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OBJECTIVE: Lymphoma is a heterogenous group of malignant tumours with proliferation of lymphoid cells or their precursors. Lymphomas in the head and neck region are usually found in Waldeyer's ring. Intraoral lymphomas are rare and the clinical presentation and roentgenological appearance may resemble other and benign conditions, entailing a risk for diagnostic delay. The objective of the present literature review was to identify subjective symptoms, clinical presentations and roentgenological appearances which should raise suspicion of lymphoma. MATERIALS AND METHODS: = 567 cases) of intraoral lymphomas. Information of demographics, clinical presentation, subjective symptoms and roentgenological appearance was registered. RESULTS: The most common clinical presentation was a broad-based swelling or bulging mass with or without simultaneous ulceration, frequently with a relatively rapid growth pattern. Subjective symptoms varied considerably. Intraosseous lymphomas were frequently associated with paresthaesia or numbness. The most common roentgenological finding was a radiolucency with diffuse demarcation. CONCLUSIONS: The clinical presentation, symptomatology and roentgenological appearance of intraoral lymphomas varied. Diagnostic delay was usually associated with a lymphoma initially misdiagnosed as a lesion of dental aetiology or a reactive lesion. Inadequate healing after tooth extraction or symptoms of numbness or pain without obvious dental origin should merit further clinical and roentgenological examination. Biopsy is indicated when there is the slightest doubt of the true nature of mucosal lesion.

Objectives The aim of this study was to evaluate the need for dental treatment, compliance with post-radiation prophylactic care and incidence of long-term complications following radiotherapy to the head and neck. Methods The study is a retrospective analysis of dental records of patients referred for oral examination before radiation treatment to the head and neck between 2006 and 2016. Data of dental status and need for dental treatment before radiation therapy were used as baseline information. Dental records could be obtained from 126 patients (men n = 74; women n = 52). The mean time from completed radiotherapy to follow-up was 5.8 years (SD 2.9). Results The need for dental treatment was for the majority of patients relatively modest and mainly due to caries and fractures of teeth or fillings, but extensive need for dental treatment was noted in a few patients. One hundred and twenty-five out of 126 patients had complied with individual post-radiation prophylactic care programmes provided by the regular caregiver. Ninety-two out of 126 obtained dental records (73%) described hyposalivation and/or xerostomia. Osteoradionecrosis developed in 11 patients (8.7%), frequently requiring long-term treatment. Conclusions The results indicate that dental status may often be preserved if the patient is given regular information on oral hygiene and complies with prophylactic follow-up. Individual cases develop serious complications, and dental hygienists and dentists must be observant on early signs of rampant caries, trismus and osteoradionecrosis.

To study the prevalence and profile of thyroid disease in a cohort of referred patients with oral lichen planus (OLP) in comparison with a random population sample and to examine the clinical characteristics of OLP patients with and without thyroid disease.Data from 1611 patients with OLP and 1615 patients from the general population were collected by using a standardized registration method. Patients with OLP using levothyroxine (OLP/levothyroxine+) were re-examined to collect information about existing OLP lesions and to confirm the thyroid disease diagnosis. The clinical characteristics of OLP lesions in this group were compared with those in an age- and gender-matched population of patients with OLP without a history of thyroid disease or levothyroxine medication (OLP/levothyroxine-).Nearly 11% (n=170) of the patients with OLP were taking levothyroxine compared with 2.5% (n=40) of the controls (multivariate odds ratio 2.99, 95% confidence interval 2.03-4.44; P.0001). No difference was found in the thyroid disease profile between the groups. At the time of re-examination, patients with OLP/levothyroxine- displayed more erythematous OLP lesions and complained of more severe symptoms compared with the OLP/levothyroxine+ group (P.001).The prevalence of thyroid disease in patients with OLP was significantly higher than in the general population. The OLP lesions of patients with concomitant thyroid disease have a different presentation over time, which indicates a specific subgroup of OLP.

Whether psoriasis can manifest itself in the oral mucosa has been a matter of debate for many years. If an oral version of psoriasis exists, most researchers regard this manifestation as rare. The present report describes two patients who presented with lesions possibly related to cutaneous psoriasis. One patient had patchy erythematous lesions on the gingiva, and one had serpiginous lesions in the hard palate. We discuss these cases in relation to the existing literature, with special emphasis on the clinical and histopathologic criteria for the diagnosis of oral psoriasis.

