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Abati S, Sandri GF, Finotello L, Polizzi E. Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review. Cancers (Basel) 2024; 16:2487. [PMID: 39001549 PMCID: PMC11240708 DOI: 10.3390/cancers16132487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
This paper examines the clinical differentiation of pigmented lesions in the oral mucosa, which poses significant diagnostic challenges across dental and medical disciplines due to their spectrum from benign to potentially malignant conditions. Through a literature review and analysis of clinical cases, this study clarifies current diagnostic methodologies, with an emphasis on differential diagnosis, to provide a practical guide for clinicians. The classification of pigmented lesions, such as endogenous, focal melanocytic, and multifocal pigmentation, based on clinical and histological features, highlights the necessity for a structured and informed approach. A retrospective examination of cases from our oral medicine and pathology clinic, coupled with analysis of photographic and histological records, aids in classifying these lesions. This fosters a better understanding and promotes informed discussions among clinicians, ultimately aiming to enhance early and precise diagnosis, thus improving patient management and outcomes.
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Affiliation(s)
- Silvio Abati
- Clinical Unit of Oral Medicine and Pathology, Dental School, IRCCS San Raffaele Hospital and University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Giacomo Francesco Sandri
- Clinical Unit of Oral Medicine and Pathology, Dental School, IRCCS San Raffaele Hospital and University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Leonardo Finotello
- Clinical Unit of Oral Medicine and Pathology, Dental School, IRCCS San Raffaele Hospital and University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Elisabetta Polizzi
- Center for Oral Hygiene and Prevention, Dental School, IRCCS San Raffaele Hospital and University Vita-Salute San Raffaele, 20132 Milan, Italy
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2
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Goenka S. Comparative evaluation of six commercial adult toothpaste formulations reveals cytotoxicity and altered functions in a human oral melanocyte model: an in vitro study. Odontology 2024:10.1007/s10266-024-00957-7. [PMID: 38822982 DOI: 10.1007/s10266-024-00957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
This study aims to compare six commercial adult toothpaste (labeled as A, B, C, D, E, and F) for cytotoxicity and melanocyte function alterations in vitro using primary human epidermal melanocytes from a Caucasian donor (HEMn-LP cells) as a model of oral melanocytes. Cells were incubated with toothpaste extracts (50% w/v) in culture media at dilutions (1:25, 1:50, 1:100, 1:200, 1:500, 1:800, and 1:1000) for 24 h. MTS and LDH assays were used to assess cytotoxicity. The effects of noncytotoxic toothpaste concentrations on melanocyte functional endpoints were then examined using spectrophotometric methods. All toothpaste showed concentration-dependent cytotoxicity that was heterogeneous across toothpaste containing SLS detergent. IC50 values of cytotoxicity followed the order: A = E > C > B > D > F. To compare toothpaste, they were tested at 1:800 and 1:1000 dilutions that were noncytotoxic after 24 h. None of the toothpaste affected cellular melanin production. However, toothpaste A, C, and D suppressed tyrosinase activity at both dilutions, while toothpaste B suppressed tyrosinase activity only at 1:800 dilution. Toothpaste A, C, E, and F elevated ROS production at 1:800 dilution, with no change at 1:1000 dilution. Toothpaste has a heterogeneous effect on melanocytes. Toothpaste B, E, and F at 1:1000 dilution were the safest as they did not alter melanocyte functions at this dilution, although toothpaste F is the least cytotoxic of these. Future studies are necessary to expand these results in a physiological environment of oral tissue. The findings of this study provide novel insight into the biocompatibility studies of toothpaste on oral melanocytes. They can aid dental practitioners and consumers in selecting noncytotoxic toothpaste that do not contribute to ROS generation by melanocytes in the oral cavity or lead to cytotoxicity and impaired cellular function.
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Affiliation(s)
- Shilpi Goenka
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, 11794-5281, USA.
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
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3
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Zisis V, Papadopoulos P, Anagnostou E, Andreadis D, Poulopoulos A. Citalopram-Induced Oral Melanotic Macules in a Female Patient and a Review of the Literature. Cureus 2024; 16:e60889. [PMID: 38910786 PMCID: PMC11193105 DOI: 10.7759/cureus.60889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Pigmented lesions in the oral cavity can arise from the accumulation of external substances or internal pigments, resulting in black or brown discoloration. The etiology can be categorized as physiologic, reactive, neoplastic, idiopathic, or indicative of systemic illness. Several systemic drugs have been linked to the development of oral and/or cutaneous pigmentation, either by stimulating the production of melanin or by the accumulation of the drug or its byproducts. The medications most commonly associated with this condition include antimalarials, hormones, oral contraceptives, phenothiazines, chemotherapeutics, amiodarone, minocycline, zidovudine, clofazimine, and ketoconazole. The aim of this case report is to illustrate the drug-induced appearance of multiple melanotic macules in an 89-year-old female patient. The patient was referred to the Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, complaining of the recent and constant appearance of black spots in her oral cavity. Her medical history revealed a multitude of prescribed drugs, with citalopram being the most recently prescribed one, approximately one year prior to the examination. The clinical examination revealed multiple melanotic macules, on the upper and lower lip as well as on the hard and soft palate. Based on these findings, a biopsy of a melanotic macule of the lip was carried out. The histopathological examination showed that the basal layer of the stratified squamous epithelium exhibited hyperpigmentation (melanin-pigmented basal cells). In addition, scattered melaninophages were noted in lamina propria. Psychotropic drugs associated with cutaneous hyperpigmentation include citalopram. Therefore, our case constitutes an exception since citalopram induced intraoral and perioral, instead of cutaneous, hyperpigmentation.
