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Abstract Background Benzalkonium chloride (BAC) is a quaternary ammonium compound (QAC), that can be found in a wide variety of household products–from disinfectants to medicaments and home fragrances–but also professional products. In pets, cats have long been reported as more sensitive than dogs to QACs; in fact, signs of irritation such as oral ulcerations, stomatitis and pharyngitis can be observed after contact with concentrations of 2% or lower. In a review of 245 cases of BAC exposure in cats, reported by the Veterinary Poisons Information Service (United Kingdom) only 1.2% of the cases died or were euthanized. Nevertheless, BAC toxidromes in cats can result in transitory CNS and respiratory distress, as well as severe mucosal and cutaneous lesions. Currently, only a few reports are available concerning BAC poisoning in this species. Case presentation A 4 month-old kitten presented with severe glossitis, lameness in the hindlimbs and episodes of vomiting and diarrhoea. The cause was unknown until the owners reported use of a BAC-containing mould remover (5%) 4 days later. The patient developed severe oral burns requiring a pharyngeal tube for feeding and severe cutaneous chemical burns. The kitten was managed with supportive therapy and required hospitalization for 10 days. The symptoms disappeared completely 3 weeks after exposure. Conclusions BAC is a very common compound contained in several household and professional products but, to the best of our knowledge, no previous case had been reported in Italy. We hope that this report will help raise awareness on the hazards of BAC products for cats in both domestic and work contexts.

Background: Benzalkonium chloride (BAC) is a quaternary ammonium compound (QAC), that can be found in a wide variety of household products–from disinfectants to medicaments and home fragrances–but also professional products. In pets, cats have long been reported as more sensitive than dogs to QACs; in fact, signs of irritation such as oral ulcerations, stomatitis and pharyngitis can be observed after contact with concentrations of 2% or lower. In a review of 245 cases of BAC exposure in cats, reported by the Veterinary Poisons Information Service (United Kingdom) only 1.2% of the cases died or were euthanized. Nevertheless, BAC toxidromes in cats can result in transitory CNS and respiratory distress, as well as severe mucosal and cutaneous lesions. Currently, only a few reports are available concerning BAC poisoning in this species. Case presentation: A 4 month-old kitten presented with severe glossitis, lameness in the hindlimbs and episodes of vomiting and diarrhoea. The cause was unknown until the owners reported use of a BAC-containing mould remover (5%) 4 days later. The patient developed severe oral burns requiring a pharyngeal tube for feeding and severe cutaneous chemical burns. The kitten was managed with supportive therapy and required hospitalization for 10 days. The symptoms disappeared completely 3 weeks after exposure. Conclusions: BAC is a very common compound contained in several household and professional products but, to the best of our knowledge, no previous case had been reported in Italy. We hope that this report will help raise awareness on the hazards of BAC products for cats in both domestic and work contexts. [ABSTRACT FROM AUTHOR]

The pathological lesions of the oral cavity were the subject of extensive study by a plethora of important physicians of the ancient world, starting with Hippocrates and the texts of the Hippocratic Collection. Although the observations and descriptions of the lesions lack their modern counterparts, they nevertheless include a wide range of different diseases and a surprisingly large collection of medications for their treatment. Stomatological diseases such as inflammation of the gums, floor of the mouth and jaws are recognized. The study by a number of important physicians of ulcerations of the oral cavity, as well as other pathological lesions, the most important of which is aphthae, is also systematic. Therapies are proposed that try to approach the cure of diseases with purely rationalistic-scientific approach and free from any theurgical element. [ABSTRACT FROM AUTHOR]

The oral cavity can present early manifestations of several systemic diseases. Since the emergence of the COVID-19 pandemic, there have been many published studies reporting the direct effect of the virus on orofacial structures. In the present study, oral signs and symptoms of 22 hospital-admitted COVID-19 patients were examined and compared to a matching control group. Loss of taste and smell was the most prevalent symptom (65%), followed by oral dryness (45%) and halitosis (30%). The most common oral lesions were candidal infections (68%). Other less common manifestations were oral ulcerations (36%) followed by the appearance of white patches (27.3%). There was a statistically significant association between candidal infection and age in the study group, where the p-value was 0.008. In the present study, 80% of those who had candida infections were aged 60 years or above. There was no significant association with comorbidities such as diabetes mellitus and hypertension.