The primary objective of this study was to investigate the association of systemic diseases, use of medications, allergies and tobacco habits with geographic tongue (GT) and fissured tongue (FT) lesions. The secondary objectives were to evaluate the clinical characteristics of tongue lesions and to compare the overall results for referred and non-referred patients.Non-referred patients with GT (GTgp; n = 130) and FT (FTgp; n = 62) were examined by general practitioners (gp) and compared to a control group without oral mucosal lesions (C; n = 1029). Referred patients with GT (GTs; n = 166) and FT (FTs; n = 15) were examined by oral medicine specialists (s) and compared to GTgp and FTgp. Statistical analyses were performed using unpaired t-test or Fisher's exact test. A multiple logistic regression model was developed to control for age and gender as confounders.Compared to the C group, GTgp patients used more anti-hypertensive medications and Swedish snus (p 0.01). The GTgp group consisted of older males (p 0.001) compared to C. Compared to the GTgp group, the GTs group was younger, more likely to have symptomatic lesions (p 0.0001) and comprised of more females. Among the groups examined, FT patients had the highest mean age.This study identified an association between GT and anti-hypertensive medications, as well as the use of Swedish snus. It also found differences in the activities and symptoms of the lesions between referred patients and their counterparts who were seen in general dental practice; these parameters influenced the results when these conditions were taken into account.

Objective To determine the levels of antithyroid antibodies and thyroid hormones in the sera of patients with oral lichen planus (OLP), and to quantify the expression of thyroid proteins in OLP lesions. Subjects and methods Venous blood samples were drawn from 110 patients with OLP who had no history of thyroid disease or levothyroxine supplementation (OLP+/LT4 -). A random population sample of 657 healthy subjects was used as the control group. Two additional groups were used as comparators. Immunohistochemical and qPCR analyses were performed on tissue specimens collected from the patients with OLP and thyroid disease and healthy subjects. Results No association was found between the presence of antithyroid antibodies and OLP. More patients in the OLP+/LT4 - group showed high levels of thyroid-stimulating hormone and low levels of free thyroxine than were seen in the control group. Thyroid-stimulating hormone receptor was more highly expressed in the OLP lesions of patients with thyroid disease than in the healthy oral mucosa. Conclusions A significant number of patients with OLP who are not previously diagnosed with thyroid disease have thyroid parameters that are compatible with hypothyroidism. The expression of thyroid-stimulating hormone receptor in OLP lesions suggests that mechanisms related to autoimmune thyroid disease are involved in the aetiology of OLP.

The implementation of information technology in healthcare is a significant focus for many nations around the world. However, information technology support for clinical care, research and education in oral medicine is currently poorly developed. This situation hampers our ability to transform oral medicine into a 'learning healthcare discipline' in which the divide between clinical practice and research is diminished and, ultimately, eliminated. This paper reviews the needs of and requirements for information technology support of oral medicine and proposes an agenda designed to meet those needs. For oral medicine, this agenda includes analyzing and reviewing current clinical and documentation practices, working toward progressively standardizing clinical data, and helping define requirements for oral medicine systems. IT professionals can contribute by conducting baseline studies about the use of electronic systems, helping develop controlled vocabularies and ontologies, and designing, implementing, and evaluating novel systems centered on the needs of clinicians, researchers and educators. Successfully advancing IT support for oral medicine will require close coordination and collaboration among oral medicine professionals, information technology professionals, system vendors, and funding agencies. If current barriers and obstacles are overcome, practice and research in oral medicine stand ready to derive significant benefits from the application of information technology.

Where have all the worms gone? Not too long ago, new malware was making its way around the world on a very regular basis. Headlines on technology sites excitedly and incessantly warned us about the wrath of Code Red, Slammer, Sober, Netsky, Nimda, ILoveYou and their equally oddly-named brethren. Happily it's been a while since a worm or virus paralysed systems on a wide scale. But unhappily, critical data has never been more at risk.

The etiology for many of the mucosal lesions we encounter in clinical practice is frequently uncertain or unknown and there is reason to believe that multicausality plays an important role. To detect multicausal relationships, the analysis must include multiple variables and large amounts of data. A traditional retrospective analysis is often based on a limited number of variables and frequently entails methodological errors where vital information may be missing. Prospective studies may be hampered by the fact that the prevalences of many conditions are relatively low. The search for new knowledge in oral medicine should therefore be facilitated by prospective use of formalized information gathered in multicenter studies. MedView is a computer program that is based on formalized input and registration of all clinical information. The output applications are focused on visualization and statistical analysis. MedView is aimed at clinical research and is well suited for multicenter studies. It also contains applications for education and distant consultations.