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Affiliation(s)
- Vasileios Zisis
- Oral Medicine/Pathology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Petros Papadopoulos
- Oral Medicine/Pathology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Dimitrios Andreadis
- Oral Medicine/Pathology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Mahayni M, Kujan O, Hamadah O. Aesthetic Gingival Melanin Pigmentation Treatment in Smokers and Non-Smokers: A Comparison Study Using Nd:YAG Laser and Ceramic Bur. J Pers Med 2023; 13:1034. [PMID: 37511647 PMCID: PMC10381627 DOI: 10.3390/jpm13071034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/28/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Aesthetic concerns are increasing rapidly; thus, several approaches have been suggested for treating gingival melanin pigmentation. Lasers have been reported as an effective new tool, and the Nd:YAG laser beam has an affinity for melanin and haemoglobin. However, ceramic gingival bur is simple and has less bleeding effect during operation than conventional techniques. This study aimed to compare the outcomes of gingival depigmentation using the Nd:YAG laser and ceramic bur in two different groups (smokers and non-smokers). A total of 40 patients presenting with gingival melanin pigmentation were enrolled in this split-mouth study. The sample was divided into two groups: smokers and non-smokers. Treatment was performed using the Nd:YAG laser (3 W, 60 mJ/pulse, and 50 Hz) and ceramic bur with a one-week interval between the two methods. Clinical indices were recorded, including intraoperative bleeding, wound healing, post-operative pain, and the recurrence of pigmentation, and follow-up periods were determined in the 3rd, 6th, and 9th months postoperatively. Both treatments promoted a similar pain experience and recurrence rate of pigmentation (p > 0.489, p = 1.000, respectively). Bleeding during surgery and complete healing recovery after one week were statistically significantly higher when using ceramic bur (p = 0.00, p = 0.041, respectively). Concerning the effect of smoking on the treatment, a higher recurrence rate was observed in SG than N-SG in laser sites (50%, and 95%, respectively) and bur sites (60%, and 85%, respectively), but statistically no significant difference was observed (p > 0.080). In conclusion, both procedures are adequate for aesthetic gingival depigmentation treatment. The Nd:YAG laser showed greater effectiveness in controlling bleeding, while ceramic bur showed a faster clinical recovery. Furthermore, smokers were more likely to have low depigmentation treatment stability.
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Affiliation(s)
- Massa Mahayni
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, 17 Monash Avenue, Nedlands, WA 6009, Australia
| | - Omar Hamadah
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria
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Tavares TS, Da Costa AAS, Aguiar MCF, Loyola AM, Barcelos NS, Abreu MHNG, Mesquita RA, Tarquínio SBC, De Moraes Ê, Vasconcelos ACU, Costa NL, Mendonça EF, Cardoso SV, Nonaka CFW, Andrade ADO, Johann ACBR, Michels AC, Libório-Kimura TN, Neto GOP, Caldeira PC. Differential diagnoses of solitary and multiple pigmented lesions of the oral mucosa: Evaluation of 905 specimens submitted to histopathological examination. Head Neck 2021; 43:3775-3787. [PMID: 34519124 DOI: 10.1002/hed.26872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim was to analyze the frequency, clinical and demographic features of solitary and multiple/diffuse oral pigmented lesions submitted to histopathological examination, and to summarize the features that guide the clinical differential diagnosis. METHODS Clinical and demographic data were retrieved from biopsy records and descriptive statistics were performed. RESULTS Nine hundred and five (0.51%) oral pigmented lesions were retrieved among 177 356 specimens, being 95.9% solitary and 4.1% multiple/diffuse lesions. Regardless the overlapping clinical presentation, age, site, association with amalgam restoration, and a nodular appearance may help in the clinical differential diagnosis of solitary oral pigmentations. Patient's habits, site, and systemic signs and symptoms are helpful in the clinical differential diagnosis of multiple/diffuse lesions. CONCLUSIONS Oral pigmented lesions are a rare diagnosis in oral pathology and solitary lesions are more commonly submitted to biopsy. Some key features help in the differential diagnosis, though biopsy can be warranted in doubtful cases.
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Affiliation(s)
- Thalita Soares Tavares
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Maria Cássia Ferreira Aguiar
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriano Mota Loyola
- Area of Pathology, School of Dentistry, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Natália Santos Barcelos
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Êmile De Moraes
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Nádia Lago Costa
- Department of Stomatology (Oral Medicine and Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Elismauro Francisco Mendonça
- Department of Stomatology (Oral Medicine and Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Sérgio Vitorino Cardoso
- Area of Pathology, School of Dentistry, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | | | | | | | - Arieli Carini Michels
- Department of Dentistry, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Gerson Oliveira Paiva Neto
- Department of Pathology and Forensic Medicine, School of Medicine, Universidade Federal do Amazonas, Manaus, Brazil
| | - Patrícia Carlos Caldeira
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Radhakrishnan S, Santhosh K, Anbuselvan GJ, Kanthasamy G. A Focal Intrinsic Physiologic Pigmentation of Tongue. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S878-S880. [PMID: 34447221 PMCID: PMC8375959 DOI: 10.4103/jpbs.jpbs_745_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 01/11/2023] Open
Abstract
Pigmentation is defined as the process of deposition of pigments in the tissues. It can be endogenous or exogenous in origin and may be physiological or pathological. Pigmentation is a common intraoral finding; various diseases can lead to varied discolorations of the mucosa. Diagnosis of pigmented lesions of the oral cavity is a challenging task, therefore understanding of the causes of mucosal pigmentation and appropriate evaluation of the patient are essential in the diagnosis of the pigmented lesions.