The aim of this article is to present the case of acute febrile neutrophilic dermatosis (Sweet syndrome—SS) after Ad26.COV2.S vaccination against SARS‐CoV‐2. To the best of our knowledge, this is the second case of SS provoked by this specific vaccine. What is more, the mildly symptomatic beginning of the disease, later followed by typical SS manifestation with a variety of symptoms including nodular erythema of the feet and oral ulcerations, made it very challenging to establish the diagnosis. The article focuses on the current literature on the acute febrile neutrophilic dermatosis, along with the coexistence with other neutrophilic dermatoses and anti‐SARS‐CoV‐2 vaccinations as provoking factors. It emphasizes the necessity for sharing the knowledge and experience on the subject of SS's clinical manifestations and underlying causes to facilitate prompt diagnosis and introduction of appropriate treatment. [ABSTRACT FROM AUTHOR]

Drug induced erythema multiforme (EM) is a rare clinical entity which majorly involves the oral cavity. It commonly occurs due to intake of drugs such as NSAID'S, certain antibiotics, and anticonvulsants. It is characterized by rapidly rupturing vesicles leading to ill-defined erosions in the oral cavity and encrusted lip lesions. These lesions are usually difficult to differentiate from other vesiculo bullous and ulcerative lesions which would have a similar presentation and the absence of skin lesions can sometimes lead to misdiagnosis. Drug induced EM has an acute onset and is a selflimiting inflammatory hypersensitivity reaction that causes blistering and ulcerations of the skin and mucous membrane. The lesions heal following the discontinuation of the causative medications. This case report describes a case of drug induced erythema multiforme of the oral cavity that occurred consequent to the intake of Tab. Diclofenac Sodium and Tab. Cephelexin. The patient developed painful, bleeding, burning ulcerations with severe crustations on the upper, and lower lip, lateral and ventral surface of tongue, hard palate and retro molar regions. The case was managed with corticosteroids. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis (Tb) is a fatal infectious disease that primarily affects the pulmonary system and rarely occurs in other body organs including oral cavity. The aim of this study was to report all patients with primary manifestations of oral tuberculosis and to evaluate the clinical characteristics of oral tuberculosis lesions. All these patients were subsequently diagnosed with tuberculosis based on oral histological findings and referred for management and therapy. Materials and Methods: Twelve patients with oral lesions from the year 2010 to 2018 were histologically diagnosed as having tuberculosis, who did not give any history of the disease, following surgical biopsy. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Results: Oral TB was found in all 12 patients; 8 males and 4 females, with male to female ratio 8:4. Involved oral sites included the angle of the mandible (one case), right mandibular molar region (two cases), left mandibular molar region (four cases), gingiva (three cases), buccal mucosa (one case), and the tongue (one case). Oral TB patients in this series ranged in the age group of 6–65 years. All the lesions were suggestive of primary tuberculosis. The appearance of the affected mucosa in oral TB was variable. The most common manifestation was ulceration and swelling of the mucosa. Conclusion: TB should be considered in patients with oral ulcerations and swellings. A biopsy specimen for histological study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis along with other conditions.

