Comprehensive Oral Examination Research Articles

Oral Health-Related Quality of Life in Rare Disorders of Congenital Facial Weakness.

Congenital facial weakness (CFW) encompasses a heterogenous set of rare disorders presenting with decreased facial movement from birth, secondary to impaired function of the facial musculature. The aim of the present study is to provide an analysis of subject-reported oral health-related quality of life (OHRQoL) in congenital facial weakness (CFW) disorders. Forty-four subjects with CFW and age- and sex- matched controls were enrolled in an Institutional Review Board (IRB)-approved study. Demographic data, medical and surgical history, comprehensive oral examination, and the Oral Health Impact Profile (OHIP-14) were obtained. Compared to unaffected controls, subjects with CFW had higher OHIP-14 scores overall (mean ± SD: 13.11 ± 8.11 vs. 4.46 ± 4.98, p < 0.0001) and within five of seven oral health domains, indicating decreased OHRQoL. Although subjects with Moebius syndrome (MBS) were noted to have higher OHIP-14 scores than those with Hereditary Congenital Facial Paresis (HCFP), there was no significant correlation in OHIP-14 score to age, sex, or specific diagnosis. An increase in OHIP-14 scores in subjects was detected in those who had undergone reanimation surgery. In conclusion, subjects with CFW had poorer OHRQoL compared to controls, and subjects with MBS had poorer OHRQoL than subjects with HCFP. This study provides better understanding of oral health care needs and quality of life in a CFW cohort and suggests that guidelines for dental treatment are required.

Title: Cross-sectional associations between nutrient intake and tooth decay in older Australian men: The Concord Health and Ageing in Men Project.

Poor nutrition is a risk factor for dental decay in younger people. However, except for sugar it is unclear if this is true in older age groups. The aim of this study was to analyze the possible associations between overall dietary intake of nutrients and diet quality and presence of dental decay in community dwelling older men. A cross-sectional analysis of a longitudinal study with a standardized validated diet history assessment and comprehensive oral health examination in 520 community dwelling men (mean age: 84 years) participating in the Concord Health and Ageing in Men Project. Nutrient Reference Values (NRVs) were used to determine if individual micronutrients and macronutrients were meeting recommendations. Acceptable Macronutrient Distribution Ranges (AMDR) were attained for fat and carbohydrate intakes and were incorporated into a dichotomous variable to determine if the participants were consuming a high fat and low carbohydrate diet. Diagnosis of coronal caries was based on visual criteria and inspection and was completed on each of the five coronal surfaces. Root surface caries was textual changes across four root surfaces. This diagnosis was used to categorize participants by presence and severity of coronal and root caries. Adjusted logistic regression showed not meeting the recommended intakes for thiamin (odds ratio (OR): 2.32 95% confidence interval (CI) 1.15 - 4.67), and zinc (OR: 3.33, 95% CI 1.71 - 6.48) were associated with presence of severe root decay. Adjusted analysis also showed that participants who were outside the recommended AMDR for fat (OR: 0.61, 95% CI 0.38 - 0.98), and those who consumed a high fat and low carbohydrate diet (OR: 0.56, 95% CI 0.35 - 0.91) were less likely to have coronal tooth decay. Our study shows associations between micronutrients and macronutrients and coronal and root surface decay. Although this study cannot prescribe causality or be generalized to all older adults, diet has a possible association with dental decay in older men.