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Affiliation(s)
| | - Kalaiselvi Santhosh
- Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India
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Houlihan OA, Rangaswamy G, McArdle O. A rare case of melanotic hyperpigmentation of the tongue secondary to radiotherapy. Rep Pract Oncol Radiother 2021; 26:320-323. [PMID: 34211784 DOI: 10.5603/rpor.a2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Melanotic hyperpigmentation of the mucosa secondary to radiotherapy is a rare occurrence. It is a diagnosis of exclusion. Literature review has identified only two case reports published to date. We present a case of a patient treated at our institution. An 18-year-old male patient of Nigerian descent underwent radical radiotherapy (36 Gy in 18 daily fractions) to his right neck for paediatric type follicular lymphoma over a period of four weeks. He developed hyperpigmented tongue lesions during the third week of radiotherapy. There was no associated tongue discomfort, inflammation, infection, or pigmentation change elsewhere in the oral mucosa. Review of medications and past medical history did not demonstrate any potential contributing factors. Full blood count and biochemistry, morning cortisol levels and coagulation screen were all normal apart from mild neutropenia and lymphopenia. His oral cavity received a mean dose of 16.4 Gy, with the right side of his tongue receiving up to 37.5 Gy as this was within the planning target volume (PTV). He had an excellent response to radiotherapy and remains in remission. The tongue lesions resolved spontaneously 3 months post treatment.
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Affiliation(s)
| | | | - Orla McArdle
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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8
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Kawar NI, Alrayyes SM, Khuzam M, Haddad JR, Tilwani SK. Gingival Sculpting-A Simple Gingival Depigmentation Technique using Bur Abrasion and Scalpel Combined: A Case Report. Clin Adv Periodontics 2021; 11:145-149. [PMID: 33538102 DOI: 10.1002/cap.10148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dentofacial esthetics demands have increased tremendously in the past decade. Psychological impact of unsatisfactory esthetic appearance can manifest in decreased sense of self-esteem and can negatively affect social and professional interactions. Esthetic awareness of dental patients has extended to include requests of gingival color modification. Gingival pigmentation can be physiological due to ethnic pigmentation or can be a result of various pathological processes. Different surgical modalities, tools and materials have been used in management of gingival pigmentation. This case report is introducing a simple, cost effective, minimally invasive technique of gingival sculpting for the purpose of significantly reducing gingival pigmentation. CASE PRESENTATION A healthy 32-year-old male patient presented with a chief complaint of gingival pigmentation that is causing him distress and low self-esteem. Gingival sculpting technique was used. This simple technique uses a combination of two methods, bur abrasion and scalpel blade with copious irrigation. The procedure resulted in minimal intra and postoperative complications and excellent esthetic results achieved instantly and maintained at 3 months postoperatively. High patient esthetic satisfaction was achieved. CONCLUSION Gingival sculpting is minimally invasive procedure that can be performed at any dental office. It renders excellent esthetic results using minimal chair time and down time for the patient. It is well tolerated by the patient with minimal bleeding, postoperative pain, and rapid healing time. Long-term follow-up is needed to ensure stability and lack of recurrence.
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Affiliation(s)
- Nadia I Kawar
- College of Dentistry, Periodontics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sahar M Alrayyes
- Department of Pediatric Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maher Khuzam
- College of Liberal Arts, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jacob R Haddad
- College of Liberal Arts, Benedictine University, Lisle, Illinois, USA
| | - Sunny K Tilwani
- College of Dentistry, Periodontics, University of Illinois at Chicago, Chicago, Illinois, USA
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9
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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Oral and nail pigmentations: a useful parallelism for the clinician. J Dtsch Dermatol Ges 2020; 18:7-14. [PMID: 31951106 DOI: 10.1111/ddg.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
Abstract
Oral (OP) and nail (NP) pigmentations may occur simultaneously in physiological or pathological conditions, and may be a sign of underlying syndromic conditions that necessitate further investigation and treatment. Interestingly, the nail unit and oral cavity show a clinical parallelism that may help the clinician to conduct a correct examination and reach a prompt diagnosis. Both OP and NP can manifest clinically with focal or diffuse involvement and are due to external factors (exogenous pigmentation, drug-induced pigmentation) or endogenous factors (racial pigmentation, post-inflammatory pigmentation, nevi, genetic conditions and other disorders). The most concerning differential diagnosis is melanoma. Here we report the pathogenetic basis of OP and NP, together with the description of similar clinical features. To the best of our knowledge this is the first paper to summarize and describe the causes of pigmentation of both the oral cavity and the nail unit.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Veronesi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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10
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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Orale und Nagelpigmentierungen: eine für den Kliniker nützliche Parallelität. J Dtsch Dermatol Ges 2020; 18:7-16. [DOI: 10.1111/ddg.14023_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Emi Dika
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Michela Starace
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Martina Lambertini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Annalisa Patrizi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Giulia Veronesi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Aurora Alessandrini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Bianca Maria Piraccini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
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11
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Nair V. Laugier-Hunziker syndrome: complete clearance of mucosal lentigines with a single session of Q-Switched Nd:YAG laser. J COSMET LASER THER 2019; 21:343-345. [PMID: 31476932 DOI: 10.1080/14764172.2019.1660791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Laugier-Hunziker (LH) syndrome is a rare condition in which melanocyte overactivity produces lentiginous lesions of the lips and buccal mucosa. Objective: Given the paucity of reports on therapeutic options in LH syndrome, this case is herein reported to show the response to treatment with the Q-Switched Nd:YAG laser in a 32-year-old man with LH Syndrome. Methods: The Q-Switched Nd:YAG laser was used to treat the lentiginous lesions on the mucosal surface of the lower lips using a single pass at 532 nm. Results: There was complete clearance of the mucosal lentiginous lesions with a single laser session, and recurrence was not observed after 12 months. Conclusion: The Q-Switched Nd:YAG laser is an effective treatment option for cosmetic benefit in LH Syndrome.