Oral lichen planus (OLP) is generally regarded as a premalignant condition. The objective of the present study was to assess the number of oral malignant tumours in a retrospective analysis of 1028 patients (mean age=55 years; range=18-86; female, n=667; men, n=351) who between 1978 to end of 1993 were diagnosed with OLP at the Faculty of Odontology, Goteborg University, Sweden. Patients with malignant tumours were identified through the Swedish Cancer Registry at the National Board of Health and Welfare, which annually reports the incidence of malignant neoplasms in the Swedish population. The incidence of oral squamous cancer (OSCC), other malignant tumours and survival in the study group was compared to the Swedish population. The total time with OLP in the study group amounted to 7009 person years, with a mean follow up of 6.8 years (SD=4.9). The observed incidence of OSCC was higher than the expected incidence in the study group. The difference was statistically significant (P

Previous studies have shown that local anaesthetics possess a wide range of effects on the pathophysiology of burns, including inhibition of burn oedema and inhibition of progressive burn ischemia. The present randomised double-blind cross-over study in six volunteers investigated the effects of intravenous lidocaine infusion on partial thickness skin burns. A thermoprobe was used to induce a standardised thermal injury (1 cm(2)) on the flexor side of one forearm and was repeated on the opposite side 1 week later. Subjects received either an intravenous bolus dose of lidocaine (1 mg kg(-1)) immediately after the thermal trauma followed by continuous intravenous infusion of lidocaine (40 microg kg(-1) min(-1)) during 4 h or equal volumes of isotonic saline. Macrophotographs of the experimental skin area were taken preburn and 1, 2, 3, 4, and 12 h postburn and evaluated by computerised image colour analysis using normalised rgb (n-rgb) and Hue-Saturation-Intensity (HSI) colour systems as a quantitative measure of pathophysiological events. Maximum erythema occurred 2-3 h postburn. Differences between lidocaine- and placebo-treated burns were not significant during the first 4 h postburn. At 12 h postburn, the lidocaine-treated burn demonstrated a significantly faster restitution of residual erythema compared to control sites. The present study shows that intravenous lidocaine significantly inhibits the long-term inflammation-induced tissue responses to thermal trauma.

Vascular changes following deep skin burns are characterised by vasoconstriction and progressive ischemia. Nitric oxide (NO) has been shown to be a potent regulator of vascular smooth muscle tone and tissue perfusion. We assessed the importance of NO on post-burn skin perfusion in rats using laser Doppler. The present results show that neither the NO-synthase inhibitor, NG-nitro- l -arginine ( l -NNA) ( n =6) nor the NO precursor, l -arginine, significantly influenced skin perfusion in nonburned skin compared to saline-treated animals. In the area of full-thickness skin burn, neither l -arginine ( n =6) nor l -NNA ( n =6) had significant influence on post-burn perfusion compared to saline-treated controls ( n =6). Administration of l -NNA ( n =6) significantly impaired skin perfusion in the area adjacent to the contact burn representing a partial-thickness burn, while the NO precursor, l -arginine ( n =6) had no significant effect on burn perfusion as compared to saline-treated controls ( n =6). In conclusion, impairment of perfusion in a full thickness burn following administration of NO-synthase inhibitor suggests that nitric oxide is involved in the mechanisms responsible for maintaining adequate circulation post-burn. The lack of additional improvement of perfusion in response to l -arginine may suggest that NO synthesis in response to the thermal trauma is already at a peak.

Burn injuries trigger a pronounced inflammatory response in the burned skin, resulting in oedema formation and impaired circulation. This response involves activation of the nitric oxide (NO) synthetic pathway, which could play a key role in the complex hemodynamic and hemostatic changes occurring as a result of a burn trauma. The results presented in full-thickness skin burns of rats show that the NO-precursor, L-arginine (n = 10), inhibit burn-induced plasma extravasation as compared to saline-treated burned controls (n = 10) (p

Server virtualisation offers many real benefits to enterprises, maximising hardware resources and providing significant cost and energy savings. But there is a downside: all of the security issues we battle on networked systems also plague virtual machines, along with a few brand new threats to data.

D-myo-inositol-1,2,6-triphosphate (1,2,6-IP3) has beneficial effects in experimental, progressive burn-induced ischaemia and oedema. A 1 cm2 full-thickness burn was made in the skin of 20 rats with a hot aluminium rod followed by infusion of 1,2,6-IP3 (60 mg.kg.-1 h-1) or isotonic saline (n = 10 in each group). One hour later Evans blue was injected intravenously. Colour photographs of the area of the burn were taken in a standard manner before the burn and at intervals for three hours afterwards. The photographs were analysed by digital image colour analysis using normalised red-green-blue values. The increase in normalised blue values between 60 and 180 minutes after the burn was significantly reduced in animals treated with 1,2,6-IP3 compared with control animals (p0.001). Spectrophotometric analysis of extravasated Evans blue in the skin 180 minutes after the burn showed that it had been significantly inhibited by treatment with 1,2,6-IP3 (p0.001). In conclusion, digital image analysis allowed repeated evaluation over time and confirmed previous data about the ability of 1,2,6-IP3 to inhibit extravasation of plasma after burns.

