Classification Of Vesiculobullous Lesions Of Oral Cavity.pdf [REPACK]
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Persistent oral ulcers and erosions can be the final common manifestation, sometimes clinically indistinguishable, of a diverse spectrum of conditions ranging from traumatic lesions, infectious diseases, systemic and local immune-mediated lesions up to neoplasms. The process of making correct diagnosis for persistent oral ulcers still represents a challenge to clinicians. Major diagnostic criteria should include the clinical appearance of both ulcer and surrounding non-ulcerated mucosa, together with the evaluation of associated signs and symptoms, such as: number (single or multiple), shape, severity of the ulcer(s), conditions of remaining mucosa (white, red or with vesiculo-bullous lesions) and systemic involvement (e.g. fever, lymphadenopathy or evaluation of haematological changes). The aim of this paper was to review the literature relating to persistent oral ulcers and provide a helpful, clinical-based diagnostic tool for recognising long-standing ulcers in clinical dental practice. The authors, therefore, suggest distinguishing simple, complex and destroying (S-C-D system) ulcerations, as each requires different diagnostic evaluations and management. This classification has arisen from studying the current English literature relating to this topic, performed using MEDLINE / PubMed / Ovid databases.
Abstract:The aim of this study is to report on the oral lesions detected in 123 patients diagnosed at the University Hospital of Bari from October 2020 to December 2020, focusing on the correlation of clinical and pathological features in order to purpose a new classification. Methods. General and specialistic anamnesis were achieved and oral examination was performed. The following data were collected: age/gender, general symptoms and form of Covid-19, presence and features of taste disorders, day of appearance of the oral lesions, type and features of oral lesions and day of beginning of therapies. If ulcerative lesions did not heal, biopsy was performed. Results. Many types of oral lesions were found and classified into four groups considering the timing of appearance and the start of the therapies. Early lesions in the initial stages of Covid-19 before the start of therapies was observed in 65.9% of the patients. In the histopathological analysis of four early lesions, thrombosis of small and middle size vessels was always noticed with necrosis of superficial tissues. Conclusion. The presence of oral lesions in early stages of Covid-19 could represent an initial sign of peripheral thrombosis, a warning sign of possible evolution to severe illness. This suggests that anticoagulant therapies should start as soon as possible.Keywords: Covid-19; oral lesions; oral ulcers; classification
Further to these concerns, we know that premalignant conditions tend to develop in what is known as field change. This means that for any subsite within the oral cavity at which cellular nuclear damage resulted in a PMD (or even cancer), the adjacent mucosa is almost equally at risk of producing additional PMD lesions even if they appear normal to the naked eye.
It is important to note that a role for primary prevention in patients with leukoplakia is not confirmed. For example, smoking is a risk factor for the development of leukoplakia, but smoking cessation does not necessarily reduce the risk of developing OCC. There is, however, benefit in screening for potentially malignant lesions, and this was demonstrated in a recent review of the US SEER-Medicare database of head and neck cancer. Yanik et al.  reported better treatment and survival outcomes in patients who developed oral cell carcinoma whilst under follow-up for a premalignant lesion . This correlated with the fact that oral cancers were identified at an earlier stage in this patient cohort. Patients without the benefit of such close observation tended to present with more developed or advanced tumour forms. A role for screening patients following treatment for head and n