[Show abstract][Hide abstract] ABSTRACT: Human T-lymphotropic virus-1 (HTLV-1) can cause adult T-cell leukemia/ lymphoma (ATL/L), which is a rare and aggressive type of blood cancer. Herein, we report a case of ATL/L in a middle-aged man with unusual jaw presentations. The patient presented with mandibular, maxillary and palatal bony hard expansion, accompanied by generalized tooth mobility six months prior to admission to the Department of Oral Medicine. The panoramic radiograph showed generalized rarefaction of jaw bones. After laboratory examinations and bone marrow aspiration, ATL/L was diagnosed in association with HTLV-1. The patient underwent chemotherapy. Although the majority of infections associated with HTLV-1 are asymptomatic, some patients may develop blood diseases such as ATL/L and neurological disorders, mainly HTLV-1 associated myelopathy and tropical spastic paraparesis. ATL/L is a rare hematological malignancy in oral cavity that should be included in the differential diagnosis of cases with jaw swelling or generalized demineralization. Serum levels of anti-HTLV-1 antibodies should be examined in suspicious patients, particularly in endemic regions.
[Show abstract][Hide abstract] ABSTRACT: Basal cell carcinoma (BCC) is the most common cutaneous malignancy among Caucasians. Rare examples of aggressive and neglected BCC have been reported. Here we report a unique case of a neglected BCC with significant jaw involvement. A 50-year-old female, referred by an otorhinologist, presented with a large ulcer on her chin, which was extended to her mandibular vestibule. The ulcer was 9×5.5 cm in size, and tissue destruction, necrosis was observed in the central portion, and the mandibular bone was exposed. On intraoral examination, tooth mobility and severe bone loss were evident. Due to the primary cutaneous origin of the lesion, BCC was considered as preliminary diagnosis. Biopsy was performed and diagnosis of BCC was confirmed. The diseased mandibular bone was resected and reconstructed with a surgical plate. The soft tissue defect was reconstructed with deltopectoral flap. The patient refused secondary stage plastic surgery. Although BCC is not a lethal malignancy, if left untreated and neglected, it can result in severe destruction, disfigurement, and even mortality.
Iranian Journal of Medical Sciences 05/2015; 40(3):277-81.
[Show abstract][Hide abstract] ABSTRACT: Oral lesions are among the earliest clinical manifestations of human immunodeficiency (HIV) infection and are important in early diagnosis and for monitoring the progression to acquired immunodeficiency syndrome (AIDS). The purpose of this study was to determine the prevalence of oral lesions and their relationship with a number of factors in HIV/AIDS patients attending an HIV center.
A total of 110 HIV-positive patients were examined to investigate the prevalence of oral lesions according to the criteria established by the European Community Clearing House on Oral Problems Related to HIV Infection. An independent T-test was used for correlation of oral lesions with CD4+ count and a χ2 test was used for analysis of the relationship of co-infection with hepatitis B virus (HBV), sexual contact, route of transmission, history of drug abuse, and history of incarceration.
Most of the cases were male patients (82.7%). The mean age across all participants was 36.2±8.1 years. Rampant carries, severe periodontitis and oral candidiasis were the most notable oral lesions. Oral lesions were more prevalent in patients between 26-35 years of age. There was a significant difference between patients with and without pseudomembranous candidiasis and angular cheilitis according to mean level of CD4+.
The most common oral presentations were severe periodontitis, pseudomembranous candidiasis and xerostomia.
Iranian Journal of Otorhinolaryngology 03/2015; 27(78):43-54.
[Show abstract][Hide abstract] ABSTRACT: Oral lichen planus (OLP) is a common chronic mucocutaneous disease. Patients with atrophic and erosive types of OLP often have symptoms of soreness, and require proper treatment. The main treatment for OLP has been the administration of topical or systemic corticosteroids. The objective of this study was to compare the efficacy of adcortyl cream (triamcinolone acetonide in orabase) with topical pimecrolimus cream for the treatment of erosive OLP.
Twenty-eight patients with OLP were enrolled in a single blind clinical trial and assigned to either a pimecrolimus 1% cream group or an adcortyl 0.1% cream group. The medication was applied every day for 2 months and patients were assessed every 2 weeks.
The mean lesion size and mean pain and burning sensation scores did not differ between the pimecrolimus and adcortyl cream groups. The pimecrolimus cream was well tolerated. No clinical drug-related adverse events were observed.
Topical pimecrolimus cream may be recommended as a safe and effective alternative therapy in the treatment of OLP. Pimecrolimus cream is as effective as adcortyl cream in managing the signs and symptoms of OLP.
Iranian Journal of Otorhinolaryngology 03/2015; 27(79):119-26.
[Show abstract][Hide abstract] ABSTRACT: Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (TRIAL REGISTRATION NUMBER: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.