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Affiliation(s)
- Vivek Nair
- Dr Nair's Skin Clinic & Hair Transplant Centre , Gurgaon , India
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12
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Maymone MB, Greer RO, Burdine LK, Dao-Cheng A, Venkatesh S, Sahitya PC, Maymone AC, Kesecker J, Vashi NA. Benign oral mucosal lesions: Clinical and pathological findings. J Am Acad Dermatol 2019; 81:43-56. [DOI: 10.1016/j.jaad.2018.09.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023]
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13
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Kawasaki G, Yoshitomi I. Effect of dioxin-related compounds on oral pigmentation in patients affected by the Yusho incident. Arch Oral Biol 2019; 102:244-248. [PMID: 31085466 DOI: 10.1016/j.archoralbio.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/05/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND/AIM Toxins such as polychlorinated biphenyls (PCBs) and dioxins dramatically affect patients even decades after exposure. Patients with Yusho, a condition caused by exposure to PCBs and dioxins, have diverse mental and physical complaints, even though it is almost 50 years since the Yusho incident. Oral pigmentation is one of the major symptoms in Yusho patients. PATIENTS AND METHODS A total of 183 participants in the Yusho health study were examined. Oral examinations, including recording the prevalence of oral pigmentation, were performed by two oral surgeons. Demographic and clinical characteristics, including blood concentration of PCB and 2,3,4,7,8-pentachlorodibezofuran (2,3,4,7,8-PeCDF), which are the major causes of Yusho, were obtained from the results of recent surveys conducted by the Yusho Study Group. RESULTS The mean serum PCB and 2,3,4,7,8-PeCDF levels of the 183 Yusho patients were 1.59 ± 1.25 ppb and 29.0 ± 42.9 pg/g lipid, respectively. There was a significant correlation between the levels of PCB and 2,3,4,7,8-PeCDF (r = 0.64, p < 0.01). The rate of oral pigmentation in Yusho patients (25.7%) was significant higher than among potential victims of Yusho (13 of 183, 7.1%) (p < 0.05). CONCLUSION The prevalence of oral pigmentation was still significantly higher in Yusho patients, even 50 years after exposure, although blood PCB levels have decreased in that time.
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Affiliation(s)
- Goro Kawasaki
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Izumi Yoshitomi
- Department of Oral Surgery, Isahaya General Hospital, Isahaya, Japan
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14
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Rosebush MS, Briody AN, Cordell KG. Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa. Head Neck Pathol 2019; 13:47-55. [PMID: 30671761 PMCID: PMC6405786 DOI: 10.1007/s12105-018-0980-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 01/14/2023]
Abstract
Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.
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Affiliation(s)
- Molly S. Rosebush
- Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
| | | | - Kitrina G. Cordell
- Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
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15
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Le Donne M, Bodard AG, Lesage C, Fleury B. Oral manifestations of a sinus melanoma: case report and literature review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Mucosal melanoma (MM) is a rare malignancy of the head and neck. Sinonasal melanomas are the most frequent, followed by oral melanomas. Observation: A 67-year-old patient with a known left sinus melanoma initially treated with immunotherapy was referred for consultation concerning mobile teeth. A pigmented lesion infiltrating the left maxillary arch in the molar area was detected. The malignancy had invaded the oral mucosa. Despite many proposed treatments (immunotherapy, chemotherapy, and radiotherapy), the patient showed metastatic progression, which resulted in death. Discussion: Sinus MMs are malignancies with poor prognosis because these are often diagnosed in the late stages of disease progression. As these tumors are rare, there is no treatment consensus and surgery remains the best option. Diagnosis of pigmented lesions of the oral mucosa is sometimes complicated because of various implied etiologies. Conclusion: This case report shows that sinus MMs can induce pigmentation in the oral mucosa. These are rare malignancies with poor prognosis, for which no treatment consensus exists to date.
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Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS One 2018; 13:e0207026. [PMID: 30399191 PMCID: PMC6219804 DOI: 10.1371/journal.pone.0207026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dark pigmented lesions of the oral mucosa can represent a major diagnostic challenge. A biopsy is usually required to determine the nature of such intraoral discolorations. This study investigates the potential use of infrared spectroscopy for differential diagnosis of amalgam tattoos versus benign or malignant melanocytic neoplasms. Materials and methods For this retrospective study, formalin-fixed paraffin-embedded tissue (FFPE) specimens of dark pigmented lesions concerning the oral mucosa or the lip were investigated using mid infrared spectroscopy. The samples were chosen from patients who had undergone a mucosal biopsy at the University Hospital Innsbruck (Austria) between the years 2000 and 2017. Principal component analysis was used for data exploration. Evaluation was based on the superimposition of the recorded spectra and the corresponding histologic slides. Results In total, 22 FFPE specimens were analyzed. Clear differences were found between amalgam and non-amalgam samples. A general weakening of the penetrating infrared radiation allowed for unspecific discrimination between these two classes. An overall accuracy in predicting the correct class of 95.24% was achieved. Conclusion Infrared spectroscopy appears to be a suitable technique to differentiate between amalgam tattoos and melanocytic lesions in FFPE samples. It could potentially be applied in vivo, too, serving as a non-invasive diagnostic tool for intraoral dark pigmented lesions.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Raphael Henn
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - Tom Helten
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Susanne Sprung
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bernhard Zelger
- University Hospital for Dermatology, Venereology and Allergology, Innsbruck, Austria
| | - René Steiner
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Dagmar Schnabl
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Vincent Offermanns
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | | | - Christian W. Huck
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
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Lambertini M, Patrizi A, Fanti P, Melotti B, Caliceti U, Magnoni C, Misciali C, Baraldi C, Ravaioli G, Dika E. Oral melanoma and other pigmentations: when to biopsy? J Eur Acad Dermatol Venereol 2017; 32:209-214. [DOI: 10.1111/jdv.14574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/16/2017] [Indexed: 12/13/2022]
Affiliation(s)
- M. Lambertini
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - A. Patrizi
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - P.A. Fanti
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - B. Melotti
- Medical Oncology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - U. Caliceti
