Abstract
BackgroundThe aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes.Material and MethodsPICOS outline: Population: subjects diagnosed clinically and/or pathologically. Intervention: exposition to oral hygiene products. Comparisons: patients using products at different concentrations. Outcomes: clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study design: any. Exclusion criteria: reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers.ResultsFifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, experimental studies mostly an “unclear risk”. Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently.ConclusionsOMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP. Key words:Systematic review, oral mucosal peeling, dentifrices, sodium lauryl-sulphate, oral hygiene products.
Highlights
A possible relationship between oral epithelium desquamation and dentifrices was hypothesized in early 1970s by Pnacek (1), and very few cases have been reported ever since (2-4), oral mucosal peeling (OMP) induced by oral hygiene products seems to be a relatively common finding in clinical practice (5)
Several agents have been linked to adverse oral mucosal reactions, but attention has focused on detergents, sodium lauryl sulphate (SLS) (3,6-10), which has been reported to induce OMP together with mucosal inflammation, higher permeability to chemicals, and denaturation of proteins (11)
This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines (19) and followed the outlines of PICOS (20): i) Population: subjects clinically and/or pathologically diagnosed of OMP; ii) Intervention: exposition to oral hygiene products; iii) Comparisons: patients using different dentifrices and mouthwashes at different concentrations under experimental conditions; iv) Outcomes: primary outcome: clinical and histological outcomes after using dentifrices and mouthwashes
Summary
A possible relationship between oral epithelium desquamation and dentifrices was hypothesized in early 1970s by Pnacek (1), and very few cases have been reported ever since (2-4), oral mucosal peeling (OMP) induced by oral hygiene products seems to be a relatively common finding in clinical practice (5). -and considering differential diagnoses of OMP include erosive oral disorders such as lichen planus, autoimmune alterations, candidosis, mechanical, thermal or chemical trauma, adverse drug reactions, viral infections, and recurrent aphtous ulcerations- establishing a definitive diagnosis is paramount (11,17). In this situation, where the aetiopathogenesis is poorly understood, the clinical presentation is often unrecognised, the diagnosis and treatment are not soundly founded, along with the lack of previous reviews on this topic justify the need for a systematic review on the relationship of OMP with the use of dentifrices and mouthwashes. Conclusions: OMP management should consider differential diagnosis with oral desquamative lesions, desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP
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