[Show abstract][Hide abstract] ABSTRACT: 52 Background: Medical error is defined as an adverse event caused by medical management, which can be prevented. The aim of this study was to investigate the accuracy of diagnosis of oral and maxillofacial diseases made by health care practitioners. Methods: A descriptive cross sectional study was done between Apr. 2009 and Mar.2010. 372 Patients with oral and maxillofacial lesions who had referred to oral medicine Department of Mashhad dental school or had examined by health care practitioners were examined by two oral medicine specialists and a self established questionnaire was completed. The main aim of this questionnaire was to investigate the accuracy of diagnosis of oral and maxillofacial diseases made by health care practitioners. If it was necessary, histopathologic evaluation was made to achieve a definite diagnosis. Results: Only 30/6% of initial diagnoses were consistent with the diagnosis made by oral medicine specialists. Lichen planus and inflammatory hyperplasia have been the most common diseases which health care practitioners did not mention a diagnosis for them. Among the most common misdiagnosis lichen planus and abscess each involved 8 percent of misdiagnosis. Conclusions: Unfortunately in present study there was little compatibility between diagnosis of dentists and practitioners with oral medicine specialist. Sometimes misdiagnosis results in postponing the treatment, patients`suffering and leads to side effects of unnecessary or incorrect treatment. As old people are more susceptible to oral diseases and lesions, there should be a holistic effort to find the cause of present problems and then resolving them through educational promoting and expanding the teamwork among physicians to diagnosis and treatment of the patients.
[Show abstract][Hide abstract] ABSTRACT: Objectives: Assessment in the setting of clinical training is not well developed, but methods based on observation of routine encounters like CBD and mini-CEX offer a feasible and rich alternative. This study aimed to explore oral medicine faculty and residents' experiences on new workplace assessment methods.
Methods: In the first step of this qualitative study, a workshop was conducted for residents and staff entitled Workplace Assessment. After that, during 6 months in 2011, assessment tools such as mini-CEX and CBD were applied for assessing the judgment and clinical reasoning. By these methods, it was possible to get an opportunity for educational feedback. Interview was conducted and the data were recorded, transcribed, and then categorized.
Results: Advantages and disadvantages of new methods based on observation were as follows; Advantages: These new methods were valid and could qualify the residents' ability better than traditional methods, the new methods could be weak points of residents in each diagnostic field of oral lesions, each resident could present his/her clinical competencies in a quantitative manner at the end of the course. Disadvantages: Considerable time consumption for residents and staffs, lack of inter rater reliability.
Conclusions: Although time consuming, the new approach was useful for qualifying the clinical competency of residents. It seems that both staff and residents must be trained for achieving better results.
9th Iranian & 13th Kuwaiti Divisions of IADR joint Congress 2013; 12/2013
[Show abstract][Hide abstract] ABSTRACT: The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran.
This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly.
In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis.
The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected.
These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.
[Show abstract][Hide abstract] ABSTRACT: Schwannoma is usually a solitary slow growing and encapsulated soft tissue or intrabony lesion. This tumor is often associated with the nerve sheath. Only a few ancient schwannomas have been reported in different parts of head and neck and in the gingiva, this tumor is very rare. In this report, a 14-year-old male patient with an ancient schwannoma of gingiva discussed. he was referred to oral medicine department of Mashhad dental school with Chief complaint of an asymptomatic enlargement of gingiva and histopathologic examination recommended. Based on clinical, histologic and immunohistochemical findings, the diagnosis of ancient schwannoma was made Ancient schwannoma is very rare in gingiva but the dentist must note the clinical presentation of periodontitis and any gingival enlargement should not be considered periodontitis. The purpose of this study is report of a rare case of ancient schwannoma in gingiva and a review of ancient schwannomas in literature.
Journal of Applied Sciences 12/2010; 10(23). DOI:10.3923/jas.2010.3137.3140
[Show abstract][Hide abstract] ABSTRACT: It seems that Oral Squamous Cell Carcinoma (OSCC) in young adults is different from OSCC in older patients especially in risk factors. No significant habits are seen in younger patients. It is claimed that viral infections, especially human papillomavirus, are associated with several human carcinomas, especially oral cancers. The aim of this study was to investigate the presence of viruses in Oral Squamous Cell Carcinoma (OSCC) in young patients (20-40 years old) attending Mashhad Dental Faculty from 1996 to 2009 for the first time in Iranian population. Twenty one formalin-fixed, paraffin-embedded sections of patients under 40 years with clinical diagnosis of OSCC, who had referred to Mashhad Dental Faculty from 1996 and 2009, were evaluated for DNA extraction. All specimens were tested for presence of Human papilloma virus, Epstein-Barr virus, Herpes simplex virus type 1 and Cytomegalovirus virus. From 21 specimens, viruses were detected only in three cases. Two samples were positive for EBV and the third one was co-infected with EBV and HSV-1. All of our specimens were negative for HPV and CMV. We concluded that viruses had no important role in OSCC in our young patients. Further researches are needed to clarify this role and to identify other possible risk factors.