Background/aims: In the present study, a model for measuring the intensity of skin erythema by computer-assisted digital image analysis (DIA) was elaborated. The DIA technique was compared with laser Doppler perfusion imaging (PIM) to evaluate the relationship between erythema and skin perfusion. Methods: To produce erythema, three different types of nicotine patches (Nicotinell®, Nicorette® and Nicorette® placebo) were randomly applied ventrally on the upper arms for the time period recommended by the manufactures. After removal of the patches, colour photographs for subsequent DIA were taken and laser Doppler scanning for PIM was performed. The relationship between PIM and DIA was estimated intra- and inter-individually. Results/conclusions: A statistically significant linear correlation between PIM and DIA data was found, but the relationship was relatively weak. This may be explained by the fact that DIA and PIM are influenced by different physiological factors such as skin chromophores and velocity of moving cells. The results strengthen the theory that erythema and perfusion measurements reflect separate physiological phenomena and that the methods should be considered complements to each other in the experimental situation.

Objectives: To study the severity of symptoms and estimate the prevalence of oral mucosal lesions in a non-referral adult Swedish population, as registered by general dental practitioners. This study also aims to evaluate the possibi-lity of dental practitioners collecting large quantities of reliable and accurate clinical data on oral mucosal lesions. Study Design: Data from 6,448 adult Swedish patients were collected by general dental practitioners using a standardized registration method. A correlation analysis between a group with oral mucosal lesions and a control group, with no oral mucosal lesions, was performed for various parameters such as symptoms from the oral mucosa, systemic diseases, medication, allergy history, tobacco habits and the patient’s own assessment of their general health. In addition, clinical photos were taken of all oral mucosal lesions in order to determine the degree of agreement between the diagnoses made by general dental practitioners and those made by oral medicine specialists. Results: A total of 950 patients (14.7%) presented with some type of oral mucosal lesion and of these, 141 patients (14.8%) reported subjective symptoms. On a visual analogue scale, 43 patients (4.5%) scored their symptoms

174 patients referred to the Department of Oral and Maxillofacial Surgery, Central Hospital, Karlstad, Sweden during 1987 to 1989 for lichenoid lesions and evaluation of a possible connection with amalgam restorations were invited to a clinical re-examination. 159 of the patients were re-examined with the purpose of evaluating the long-term effect upon performed substitution therapy. Partial or total removal of amalgam had been recommended according to a set of given criteria. The re-examination showed that 62 patients had performed partial and 69 patients total removal of amalgam fillings. 28 patients had not performed any substitution therapy. There was a difference between recommended and performed therapy. The results demonstrated that 92% of patients with lichenoid lesions only in contact with amalgam fillings healed or improved clinically following removal of amalgam. No statistical difference was found in healing between patients who only removed fillings in contact and those who had removed all amalgam restorations. More than 60% of buccal lichenoid lesions without contact with amalgam at time of referral disappeared following amalgam substitution. Gingival lichenoid lesions did not respond to substitution of amalgam to another material. 3 out of 17 patch-tested patients demonstrated a hyper-sensitivity reaction to mercury. All lichenoid lesions in these patients healed following total substitution. Partial or total removal of amalgam fillings was also performed on 10 patients with completely negative patch-tests. 6 out of these patients demonstrated complete healing of their lichenoid reactions at re-examination. The lichenoid reaction is to be regarded as a reaction pattern within the oral mucosa directed towards a specific agens in patients predisposed to develop such a reaction. Dental amalgam plays an etiological role in the development of lichenoid reactions and should be removed when in clinical contact with the lichenoid lesion. Total removal of amalgam may also be tried in other cases in patients with long-standing atrophic or erosive lesions where other therapy forms have been tried with poor clinical result.