- Otorhinolaryngology Unit; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - C. Magnoni
- Department of Skin and Venereal Diseases; University of Modena and Reggio Emilia; Modena Italy
| | - C. Misciali
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - C. Baraldi
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - G.M. Ravaioli
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - E. Dika
- Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
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Ristic L, Dakovic D, Postic S, Lazic Z, Bacevic M, Vucevic D. Clinical Characteristics of Abutment Teeth with Gingival Discoloration. J Prosthodont 2017; 28:e45-e50. [PMID: 28383139 DOI: 10.1111/jopr.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The grey-bluish discoloration of gingiva (known as "amalgam tattoo") does not appear only in the presence of amalgam restorations. It may also be seen in cases of teeth restored with cast dowels and porcelain-fused-to-metal (PFM) restorations. The aim of this article was to determine the clinical characteristics of abutment teeth with gingival discoloration. MATERIALS AND METHODS This research was conducted on 25 patients referred for cast dowel and PFM restorations. These restorations were manufactured from Ni-Cr alloys. Ninety days after cementing the fixed prosthodontic restorations, the abutment teeth (n = 61) were divided into a group with gingival discoloration (GD) (n = 25) and without gingival discoloration (NGD) (n = 36). The control group (CG) comprised the contralateral teeth (n = 61). Plaque index, gingival index, clinical attachment level, and probing depth were assessed before fabrication and also 90 days after cementation of the PFM restorations. RESULTS The gingival index, clinical attachment level, and probing depths of the abutment teeth that had GD were statistically higher before restoration, in comparison with the abutment teeth in the NGD and control groups. Ninety days after cementation, the abutment teeth with GD had significantly lower gingival indexes and probing depths, compared to the abutment teeth in the NGD group. Both abutment teeth groups (GD and NGD) had significantly higher values of clinical attachment levels when compared to the control group. There were no statistically significant differences in plaque index values between the study groups. CONCLUSIONS The results of this study indicated that impairment of periodontal status of abutment teeth seemed to be related to the presence of gingival discolorations. Therefore, fabrication of fixed prosthodontic restorations requires careful planning and abutment teeth preparation to minimize the occurrence of gingival discolorations. CLINICAL RELEVANCE With careful preparation of abutment teeth for cast dowels and crown restorations it may be possible to decrease the frequency of gingival discolorations adjacent to abutment teeth.
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Affiliation(s)
- Ljubisa Ristic
- Military Medical Academy - Dental Clinic, Beograd, Serbia
| | | | - Srdjan Postic
- Department of Prosthodontics, University School of Dental Medicine, Belgrade, Serbia
| | - Zoran Lazic
- Military Medical Academy - Dental Clinic, Beograd, Serbia
| | - Miljana Bacevic
- Department of Prosthodontics, University School of Dental Medicine, Belgrade, Serbia
| | - Dragana Vucevic
- Military Medical Academy - Institute for Medical Research, Beograd, Serbia
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Masilana A, Khammissa RAG, Lemmer J, Feller L. Physiological oral melanin pigmentation in a South African sample: A clinical study. ACTA ACUST UNITED AC 2017; 8. [PMID: 28139894 DOI: 10.1111/jicd.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/08/2016] [Indexed: 12/22/2022]
Abstract
AIM Physiological oral melanin pigmentation is genetically determined, more frequently affecting people with darker skin. It can involve any oral mucosal site, but predominantly the gingiva. The aim of the present study was to determine the prevalence and to characterize the clinical features of physiological oral melanin pigmentation in a South African population sample. METHODS A trainee in the discipline of periodontology and oral medicine interviewed all participants and examined the oral soft tissues. The diagnosis of physiological oral melanin pigmentation was based on clinical findings and on the history reported by the patient. A predetermined list of exclusion criteria was applied. RESULTS The study population comprised 430 participants, of whom 319 (74%) were black, 55 (13%) Indian, 54 (12.5%) white, and two (0.5%) were mixed race. A total of 182 participants were diagnosed with physiological oral melanin pigmentation. The overall prevalence of physiological oral melanin pigmentation in the ethnically-mixed study population was 42%: 54% of blacks were affected, 16% of Indians, and 21% of whites. The female (101): male (81) ratio was 1.2:1; the gingiva was the site most frequently affected (73%). The total number of oral mucosal sites with physiological oral melanin pigmentation in the study population was 263; 68% of participants had one, 22% had two, 7% had three, and 3% had four sites affected. There was no significant association between the number of sites affected and sex or age. CONCLUSIONS In this study of a South African population sample, the prevalence of physiological oral melanin pigmentation was higher in blacks than in Indians or whites, and the gingiva was the oral mucosal site most frequently affected.
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Affiliation(s)
- Aubrey Masilana
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Razia A G Khammissa
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Liviu Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Pérez-López D, Pena-Cristóbal M, Otero-Rey EM, Tomás I, Blanco-Carrión A. Clinical value of diascopy and other non-invasive techniques on differential diagnosis algorithms of oral pigmentations: A systematic review. J Clin Exp Dent 2016; 8:e448-e458. [PMID: 27703615 PMCID: PMC5045694 DOI: 10.4317/jced.53005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To determine the diagnostic value of diascopy and other non-invasive clinical aids on recent differential diagnosis algorithms of oral mucosal pigmentations affecting subjects of any age. MATERIAL AND METHODS Data Sources: this systematic review was conducted by searching PubMed, Scopus, Dentistry & Oral Sciences Source and the Cochrane Library (2000-2015); Study Selection: two reviewers independently selected all types of English articles describing differential diagnosis algorithms of oral pigmentations and checked the references of finally included papers; Data Extraction: one reviewer performed the data extraction and quality assessment based on previously defined fields while the other reviewer checked their validity. RESULTS Data Synthesis: eight narrative reviews and one single case report met the inclusion criteria. Diascopy was used on six algorithms (66.67%) and X-ray was included once (11.11%; 44.44% with text mentions); these were considered helpful tools in the diagnosis of intravascular and exogenous pigmentations, respectively. Surface rubbing was described once in the text (11.11%). CONCLUSIONS Diascopy was the most applied method followed by X-ray and surface rubbing. The limited scope of these procedures only makes them useful when a positive result is obtained, turning biopsy into the most recommended technique when diagnosis cannot be established on clinical grounds alone. Key words:Algorithm, differential diagnosis, flow chart, oral mucosa, oral pigmentation, systematic review.
