title: Leprosy and its dental management guidelines.
abstract: OBJECTIVE
  Leprosy is a chronic, non-fatal disease caused by Mycobacterium leprae. It can cause cutaneous lesions, peripheral nerve lesions and orofacial manifestations, including destruction of the alveolar premaxillary process associated with loss of the maxillary incisors. The aims of this study were to assess orofacial manifestations of disease in patients attending the Bombay Leprosy Project clinics and develop clinical guidelines for dentists.
  
  
  METHODS
  A cross-sectional questionnaire based study was administered to 43 diagnosed leprosy patients. This included questions on perceived oral health status and oral hygiene habits. An extra-oral and intra-oral examination was also performed.
  
  
  RESULTS
  Eighty-four per cent of patients were male with a mean age of 35.9 years. Forty-nine per cent had extra-oral cutaneous lesions. Twenty-eight per cent had intra-oral lesions including hyperpigmented patches. Twenty-one per cent had cranial nerve involvement and the trigeminal nerve was most commonly affected.
  
  
  CONCLUSIONS
  From this data a clinical dental pathway protocol for managing patients with leprosy was developed. It highlights dental issues when managing leprosy patients. Nerve involvement may mean patients are unable to give an accurate account of their symptoms. Special tests should include cranial nerve examination and swabs of intra-oral ulcers. Low rates of infectivity means that normal infection control measures can be taken when treating these patients.
authors.affiliation: Centre for International Child Oral Health, King's College London, London, UK. bellad@doctors.org.uk
authors.forename: Bella
authors.initials: B
authors.lastname: Dave
authors.forename: Raman
authors.initials: R
authors.lastname: Bedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002648:Child; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D004245:DMF Index; D017742:Dental Care for Chronically Ill; D005155:Facial Nerve Diseases / Q000209:etiology; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D007918:Leprosy / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000209:etiology; D009909:Oral Health; D009910:Oral Hygiene; D017060:Patient Satisfaction; D010512:Periodontal Index; D017410:Practice Guidelines as Topic; D014076:Tooth Diseases / Q000209:etiology; D014081:Tooth Extraction; D020433:Trigeminal Nerve Diseases / Q000209:etiology; D055815:Young Adult
references.citation: Med Oral Patol Oral Cir Bucal. 2008 Aug 01;13(8):E479-82
references.pmid: 18667979
references.citation: Lancet. 2004 Apr 10;363(9416):1209-19
references.pmid: 15081655
references.citation: Oral Dis. 2007 May;13(3):270-3
references.pmid: 17448207
references.citation: Lepr Rev. 2009 Jun;80(2):156-63
references.pmid: 19743619
references.citation: Lepr Rev. 2001 Mar;72(1):35-49
references.pmid: 11355517
references.citation: Med Oral Patol Oral Cir Bucal. 2006 Nov 01;11(6):E474-9
references.pmid: 17072249
references.citation: Eur J Dent. 2010 Jul;4(3):308-13
references.pmid: 20613920
references.citation: Lancet Infect Dis. 2011 Jun;11(6):464-70
references.pmid: 21616456
references.citation: Med Oral Patol Oral Cir Bucal. 2010 May 01;15(3):e459-62
references.pmid: 20038902
references.citation: Br J Oral Surg. 1973 Mar;10(3):272-9
references.pmid: 4516112
references.citation: Oral Dis. 2004 Jan;10(1):19-21
references.pmid: 14996289
references.citation: Lepr Rev. 2007 Dec;78(4):317-20
references.pmid: 18309704
references.citation: Bull World Health Organ. 2011 Jul 1;89(7):487-95
references.pmid: 21734762