Objectives: Systemic lupus erythematosus (SLE) is a prototype autoimmune disease with extreme clinical heterogeneity and significant differences between populations, genetic factors are highly involved in this disease, ulcerations of the oral cavity in the long setting of SLE have been considered as predictors of systemic vasculitis and worse prognosis, the aim of this study was investigate cluster of differentiation 34 (CD34) gene polymorphism among systemic lupus erythematosus (SLE) patients with and without oral ulceration and control in some Iraqi peoples. Materials and Methods: Study was took place in Mirjan teaching hospital in Hilla city, Babylon (Rheumatology unit) during the period from May 2018 till January 2019. All the subjects were from the same ethnic group (Arabic) and were from the same geographical region. The American College of Rheumatology (ACR) 1997 criteria of SLE were used for diagnosis by rheumatologist. A total of 53 patients were recruited for the study and 31 control subjects were recruited for this study, the manufacturer protocol (Geneaid / Taiwan) was followed for extraction of the DNA from frozen blood samples, Polymerase Chain Reaction and then single-strand conformational polymorphism was done. Results: The PCR product of CD34 gene amplification was 608 bp, and 59.5 ° C is the best temperature for target segment amplification. Eight haplotypes were observed in the present study (A,B,C,D,E,F,G and H) for CD34 gene polymorphism, with significant difference (p value 0.05)between control and SLE patients at all haplotypes except at haplotypes (B and C), the association among haplotypes according to oral ulcer types(single or multiple) was highly significant different (p =0.001) at haplotypes (B, D, E,G and H) and the association among haplotypes according to presence of oral ulcer pain was significant in haplotypes (A,C,D,E,G and H). Conclusion: this study found that CD34gene polymorphism different between SLE patient and controls. Related to oral ulceration in SLE most common in haplotypes except F, and there were differences between haplotypes according to ulcer type and presence of pain, Future prospective longitudinal studies with adequate sample size are needed in order to ascertain any causation factors or common etiologic pathways and other oral manifestations. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis (Tb) is a fatal infectious disease that primarily affects the pulmonary system and rarely occurs in other body organs including oral cavity. The aim of this study was to report all patients with primary manifestations of oral tuberculosis and to evaluate the clinical characteristics of oral tuberculosis lesions. All these patients were subsequently diagnosed with tuberculosis based on oral histological findings and referred for management and therapy. Materials and Methods: Twelve patients with oral lesions from the year 2010 to 2018 were histologically diagnosed as having tuberculosis, who did not give any history of the disease, following surgical biopsy. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Results: Oral TB was found in all 12 patients; 8 males and 4 females, with male to female ratio 8:4. Involved oral sites included the angle of the mandible (one case), right mandibular molar region (two cases), left mandibular molar region (four cases), gingiva (three cases), buccal mucosa (one case), and the tongue (one case). Oral TB patients in this series ranged in the age group of 6–65 years. All the lesions were suggestive of primary tuberculosis. The appearance of the affected mucosa in oral TB was variable. The most common manifestation was ulceration and swelling of the mucosa. Conclusion: TB should be considered in patients with oral ulcerations and swellings. A biopsy specimen for histological study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis along with other conditions. [ABSTRACT FROM AUTHOR]

Recurrent aphthous stomatitis is the most common chronic disease of the oral cavity. The basic etiology remains uncertain and no curative treatment is available. From the perspective of the clinical presentation, the recurrent aphthous stomatitis has three characteristic types, namely the minor type, the major type and the herpetiform type. Although the exact etiology is still unknown, potential triggers include: genetic predisposition, viral and bacterial infections, food allergies, vitamin and microelement deficiencies, systemic diseases, increased oxidative stress, hormonal defects, mechanical injury and anxiety. [ABSTRACT FROM AUTHOR]

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV, is a rare autosomal recessive condition. CIPA is caused by mutations in the NTRK1 gene, leading to the inability to feel pain and decreased or absent sweating (anhidrosis). The signs and symptoms of CIPA may not be easily diagnosed at birth, but repeated severe injuries or unintentional self-injurious behavior during infancy may prompt further investigation leading to a CIPA diagnosis. We present the case of an 18-month old child who was diagnosed with CIPA, after repeated visits to a hopsital's emergency department for serious tongue and finger biting, which prompted further investigation. [ABSTRACT FROM AUTHOR]