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Affiliation(s)
- Daniel Pérez-López
- PhD Student, Facultade de Medicina e Odontoloxía, Departamento de Estomatoloxía, Universidade de Santiago de Compostela, Spain
| | - Maite Pena-Cristóbal
- Postgraduate Student, Facultade de Medicina e Odontoloxía, Departamento de Estomatoloxía, Universidade de Santiago de Compostela, Spain
| | - Eva-María Otero-Rey
- PhD, Facultade de Medicina e Odontoloxía, Departamento de Estomatoloxía, Universidade de Santiago de Compostela, Spain
| | - Inmaculada Tomás
- Senior Lecturer, Oral Sciences Research Group, Facultade de Medicina e Odontoloxía, Departamento de Estomatoloxía, Universidade de Santiago de Compostela, Spain
| | - Andrés Blanco-Carrión
- Senior Lecturer, GI-1319, Facultade de Medicina e Odontoloxía, Departamento de Estomatoloxía, Universidade de Santiago de Compostela, Spain
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Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: A review. J Pharm Bioallied Sci 2015; 7:S403-8. [PMID: 26538887 PMCID: PMC4606629 DOI: 10.4103/0975-7406.163471] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pigmentations are commonly found in the mouth. They represent in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Color changes in the oral mucosa can be attributed to the deposition of either endogenous or exogenous pigments as a result of various mucosal diseases. The various pigmentations can be in the form of blue/purple vascular lesions, brown melanotic lesions, brown heme-associated lesions, gray/black pigmentations.
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Affiliation(s)
- C Sreeja
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India
| | - K Ramakrishnan
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India
| | - D Vijayalakshmi
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India
| | - M Devi
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India
| | - I Aesha
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College, Chennai, Tamil Nadu, India
| | - B Vijayabanu
- Department of Oral and Maxillofacial Surgery, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India
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Diagnosis of oral pigmentations and malignant transformations. ACTA ACUST UNITED AC 2014; 35C:39-46. [PMID: 25496584 DOI: 10.1016/j.sdj.2014.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/04/2013] [Accepted: 03/05/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Oral pigmentation is a common finding in the mouth. Pigmentation can be either normal or abnormal discoloration of oral mucous membrane. The purpose of this review mainly focuses on the main oral pigmented lesions, in order to help the clinicians establish a better approach towards the patients with pigmented oral lesions and to provide thorough knowledge regarding such lesions for patient reassurance, early definitive diagnosis and prompt treatment. METHODS Relevant data concerning oral pigmented lesions, clinical features and the possibility of malignant transformation of such lesions were reviewed thoroughly from pubmed literature published in English. Pigmented lesions affecting the skin were not included in our review. RESULTS Few pigmented lesions have been identified and their tendency to become malignant has been reported in the literature. The oral lesions showing malignant transformation reported were mostly case series. Unfortunately, due to lack of long-term studies, follow ups and randomized controlled studies in this respect it was difficult to draw a statistical analysis. This information is quite crucial for general dental practitioners to improve their understanding regarding oral lesions and to differentiate between normal and diseased conditions, so that they can master the skill of differential diagnosis, definitive diagnosis and prompt treatment. CONCLUSION Oral pigmentation may present as focal, multifocal or diffused macular or tumefactive lesions. They may greatly vary in color as blue, purple, brown, gray or black depending on the quantity and site of melanin in the tissues [1]. Etiology of pigmentation can be multi factorial. Mostly pigmentation is physiologic but at times it can be a precursor of severe diseases. Lesions may be caused by localized harmless accumulations of melanin, hemosiderin or exogenous metals or they may be a sign of underlying systemic or genetic disease. A few lesions may be associated with life-threatening medical conditions that require immediate intervention. The differential diagnosis for any pigmented lesion is extensive, as it includes examples of endogenous and exogenous pigmentations. Although biopsy is a helpful and necessary aid in the diagnosis of focally pigmented lesions, with diffuse pigmentation lesions require a thorough dental and medical history and laboratory investigations.
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Walia I, Kaushal N. Usual pigmentation at unusual sites: Series of 3 case reports. Indian J Dent 2014. [DOI: 10.1016/j.ijd.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional.
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Affiliation(s)
- Andres Pinto
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, University Hospitals Case Medical Center and Case Western Reserve School of Dental Medicine, 2124 Cornell Road, Rm 1190, Cleveland, OH 44106, USA.
