saliva (p> 0.05). Conclusion: The presence of xerostomia-associated HCMV in saliva was elevated among HIV/AIDS patients. Further investigation is required to identify other gB genotypes that may be responsible for xerostomia and SFR changes in HIV/AIDS patients.
Background: Aplastic anemia (AA) is a hematologic disorder characterized by hypoplastic bone marrow and peripheral pancytopenia. The main symptoms are fatigue and bleeding. In the oral cavity, gingival bleeding is the common complaint.Case Management: A 18-year-old female patient referred from internal medicine department due to swelling of palate since 2 days before that interrupted eating activity. She routinely consumes Sandimun®100 mg tablets. A 2 x 1 cm black blood clot in anterior hard palate and ulcerative lesion at dorsal tongue regio 45 surrounded by necrotic area were found on intra oral examination. Patient was diagnosed with necrotizing ulcer-related neutropenia accompanied by AA-associated hemorrhagic bullae in the hard palate. Patient treated with mouthwash containing 0.1% hyaluronicacid and 1% feracrylum.Discussion: Immunosuppressant is the AA gold standard therapy. Cyclosporine (CsA) as imunosupressant is common drug to prevent T cells from attacking stem cells in bone marrow. The side effects of CsA is gingival hiperplasia.Conclusions: Gingival bleeding and gingival hiperplasia due to thrombocytopenia and the use of cyclosporine are vicious circles that need to be aware. With comprehensive management, good oral conditions will be obtained, therefore the quality of life can increase.
Background: Oral lichen planus (OLP) is a chronic autoimmune disease sprinkled by T cells on the oral mucosal surface. The goal of OLP treatment is to eliminate erythema, ulceration and relieve symptoms. Corticosteroids are the first line in the treatment of OLP, either systemically or topically. The problem arises when using topical steroids, namely the time of topical steroid attachment to the oral mucosa, especially in cases of OLP with clinical desquamative gingivitis. Some studies suggest that the use of individual gingival tray can overcome this problem. Objective: To provide information on topical steroid use in OLP cases with desquamative gingivitis clinical signs.Case Management: Women, age 31, complain that pain with burning on the lips and mouth is aggravated by spicy food. Intraoral examination shows irregular white plaques on the buccal, labial and dorsal mucosa of the tongue accompanied by diffuse erythema in the anterior gingiva of the upper and lower jaws. Patients diagnosed with OLP. Lesions improve 3 months after topical steroid administration, except lesions on the gingiva. Gingival individual tray is then used to obtain adequate attachment of topical steroids on the gingiva surface. The gingiva showed significant improvement after a month later.Conclusion: The use of topical steroid concoctions applied to the gingival individual tray is effective in treating OLP lesions especially with clinical signs of desquamative gingivitis.
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