Pemphigus vulgaris (PV) is a group of autoimmune bullous diseases that results in multiple chronic mucocutaneous bullae, erosions, and/or ulcers presenting orally first. Several previous studies reported that viral infections, especially herpes simplex virus (HSV), may trigger activation of pemphigus. The relationship between PV and viral infection can be classified into 3 groups which are casual, such as viral infection due to a complication of immunosuppressive therapy, causal, HSV is a trigger before the pemphigus is present, and studies that were examined for HSV infection in PV patients but could not find any evidence. A 37-year-old male had a 4-week history of oral ulceration. Aphthous stomatitis was initially diagnosed, and was treated with chlorhexidine gluconate. Intraoral examination revealed multiple painful erosion with sloughing on the buccal mucosa, labial mucosa and dorsum of the tongue. Anti-HSV-1 IgG was reactive, while ANA test was not. Histopathology examination revealed suprabasal acantholysis. The patient was diagnosed with oral PV concurrent HSV. We used acyclovir, systemic and topical corticosteroids, chlorhexidine gluconate and multivitamin, as well aspharmacological therapy. Some lesion healed without any further clinical sequel within 6 months. The patient is still under observation without any sign of relapse. In this case, HSV was a trigger before the oral PV presented. It is important to know the relationship between oral PV and HSV in order to provide appropriate therapy to the patient and whether or not to use antiviral in oral PV therapy. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study was to determine probable HP infection in oral aphthous samples by RUT in patients with recurrent aphthous stomatitis. Materials and Methods: This in vivo cross-sectional study was approved by the Ethics Committee of Swami Devi Dayal Dental College and Hospital according to the ethical standards. A total of 30 patients with minor recurrent aphthous stomatitis and 20 healthy control groups were included in the study. Results: Out of 30 patients with minor recurrent aphthous stomatitis, including 17 male and 13 female patients, with mean age of 47 and 38 years respectively, 21 patients (70%) were RUT (positive). Out of 20 healthy control groups, 12 males and 8 females, 2 (10%) were RUT (positive) [Table 1]. Conclusion: HP may play a role in the etiology of RAS; also it is likely that RUT may be rapid and reliable for investigation of HP in RAS lesions.

Oral ulcerations are an extremely rare manifestation of Churg-Strauss Syndrome (CSS), which have not yet been documented as a potential prodromal sign of this multisystemic autoimmune vasculitis which may also involve the kidneys. The authors present a very rare case report of widespread oral ulcerations which preceded the onset of CSS with crescentic glomerulonephritis and persisted throughout the course of the disease. Oral manifestations included atypical clusters of oral aphthae and other lingual and mucosal ulcerations. The case demonstrates the disease spectrum and review of current understanding of this disease. The dentist may be the first health care professional to see patients with symptoms and findings of this condition. Definitive diagnosis is challenging owing to the subtle onset of the disease and variable clinical and laboratory findings. Clinicians should be informed about the possibility of oral manifestations of CSS to facilitate prompt disease recognition and to provide continued oral health care to these medically complex patients. Early diagnosis and treatment is the most important factor in the management of this potentially fatal disease as well as to promote quicker remission. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study was to determine probable HP infection in oral aphthous samples by RUT in patients with recurrent aphthous stomatitis. Materials and Methods: This in vivo cross-sectional study was approved by the Ethics Committee of Swami Devi Dayal Dental College and Hospital according to the ethical standards. A total of 30 patients with minor recurrent aphthous stomatitis and 20 healthy control groups were included in the study. Results: Out of 30 patients with minor recurrent aphthous stomatitis, including 17 male and 13 female patients, with mean age of 47 and 38 years respectively, 21 patients (70%) were RUT (positive). Out of 20 healthy control groups, 12 males and 8 females, 2 (10%) were RUT (positive) [Table 1]. Conclusion: HP may play a role in the etiology of RAS; also it is likely that RUT may be rapid and reliable for investigation of HP in RAS lesions. [ABSTRACT FROM AUTHOR]

