Faculty Bibliography

Melanoacanthoma is a rare, benign, mucocutaneous pigmented lesion characterized by colonization of acanthotic epithelium by dendritic melanocytes.(1,2) The most common intraoral sites are the buccal(3,4) and masticatory mucosa subject to chronic irritation.(1,5) The pathogenesis of oral melanoacanthoma remains uncertain, although its clinical behavior is suggestive of a reactive cause.(3,4,6,7) The clinical appearance of melanoacanthoma is nondiagnostic, and biopsy is mandatory.(2,3,5,6,8) The lesion, however, requires no treatment(5) and elimination of local irritants as well as periodic observation are the recommended interventions.(1,8) We describe a 39-year-old black patient with a recently reported palatal melanoacanthoma who developed additional lesions in other intraoral sites approximately 3 months after the initial lesion was biopsied. This article also documents the reactive and reversible nature of intraoral melanoacanthoma in a rare case of multiple lesions.

We describe a case of a soft tissue neoplasm in the infraorbital region of a 31-year-old African-American man that met histologic and immunohistochemical criteria for solitary fibrous tumor. This uncommon spindle cell neoplasm was first described in the pleura, but it has since been reported in many other soft tissue locations. The lesion was locally aggressive and successfully treated by local excision. Solitary fibrous tumor can be locally destructive and can occur in a wide variety of tissues or organs; this is the seventh published case of solitary fibrous tumor in the orofacial region.

OBJECTIVE: Some patients diagnosed with chronic fatigue syndrome (CFS) have symptoms commonly observed in Sjogren's syndrome (SS), particularly xerophthalmia and xerostomia, leading to speculation that some patients with CFS might have primary SS or that the 2 disorders share common pathophysiological features. We investigated the prevalence of symptoms of mucosal dryness, salivary gland pathology, lacrimal hyposecretion, and autoantibodies (antinuclear antibody, SSA/SSB) among patients diagnosed with CFS. METHODS: Twenty-five subjects with CFS and 18 healthy control subjects were interviewed and examined, had a Schirmer test and fluorescein tear dilution, and underwent minor salivary gland (MSG) biopsy. Antibody to nuclear antigen as well as anti-La (SSA) and anti-Ro (SSB) antibody were available for subjects with CFS. Pathologists unaware of the subject group assignment examined labial salivary gland biopsy specimens and calculated a standard MSG score for each specimen. RESULTS: Mucosal dryness was reported by 13/25 (52%) subjects with CFS, of which 8 (32%) also had MSG score, low Schirmer test value, and symptoms consistent with primary SS (p = 0.05). No control subject met diagnostic criteria for primary SS. MSG focus scores < or =1 were common among both groups (CFS 14/25; controls 15/18). MSG results without pathological alteration were rare, seen in only one control and no CFS patients. Low Schirmer values were found in 10/25 (40%) CFS patients and 1/18 (6%) control (p = 0.01). CONCLUSION: A subset of patients with CFS may have primary SS.

OBJECTIVE:The purpose of this article is to provide oral care providers evidence of oral conditions and medical compromise that is impacting the oral health and oral health needs of the public. DESIGN/METHODS:Data were analyzed based on current epidemiologic data, derived in large part from the Health and Nutrition Examination Surveys, the National Center for Health Statistics, National Health Interview Survey Series 1994-1997; American Cancer Society, National Cancer Institute Surveillance Examination and End Results data base, Morbidity and Mortality Weekly Reports, peer-reviewed publications, and surveys of oral medicine-related disorders. RESULTS:Millions of Americans have medical conditions that complicate their oral health care. Oral health problems associated with age, medical health and treatment, and institutional setting are increasing. Chronic orofacial pain, persistent oral soft tissue lesions, and salivary gland and chemosensory disorders are common problems of modern society. CONCLUSIONS:Evidence suggests that the next decade will bring a significantly increased demand for diagnosis and management of patients with oral conditions and patients with oral manifestations of systemic conditions, and an increase in general oral care needs of patients who are medically compromised. These increasing demands should be reflected in dental education and continuing education.

Systemic sclerosis is a multi-system disorder characterized by abundant fibrosis of the skin, blood vessels, and visceral organs. Although resorption of the mandible has been commonly observed and reported, we found no report of resorption leading to a painful neuropathy of the inferior alveolar nerve. We report a case of a patient with systemic sclerosis, severe resorption of the angles, and inferior alveolar border of the mandible, resulting in a compression neuropathy of the inferior alveolar nerve. Diagnostic tests, medical treatment, and surgical treatment are discussed, and the relevant literature is reviewed.

BACKGROUND: Pemphigus vulgaris, or PV, is a potentially life-threatening illness that manifests itself initially in the mouth in the majority of patients. Paradoxically, it is less commonly recognized when it involves lesions on the oral mucosa rather than on the skin. CASE DESCRIPTION: This article describes the clinical presentation of 42 cases of oral PV evaluated and diagnosed by dentists. Emphasis is placed on the common distribution and appearance of oral PV lesions and diagnosis of the disease. CLINICAL IMPLICATIONS: The dentist has a unique opportunity to recognize the oral presentation of PV and contribute to an early diagnosis and, therefore, an improved treatment outcome.