| | - Christel M Haberland
- Yale Hamden Dental Center, Yale School of Medicine, Yale-New Haven Hospital, 2560 Dixwell Avenue, Hamden, CT 06514, USA
| | - Suher Baker
- Pediatric Dentistry Residency Program, Department of Dentistry, Yale School of Medicine, Yale-New Haven Hospital, 1 Long Whart Drive, Suite 403, New Haven, CT 06511, USA
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Feller L, Masilana A, Khammissa RAG, Altini M, Jadwat Y, Lemmer J. Melanin: the biophysiology of oral melanocytes and physiological oral pigmentation. Head Face Med 2014; 10:8. [PMID: 24661309 PMCID: PMC3994327 DOI: 10.1186/1746-160x-10-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/19/2014] [Indexed: 01/02/2023] Open
Abstract
The presence of melanocytes in the oral epithelium is a well-established fact, but their physiological functions are not well defined. Melanin provides protection from environmental stressors such as ultraviolet radiation and reactive oxygen species; and melanocytes function as stress-sensors having the capacity both to react to and to produce a variety of microenvironmental cytokines and growth factors, modulating immune, inflammatory and antibacterial responses. Melanocytes also act as neuroendocrine cells producing local neurotransmitters including acetylcholine, catecholamines and opioids, and hormones of the melanocortin system such as proopiomelanocortin, adrenocorticotropic hormone and α-melanocyte stimulating hormone, that participate in intracellular and in intercellular signalling pathways, thus contributing to tissue homeostasis. There is a wide range of normal variation in melanin pigmentation of the oral mucosa. In general, darker skinned persons more frequently have oral melanin pigmentation than light-skinned persons. Variations in oral physiological pigmentation are genetically determined unless associated with some underlying disease. In this article, we discuss some aspects of the biophysiology of oral melanocytes, of the functions of melanin, and of physiological oral pigmentation.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, University of Limpopo (Medunsa Campus), Pretoria, South Africa.
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Kawasaki G, Yoshitomi I, Yanamoto S, Yamada SI, Mizuno A, Umeda M. Pigmentation of the oral mucosa by PCB poisoning in Yusho patients. Arch Oral Biol 2013; 58:1260-4. [DOI: 10.1016/j.archoralbio.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 04/02/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
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Kumar M, Bandyopadhyay P, Kundu D, Mishra L. Cryosurgery by tetrafluoroethane: An answer to black gums. J Indian Soc Periodontol 2013; 17:257-60. [PMID: 23869138 PMCID: PMC3713763 DOI: 10.4103/0972-124x.113093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/30/2012] [Indexed: 11/24/2022] Open
Abstract
To highlight the effect of 1,1,1,2 tetrafluoroethane (TFE), a new material for cryosurgery of gingival melanin pigmentation (GMP). Five patients were treated using a TFE-cooled swab and the pre- and post-treatment photographs were compared. Complete keratinization took place in 3-4 weeks after application without any trace of pigmentation. During the follow-up period, no side effects were observed and the improved esthetics were maintained upto 1 year.
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Affiliation(s)
- Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Ghatikia, Bhubaneswar, Odisha, India
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Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17:e919-24. [PMID: 22549672 PMCID: PMC3505710 DOI: 10.4317/medoral.17679] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/04/2011] [Indexed: 01/10/2023] Open
Abstract
Diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging. Even though epidemiology may be of some help in orientating the clinician and even though some lesions may confidently be diagnosed on clinical grounds alone, the definitive diagnosis usually requires histopathologic evaluation. Oral pigmentation can be physiological or pathological, and exogenous or endogenous. Color, location, distribution, and duration as well as drugs use, family history, and change in pattern are important for the differential diagnosis. Dark or black pigmented lesions can be focal, multifocal or diffuse macules, including entities such as racial pigmentation, melanotic macule, melanocytic nevus, blue nevus, smoker’s melanosis, oral melanoacanthoma, pigmentation by foreign bodies or induced by drugs, Peutz-Jeghers syndrome, Addison´s disease and oral melanoma. The aim of this review is to present the main oral black lesions contributing to better approach of the patients.
Key words:Pigmentation, melanin, oral, diagnosis, management.
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Affiliation(s)
- Rogério-Oliveira Gondak
- Oral Pathology Division, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil.
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D'Acunto C, Piccolo V, Neri I, Misciali C, Raone B, Russo T, Patrizi A. Pigmented lesion of the floor of oral cavity: what is your diagnosis? Amalgam tattoo (AT). Clin Exp Dermatol 2012; 37:205-6. [PMID: 22340698 DOI: 10.1111/j.1365-2230.2011.04156.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C D'Acunto
- Department of Internal Medicine, Aging and Nephrological Diseases, Dermatology, University of Bologna, Bologna, Italy
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Olszewska M, Banka A, Gorska R, Warszawik O. Dermoscopy of pigmented oral lesions. J Dermatol Case Rep 2011; 2:43-8. [PMID: 21886712 DOI: 10.3315/jdcr.2008.1015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 08/25/2008] [Indexed: 01/27/2023]
Abstract
Dermoscopy is a noninvasive diagnostic technique that permits the visualization of morphologic features that are not visible to the naked eye. It is currently widely used for examination of pigmented skin lesions and early detection of cutaneous melanoma. Dermoscopy of mucous membranes is significantly less investigated and less popular among clinicians.This article reviews current knowledge about characteristic dermoscopy features of pigmented lesions of the oral mucous membranes and lips. It has to emphasized that a major advantage of dermoscopy is the capability to exclude melanoma and avoid unnecessary excisional biopsies and extensive surgery, often resulting in significant disfigurement of face and oral cavity.It has to be pointed out that there is a necessity to intensify research, which would result in clear-cut dermoscopy criteria for mucosal melanoma and the need for constructing thin, flexible dermoscopes suitable for investigation of oral mucous membranes.
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Resende RG, Teixeira RGL, Vasconcelos FDO, Silva MEDS, Abreu MHG, Gomez RS. Imatinib-associated hyperpigmentation of the palate in post-HSCT patient. J Craniomaxillofac Surg 2011; 40:e140-3. [PMID: 21862339 DOI: 10.1016/j.jcms.2011.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 06/07/2011] [Accepted: 07/25/2011] [Indexed: 11/16/2022] Open
Abstract
Pigmentation of the oral mucosa can indicate a wide range of lesions or conditions. Some drugs are associated with pigmented lesions of oral cavity. Imatinib mesylate (Gleevec(®)) is a protein inhibitor used in the management of several hematological malignancies associated with dermatological side effects, like hyperpigmentation. We report the case of a 38-year-old male post-HSCT patient who had been using imatinib mesylate for over 5 years and presented with blue pigmentation on the hard palate, the left side of the nose and both ear lobes. The differential diagnosis of hyperpigmented lesions in the oral mucosa is also presented.