Oral lesions can be a challenge to diagnose and treat. Talking, chewing, and swallowing cause friction within the mouth, making it difficult to determine the clinical appearance of the original lesion. Underlying health issues can also impact oral health so the patient health history, as well as the history and appearance of the oral lesions, is important to consider when diagnosing oral lesions. The patient presented here is a middle-aged man with oral lesions for 3 months, which severely impacted his life. This article allows the reader to identify a diagnosis based on information given, then discusses the differential diagnoses, and reveals the diagnosis and treatment plan. [ABSTRACT FROM AUTHOR]

Background: Cats with feline calicivirus (FCV)-related symptoms are commonly presented to veterinary practitioners. Various clinical manifestations have been attributed to FCV, i.e. upper respiratory tract disease (URTD), oral ulcerations, gingivostomatitis, limping syndrome and virulent systemic disease. Additionally, healthy cats can shed FCV. The aims of this study were 1) to investigate the frequency of FCV in cats with FCV-related symptoms and in healthy cats in Switzerland, 2) to assess risk and protective factors for infection, such as signalment, housing conditions, vaccination, and co-infection with URTD-associated pathogens, and 3) to address the association between clinical symptoms and FCV infection. Results: Oropharyngeal, nasal and conjunctival swabs were collected in 24 veterinary practices from 200 FCV-suspect and 100 healthy cats originating from 19 cantons of Switzerland. The samples were tested for FCV using virus isolation and reverse-transcription real-time quantitative polymerase chain reaction (qPCR) and for feline herpesvirus-1 (FHV-1), Mycoplasma felis, Chlamydophila felis, Bordetella bronchiseptica using real-time qPCR. Within the two populations (FCVsuspect/healthy), the observed PCR prevalences were: FCV 45 %/8 %, FHV-1 20 %/9 %, C. felis 8 %/1 %, B. bronchiseptica 4 %/2 %, M. felis 47 %/31 % and any co-infections thereof 40 %/14 %. Based on multivariable regression models amongst FCV-suspect cats (odds ratio [95 % confidence interval]), co-infection with M. felis (1.75 [0.97; 3.14]), group housing (2.11 [1.02; 4.34]) and intact reproductive status (1.80 [0.99; 3.28]) were found to be risk factors for FCV infection. In healthy cats, intact reproductive status (22.2 [1.85; 266.7]) and group housing (46.4 [5.70; 377.7]) were found to be associated with FCV infection. Based on an univariable approach, FCV-suspect cats were found to be significantly less often FCV-positive when vaccinated (0.48 [0.24; 0.94]). Oral ulcerations, salivation, gingivitis and stomatitis, but not classical signs of URTD were significantly associated with FCV infection (all p < 0.001). Conclusions: FCV was detected in less than half of the cats that were judged FCV-suspect by veterinary practitioners. For a clinical diagnosis, FCV-related symptoms should be revisited. FCV infection was present in some healthy cats, underlining the importance of asymptomatic carriers in FCV epidemiology. To reduce FCV-related problems in multicat environments, reduction of group size in addition to the generally recommended vaccination are advocated. [ABSTRACT FROM AUTHOR]

Orofacial granulomatosis is an uncommon disorder, but has been increasingly recognized in the past decade. It causes significant morbidity in the patient including oral ulcerations, enlargement of soft tissues which are often persistent and painful. This necessitates early medical intervention. We report one such case of a female patient who presented with a persistent upper lip enlargement. She had visited multiple general dental practitioners and general physicians but was undiagnosed. Ultrasonography proved an adjunctive tool in diagnosis. She was treated with a combination of topical and intra-lesional steroids. A 1 year follow-up did not show any evidence of recurrence. [ABSTRACT FROM AUTHOR]

Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease that initially manifests in the form of intraoral lesions, which spread to other mucous membranes and the skin. The etiology of pemphigus vulgaris is still unknown, although the disease has attracted considerable interest. The pemphigus group of diseases is characterized by the production of autoantibodies against intercellular substances and is thus classified as autoimmune diseases. Most patients are initially misdiagnosed and improperly treated for many months or even years. Dental professionals must be sufficiently familiar with the clinical manifestations of pemphigus vulgaris to ensure early diagnosis and treatment, since this in turn determines the prognosis and course of the disease. Here, we report a case of pemphigus vulgaris that was misdiagnosed in its earliest stage. [ABSTRACT FROM AUTHOR]

Crohn's disease is an inflammatory intestinal disease of unknown etiology. The disease primarily affects whites, with both sexes being affected equally. A genetic predisposition exists. Symptoms frequently present in the second to third decades of life, although they may present in the pediatric and/or geriatric populations. Oral lesions are significant as they are frequently reported to precede intestinal symptoms. Treatment of Crohn's disease is palliative, with a focus on remission. Pediatric and general dentists play a critical role in the early diagnosis of Crohn's disease. Evaluation of a pediatric patient with complaints of oral ulcerations, as well as gastrointestinal symptoms, fatigue, and/or weight loss requires prompt referral to a gastroenterologist for further evaluation for Crohn's disease. [ABSTRACT FROM AUTHOR]

Abstract Background: Measles is a highly contagious, viral infectious disease affecting mainly children and young adults. It is characterized by high fever, maculopapular rash, keratoconjunctivitis and pathognomonic oral Koplik's spots. Methods: During an outbreak of measles among soldiers in the Israeli military, patients were referred to one medical center where they were also examined for oral signs and symptoms of their illness. Results: We present a case of measles infection with distinct oral findings. These included Koplik's spots, various forms of ulcerations of the free mucosa, -like gingivitis and pericoronitis. All oral lesions resolved after cessation of systemic illness. Conclusions: The measles virus is associated with a transient inhibition of the host response. Immunosuppression may create the necessary condition for the proliferation of pathobacteria associated with the observed pericoronitis and the other gingival lesions. [ABSTRACT FROM AUTHOR]

A 33-year-old man presented with a two-week history of an asymptomatic ulcer of the oropharynx and submandibular lymph nodes swelling. Laboratory examinations were normal, but serological tests revealed positivity for rapid plasma reagin, Treponema pallidum haemagglutination assay and anti-T. pallidum IgM antibodies. Since the patient denied any homosexual relationship, a biopsy of the lesion was performed, which confirmed primary syphilis. The patient received an intramuscular injection of Benzathine Penicillin G (2.4 MU) with complete resolution of the lesion. Extragenital chancres occur in at least 5% of patients with primary syphilis, and the oral mucosa is the most frequent location as a consequence of orogenital/oroanal contact with an infectious lesion. Because of their transient nature, these oral ulcerations are often underestimated by the patient or by any unsuspecting clinician. Health professionals should consider the recent sexual history of their patients and should be prepared to recognise oral and systemic manifestations of sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Glycogen storage disease type 1b is a rare metabolic disorder which affects the transport system of glucose-6-phosphatase metabolism. As a result, hepatomegaly, failure to thrive, renal dysfunction and recurrent infections occur in affected patients. In this paper, the oral complications in three children with glycogen storage disease type 1b are discussed. Oral ulcers were a common finding, probably due to severe neutropenia and impaired neutrophil migration which characterises the onset of this rare disorder. [ABSTRACT FROM AUTHOR]

A rare case of severe Behçet's disease in a young patient is presented. The patient unnecessarily suffered from the devastating effects of the disease as a result of a delay in diagnosis, and consequently, initiation of the appropriate treatment. However, once a diagnosis was made, he was successfully treated with large doses of corticosteroids together with azathioprine, warfarin and aspirin. We highlight the importance of oral examination in diagnosing systemic diseases. [ABSTRACT FROM AUTHOR]