Journal of Applied Sciences 11/2010; DOI:10.3923/jas.2010.981.985
[Show abstract][Hide abstract] ABSTRACT: Recurrent aphthous stomatitis (RAS) is one of the most common ulcers of the oral cavity with a reported prevalence of 5- 50%. There is still no definitive treatment for RAS; however, immunosuppressive and immunomodulant agents have been proposed. In this study, we compared the therapeutic effects of 5 mg/d prednisolone with 0.5 mg/d colchicine in the treatment of RAS.
In a double-blind randomized clinical trial, 34 patients with RAS were randomly divided into two groups for treatment with prednisolone or colchicine. All patients took the medication for three months and were assessed at two weeks intervals. The groups were compared for size and number of lesions, severity of pain and burning sensation, duration of pain-free episodes and any side effects of the prescribed medicines. Both colchicine and prednisolone treatments significantly reduced RAS (p < 0.001). No significant differences in size and number of lesions, recurrence and severity of pain and duration of pain-free period were seen between the two treatment groups. Colchicine (52.9%) had significantly more side effects than prednisolone (11.8%).
Low dose prednisolone and colchicine were both effective in treating RAS. Given that the two therapies had similar efficacy, yet colchicine was associated with more side effects, , 5mg/d of prednisolone seems to be a better alternative in reducing the signs and symptoms of the disease.
Clinical and investigative medicine. Medecine clinique et experimentale 06/2010; 33(3):E189-95. · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine diagnostic value of modified Liquid Based Brush Biopsy technique.
26 oral premalignant and malignant lesions in 25 patients (12 females; 54.23+/-19.77 years and 13 males; 53.77+/-15.43 years) underwent Modified (Liquid Based) Brush Biopsy and scalpel biopsy simultaneously from the same area.
There were 16 positive and 10 negative brush biopsy results, with no inadequate readings. Histological findings were compatible with oral leukoplakia (n=5) with dysplasia, Oral lichen planus and lichenoid reaction (n=7) (with or without dysplasia) oral squamous cell carcinoma (n=11),verrucous carcinoma (n=1) and granular cell tumors (n=2). Sensitivity, specificity, positive predictive value, negative predictive value, positive diagnostic likelihood ratio (LR+) and negative diagnostic likelihood ratio (LR-) were 88.8%, 100%, 100%, 80%, infinity and 0.11 respectively (no false positive results).
It is the first attempt to do LBC with a specialized oral brush. Our results show that modified technique is a useful tool for screening of oral premalignant and malignant lesions.
[Show abstract][Hide abstract] ABSTRACT: Current treatments of oral lichen planus are palliative, not curative. Because psychiatric disorders significantly influence the development and severity of oral lichen planus, the use of psychiatric drug therapy may be an adjunct in treatment. The purpose of this study was to determine the efficacy of drug therapy of psychiatric disorders in oral lichen planus.
Our controlled clinical study consisted of forty-six patients with oral lichen planus and psychiatric disorders who were randomly divided into two groups. Both groups were given topical corticosteroids and the study group received additional psychiatric drug therapy. Patients were monitored for a period of 6 months. Response to treatment was evaluated in each group and was compared with the other group using Mann-Whitney tests. We evaluated the correlation between psychiatric disorders and the recovery of oral lesions using Spearman's correlation coefficient analysis.
Decrease in the size of the lesions was significantly greater in the study group after six months, but this difference was not significant in relationship to the pain experienced and the kind of lesion. Spearman's correlation coefficient analysis demonstrated that, in the sixth month, there was a significant and direct relationship between recovery from the psychiatric disorders and response to treatment of OLP lesions, particularly as it pertained to the kind of lesion.
The present study indicates that the combination of psychiatric drug therapy and routine treatment methods were effective in reducing the size of the lesions, but did not have any significant effect on the symptoms.
[Show abstract][Hide abstract] ABSTRACT: Squamous cell carcinoma (SCC) derived from keratocystic odontogenic tumor is an extremely rare tumor that is limited to the jaws. Most intraosseous carcinomas originate from the epithelial lining of odontogenic cysts, so they are called odontogenic carcinomas. They occur more frequently in men and the mean age of patients is 57 years. The following report describes an extremely rare case of an odontogenic carcinoma derived from a keratocystic odontogenic tumor in a 20-year-old man. The patient presented with an exophytic lesion in the retromolar region of the mandible which was first noticed by the patient 25 days earlier. In panoramic radiograph a well-defined radiolucency around the impacted 3rd molar was observed. Clinical and radiographic diagnosis was odontogenic SCC. Surgical resection was performed and histhopathologic examination of the lesion confirmed the diagnosis of SCC in the wall of a keratocystic odontogenic tumor.