Background Several drugs have been regarded as a possible aetiological factor for oral lichen planus (OLP). Objective To investigate the medication profile of patients with OLP and its possible association with the pathogenesis of OLP. Methods Data from 956 patients with OLP and 1029 controls were collected using a standardized registration method. All regular medications were recorded and classified according to the Anatomical Therapeutic Chemical Classification System. Results Patients with OLP used thyroid preparations (P

To improve diagnostic procedures and facilitate clinical decision-making, computer-assisted image analysis was performed on color slides from 30 patients with histopathologically verified oral lichenoid reactions. Areas from white hyperkeratotic and adjacent red inflamed areas of the lesions were selected and subjected to image analysis. The digitization of the color slides was done by means of an image scanner, and the digital information was transmitted to a personal computer for subsequent feature extraction and analysis. The different oral lesions were characterized as the difference in mean values between white hyperkeratotic and red inflamed areas, respectively, compared with clinically normal tissue. Statistical analyses were made on three different color systems: Red-Green-Blue (RGB), normalized red-green-blue (rgb), and Intensity-Hue-Saturation (IHS). The results showed statistically significant differences in all color systems for both the hyperkeratotic areas and adjacent inflammatory reactions. A linear correlation was obtained when the results of the image analysis of color variations were compared with a clinical score system for hyperkeratosis and inflammation evaluated by two investigators independently.

Aim: Orofacial granulomatosis (OFG) is a rare clinical entity with orofacial swelling in association with oral lesions such as mucosal oedema, ulcerations and mucosal tags. The aim of this prospective study was to evaluate the connection between OFG in childhood and systemic disease. Methods: During a 3-year period, eight children (9–16 years old) who had been referred to the clinic of oral medicine were diagnosed solely with OFG. Thus, none of them had any known systemic disease or gastrointestinal symptoms at the time of referral. The children were then medically examined and followed up for 6–8 years at the department of paediatrics for systemic disease with specific emphasis on inflammatory disorders elsewhere in the gastrointestinal tract. Results: During follow-up, four patients were diagnosed with Crohn's disease (CD). Further, one girl was found to have a food allergy-induced OFG, with delayed-type hypersensitivity to oats. One boy developed both diabetes and celiac disease during the follow-up. Only two patients had no diagnosis of systemic disease at the end of the observation period. Conclusion: OFG in childhood seems to be frequently related to systemic disease, and children with OFG should be referred to a paediatrician for examination and follow-up.

There has been a continuous debate regarding the possible malignant potential of oral lichen planus (OLP). Based on the results from follow-up studies, OLP is regarded by several authors as a pre-malignant condition, and patients with OLP have been recommended to have their lesions monitored two to four times annually. This recommendation needs reconsideration, because a recall system of all patients with OLP requires substantial economic resources. In a reality where such resources are limited, a recall system must be weighed against other benefits and the fact that the malignant potential of OLP is most likely very low. The present review focuses on the diagnostic criteria for OLP, the pre-malignant potential of OLP, and the extent to which the available information can be used to reduce morbidity and mortality of oral cancer related to OLP.

Different shape representation and classification methods for complex medical lesions were compared using oral lesions as a case study. The problem studied was the discrimination between potentially cancerous lesions, called leukoplakia, and other usually harmless lesions, called lichenoid reactions, which can appear in human oral cavities. The classification problem is difficult because these lesions vary in shape within classes and there are no easily recognizable characteristics. The representations evaluated were the centroidal profile function, the curvature function, and polar and complex coordinate functions. From these representations, translation, scale and rotation independent features were derived using Fourier transformations, auto-regressive modeling, and Zernike moments. A nonparametric kNN classifier with the leave-one-out cross-validation method was used as a classifier. An overall classification accuracy of about 84% was achieved using only the shape properties of the lesions, compared with a human visual classification rate of 65%. The best results were obtained using complex representation and Fourier/Zernike methods. In clinical practice, the preliminary diagnosis is based mainly on the visual inspection of the oral cavity, using both color, shape and texture as differentiating parameters. This study showed that machine analysis of shape could also play an important part in diagnosis and decisions regarding future treatment.

A shape-based classification method is developed based upon the Generalized Fourier Representation (GFR). GFR can be regarded as an extension of traditional polar Fourier descriptors, suitable for description of closed objects, both convex and concave, with or without holes. Explicit relations of GFR coefficients to regular moments, moment invariants and affine moment invariants are given in the paper. The dual linear relation between GFR coefficients and regular moments was used to compare shape features derive from GFR descriptors and Hu's moment invariants. the GFR was then applied to a clinical problem within oral medicine and used to represent the contours of the lesions in the oral cavity. The lesions studied were leukoplakia and different forms of lichenoid reactions. Shape features were extracted from GFR coefficients in order to classify potentially cancerous oral lesions. Alternative classifiers were investigated based on a multilayer perceptron with different architectures and extensions. The overall classification accuracy for recognition of potentially cancerous oral lesions when using neural network classifier was 85%, while the classification between leukoplakia and reticular lichenoid reactions gave 96% (5-fold cross-validated) recognition rate.© (2000) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.