(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Mouth-Diseases

Pemphigus vulgaris (PV) is an autoimmune disease accounting for 80% of all cases of pemphigus. Before the advent of corticosteroid therapy, pemphigus was fatal, with a mortality rate of up to 75% in the first year. It is still a serious disorder, but the 5% to 10% mortality rate is now primarily due to the side effects of therapy. In 75% to 80% of cases, PV lesions first appear in the oral cavity. Dentists are therefore in a unique position to recognize the oral manifestations of the disease, allowing early diagnosis and initiation of treatment. The diagnosis is based on pathological examination and immunofluorescence testing. Systemic corticosteriods and steroid-sparing agents are the mainstays of treatment; topical corticosteroids may also be used to accelerate healing of persistent oral lesions. This article describes a 71-year-old woman with multiple chronic ulcers in the oral cavity, in whom PV was diagnosed 4 months after the symptoms first appeared. The article also reviews the current literature on diagnosis and treatment of the condition.

Topics: Aged; Anti-Inflammatory Agents; Beclomethasone; Diagnosis, Differential; Female; Fluorescent Antibody Technique, Direct; Humans; Immunosuppressive Agents; Methotrexate; Mouth Diseases; Mouth Mucosa; Pemphigus; Prednisone

The use of short-acting beta2-agonists is associated with oral mucosa injuries that are probably provoked by decreased saliva flow and decreased concentrations of immunoglobulin (Ig)A in saliva.. To explore the effect of salmeterol, alone or combined with beclomethasone, on the health of oral mucosa, as well as its effect on saliva flow and IgA concentration in saliva.. Patients ranging in age from 6 to 15 years with moderate-persistent chronic asthma were enrolled. Patients received two 6-week treatments, one with salmeterol plus beclomethasone and the other with only salmeterol, with a 1-week washout period between treatments. Patients had oral cavity examinations and assessments of saliva flow, IgA in saliva, and total protein in saliva before the beginning and at the end of each treatment. The results of the baseline oral examinations were normal in all patients. The postsalmetrol (PS) examinations detected 13 patients with gingivitis and the postbeclomethasone-salmeterol (PBS) examinations disclosed 10 patients with gingivitis and 1 with lower-lip ulceration. Baseline saliva flow was 16.25 +/- 7.04 mm/minute (confidence interval [CI] 95% 13.67; 18.89), PS was 13.53 +/- 5.93 mm/minute (CI 95% 11.33; 15.73), and PBS was 16.57 +/- 5.54 mm/minute (CI 95% 14.51; 18.62). No statistical differences between the different assessments were found. Mean saliva IgA at baseline was 4.99 +/- 1.96 mg/dL (CI 95% 4.26; 5.71), PS IgA was 6.53 +/- 3.02 mg/dL (CI 95% 5.41; 7.65), and PBS IgA was 4.82 +/- 1.98 mg/dL (CI 95% 4.08; 5.56). PS IgA was significantly higher than the other two determinations (P < 0.05 by Bonferroni and Tukey tests). Baseline saliva IgA-to-protein ratio was 0.72 +/- 0.24 (95% CI 0.64; 0.80), PS IgA:protein ratio was 1.02 +/- 0.38 (95% CI 0.88; 1.16), and PBS IgA:protein ratio was 0.72 +/- 0.25 (95% CI 0.62; 0.82). PS IgA:protein ratio was significantly higher than the other two determinations (P < 0.05 by Bonferroni and Tukey tests).. In the present study it was demonstrated that salmeterol alone or in combination with beclomethasone induced injuries in the oral mucosa, but only salmeterol alone induced increases in the total and protein-adjusted IgA in saliva.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists; Albuterol; Asthma; Beclomethasone; Child; Chronic Disease; Cross-Over Studies; Drug Interactions; Female; Humans; Immunoglobulin A; Longitudinal Studies; Male; Mouth Diseases; Saliva; Salivary Glands; Salivary Proteins and Peptides; Salivation; Salmeterol Xinafoate; Single-Blind Method

Topics: Adhesives; Adolescent; Adult; Aged; Beclomethasone; Child; Clinical Trials as Topic; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Powders; Stomatitis, Aphthous

Topics: Administration, Oral; Administration, Topical; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candidiasis; Chronic Disease; Clinical Trials as Topic; Drug Therapy, Combination; Glucocorticoids; Humans; Methylprednisolone; Mouth Diseases; Mouth Mucosa; Nystatin; Pharyngeal Diseases; Placebos; Prednisone; Propionates

We present a case of plasmacytosis of the mucous membrane of the upper aerodigestive tract. This is a rare benign condition characterized by plasma cell infiltration of the mucosa, with only nine cases described previously (Ferreiro et al., 1994). The lesions, which have a cobblestone appearance, cause throat discomfort, dysphonia and mild dyspnoea. All the cases described previously failed to respond to antibiotics, systemic steroids, or to surgical resection. The present case has however responded favourably to intensive and prolonged treatment with beclamethasone oral spray and Corsodyl mouthwashes.

Topics: Aerosols; Aged; Anti-Inflammatory Agents; Beclomethasone; Chlorhexidine; Humans; Laryngeal Diseases; Male; Mouth Diseases; Mouth Mucosa; Mouthwashes; Mucous Membrane; Pharyngeal Diseases; Plasma Cells

Dry mouth is a common disorder in elderly individuals. It is not, however, necessarily related to decreased salivary flow rate, since subjective feelings of oral dryness have also been found in those with normal flow rates. The aim of this study was to examine in elderly individuals the prevalence of subjective complaints related to dry mouth, and their association with salivary flow rates and the use of systemic medication. In 1990 and 1991, 368 elderly inhabitants of Helsinki, Finland, had their oral health status examined. In addition to the clinical examination, 341 subjects were interviewed regarding different oral and non-oral complaints related to dry mouth. Findings showed that 46% (n = 158) of the subjects had noticed subjective symptoms of dry mouth. Continuous oral dryness was reported by 12% (n = 40) of the subjects, 6% of the men and 14% of the women (p < 0.05). In these 40, the oral and non-oral symptoms were more frequent in subjects reporting continuous dry mouth compared with controls. Continuous dry mouth was clearly associated with the female gender, with mouth breathing and with the use of systemic medications.

Topics: Aged; Aged, 80 and over; Albuterol; Beclomethasone; Cardiovascular Agents; Diuretics; Female; Finland; Geriatric Assessment; Humans; Male; Mouth Breathing; Mouth Diseases; Prevalence; Salivation; Secretory Rate; Sex Factors; Stimulation, Chemical; Surveys and Questionnaires; Theophylline; Xerostomia

Angina bullosa haemorrhagica (ABH) is a recently recognized condition, characterized by benign subepithelial blood-filled blisters in the mouth. The history is characteristic and distinction from other causes of oral blistering can be made by simple clinical signs or on histological grounds. This condition does not appear in standard dermatology texts, yet patients with ABH usually present to a dermatology clinic. A case with typical history is reported in an asthmatic patient who very regularly used a steroid inhaler. The possible aetiological role of such steroid-based inhalers is discussed.

Topics: Adult; Asthma; Beclomethasone; Blister; Female; Humans; Mouth Diseases; Nebulizers and Vaporizers; Oral Hemorrhage