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Affiliation(s)
- Renata Gonçalves Resende
- Department of Oral Surgery and Pathology, School of Dentistry (Prof. Evandro Abdo, Dean), Universidade Federal de Minas Gerais, Av. Antonio Carlos, 6627, Belo Horizonte-MG CEP 31270 901, Brazil
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Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S. Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study. J Periodontol 2010; 82:956-62. [PMID: 21142983 DOI: 10.1902/jop.2010.100479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals. METHODS A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses. RESULTS The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old). CONCLUSION This study depicts the effects of ETS on gingival melanin pigmentation.
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Affiliation(s)
- Srirangarajan Sridharan
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India.
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Müller S. Melanin-associated pigmented lesions of the oral mucosa: presentation, differential diagnosis, and treatment. Dermatol Ther 2010; 23:220-9. [PMID: 20597941 DOI: 10.1111/j.1529-8019.2010.01319.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Intraoral pigmentation is quite common and has numerous etiologies, ranging from exogenous to physiological to neoplastic. Many pigmented lesions of the oral cavity are associated with melanin pigment. The differential diagnosis of mucosal pigmented lesions includes hematomas, varices, and petechiae which may appear to be pigmented. Unlike cutaneous melanomas, oral melanomas are diagnosed late and have a poor prognosis regardless of depth of invasion. As such, the clinical presentation and treatment of intraoral melanoma will be discussed. Developing a differential diagnosis is imperative for a clinician faced with these lesions in order to appropriately treat the patient. This article will focus on the most common oral melanocytic lesions, along with mimics.
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Affiliation(s)
- Susan Müller
- Department of Pathology, Emory University, Atlanta, GA 30322, USA.
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Chandra S, Keluskar V, Bagewadi A, Sah K. Extensive physiologic melanin pigmentation on the tongue: An unusual clinical presentation. Contemp Clin Dent 2010; 1:204-6. [PMID: 22114419 PMCID: PMC3220114 DOI: 10.4103/0976-237x.73205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pigmented lesions are commonly found in the oral cavity. Pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic but sometimes it can be a precursor of severe diseases. Evaluation of a patient presented with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations and even in some cases biopsy and laboratory investigations are required. In this article, we report a case of extensive physiologic pigmentation on the tongue in a 32-year-old female patient, posing a diagnostic challenge.
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Affiliation(s)
- Sunira Chandra
- Departments of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
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Tanaka Y, Chang JYF. 14th International Congress, International Association of Oral Pathologists and 62nd Annual Meeting, American Academy of Oral & Maxillofacial Pathology, CPC Case 4. Head Neck Pathol 2008; 2:289-92. [PMID: 20614296 PMCID: PMC2807585 DOI: 10.1007/s12105-008-0092-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Yoichi Tanaka
- Division of Surgical Pathology, Clinical Laboratory, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Julia Yu Fong Chang
- School of Dentistry, National Taiwan University College of Medicine, Taipei, Taiwan ,Division of Oral Pathology and Diagnosis, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. ACTA ACUST UNITED AC 2008; 105:606-16. [PMID: 18206403 DOI: 10.1016/j.tripleo.2007.07.047] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/13/2007] [Accepted: 07/30/2007] [Indexed: 12/15/2022]
Abstract
The term "pigmentation of the oral mucosa" is applied to a wide range of lesions or conditions featuring a change of color of oral tissues. Lesions not associated with an accumulation of pigment (e.g., Fordyce spots) are usually not classified as pigmented lesions. Two groups of pigmented lesions of the oral mucosa are recognized: 1) melanin-associated lesions, including racial pigmentations, melanotic macules, melanocytic nevi, and malignant melanoma; and 2) nonmelanin-associated lesions (e.g., blood-related pigmentations, metallic pigmentations). This paper presents a clinicopathologic review of the recent literature with emphasis on the main diagnostic features, including the use of immunohistochemical markers. A flow-chart is added that may help the clinician in the diagnosis and management of these lesions.
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Affiliation(s)
- Marco Meleti
- Unit of Oral Pathology and Medicine, Section of Odontostomatology, Department of ENT, Dental, Ophthalmological, and Cervicofacial Sciences, University of Parma, Parma, Italy
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Arikan F, Gürkan A. Cryosurgical treatment of gingival melanin pigmentation with tetrafluoroethane. ACTA ACUST UNITED AC 2007; 103:452-7. [PMID: 17141535 DOI: 10.1016/j.tripleo.2006.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 08/02/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To introduce 1,1,1,2 tetrafluoroethane (TFE), as a new material for cryosurgery of gingival melanin pigmentation (GMP). STUDY DESIGN Twenty-one patients with GMP were treated using a TFE-cooled cotton swab. Standard digital images of pigmented areas were measured preoperatively and postoperatively with image-analyzing software. The Mann-Whitney U test was used for statistical analysis. RESULTS Keratinization was completed 3 to 4 weeks after application, without any trace of pigmentation. Statistical analysis revealed a significant difference between preoperative and postoperative measurements of pigmented areas (P < .05). During the follow-up period, no side effects were observed and improved esthetics were maintained up to month 30. CONCLUSIONS The clinical outcomes of cryosurgery with TFE for treatment of GMP are very satisfactory. The use of TFE for cryosurgical treatment of GMP is practical and inexpensive. Moreover, unlike other cryosurgery methods no special equipment is required, and it is safe to store in the dental clinic.
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Affiliation(s)
- Fatih Arikan
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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