Depression and dental caries in US adults, NHANES 2015–2018

PurposeThis study aimed to investigate the link between depression and untreated dental caries among adults in the United States.MethodsData were collected from the National Health and Nutrition Survey (2015–2018); respondents aged 20 years or older who completed a patient health questionnaire and underwent a comprehensive oral examination were included. Participants were categorized into three groups according to depressive symptoms as follows: those with no, mild, or moderate to severe depression. Data were weighted, and multiple potential covariates were included in the analysis to provide national estimates and account for the complex sample design. A multivariable weighted logistic regression model was performed to test the hypothesis that varying degrees of depression in American adults are associated with untreated dental caries. Subgroup analyses were performed based on age and gender after adjusting for potential covariates. A P value of <.05 was considered significant.ResultsAmong 8740 participants, the prevalence of untreated coronal and root caries was 20.50% and 12.92%, respectively. Moderate to severe depression was a significant risk factor (odds ratio, 1.25; 95% confidence interval, 1.09–1.66) for untreated root caries. The risk of untreated root caries increased by 87% in young adults (aged 20–44 years) and by 46% in women with moderate to severe depression. The suest analysis revealed that the impact of moderate to severe depressive disorder on untreated root caries was non-significantly different between the age subgroup (p=0.09) and sex subgroup (p=0.51). However, depression was non-significantly associated with untreated coronal caries (mild depression: OR, 1.07; 95% CI, 0.85–1.34; moderate to severe depression 1.06; 95% CI, 0.83–1.36; respectively).ConclusionThe results of this study suggested a significant association between moderate and severe depression and untreated root caries; however, the association with untreated coronal caries was non-significant. In the United States, moderate and severe depression in adults is associated with root caries.

Comparison of knowledge, awareness, and behaviors toward oral cancer among dental students and dentists: an online cross-sectional questionnaire in Türkiye

ObjectiveThis cross-sectional online questionnaire-based study evaluated the knowledge, awareness, and behaviors of dentists and senior dental students regarding oral cancer (OC).Materials and methodsThis study included 168 dentists and senior dental students who had completed all theoretical educations and clinical practices. An online survey was administered to all participants to assess their awareness of the risk factors for OC, clinical knowledge, and behaviors. The participants’ demographic characteristics and knowledge of OC were analyzed.ResultsOf the participants, 48.8% were female and 51.2% were male. Their mean age was 27.04 ± 5.56 years (range: 21–51). In addition, 59.5% were dentists, and 40.5% were senior dental students. The dentists’ mean time since graduation was 6.38 ± 5.64 years (range: 1–27). Routine oral mucosa examination for OC was significantly more frequent among the dentists than the senior dental students (p < 0.05). Among all participants, 33% of dentists and 51.5% of senior dental students had poor knowledge of OC-related or possibly predisposing factors. Routine evaluation of OC-related and predisposing risk factors, including human papillomavirus infection, smoking, alcohol use, trauma-related non-healing oral lesions caused by long-term incompatible prostheses, and poor oral hygiene, was significantly more frequent among the dentists than the senior dental students (p < 0.05).ConclusionEducating dental students about a more comprehensive oral examination and early diagnosis of OC would help overcome the current lack of adequate knowledge and attitudes in OC prevention and early detection. A core curriculum compatible with the global standards on OC should be provided to dental students.

Oral health-related quality of life and survival analysis after preventive and restorative treatment of molar-incisor hypomineralisation

The aim of this study was to assess the impact of molar-incisor hypomineralisation (MIH) on oral health-related quality of life (OHRQoL) in children and adolescents, including information on restorative care, tooth sensitivity, as well as sociodemographic factors. Thirty-five patients aged between 7 and 17 years underwent a comprehensive oral examination. Severity of MIH was graded using the MIH Treatment Need Index (MIH-TNI), OHRQoL using the Child Oral Health Impact Profile (COHIP-19). Clinical quality of restorations was assessed according to modified FDI-criteria, tooth sensitivity using the Schiff Cold Air Sensitivity Scale (SCASS). The mean age was 11.3 ± 3.0 years, 34% were female. On average, 6.9 ± 2.8 teeth were affected, 62,9% had hypersensitive teeth (SCASS ≥ 1). Eighty-nine percent of patients had received restorative care, with a mean of 3.3 ± 2.1 teeth restored, most often with composite, followed by fissure sealing. Nine percent of restorations failed by the FDI-criteria. Mean estimated survival times for success were 4.9 years (95% CI 3.5; 6.2) and 5.6 years (95% CI 5.0; 6.3) for fissure sealants and composite restorations, respectively. The mean COHIP-19 score was 64.3 ± 8.2 (max. possible score = 76). A higher severity of MIH-TNI correlated significantly with impaired OHRQoL (rs = − 0.38, p = 0.013). However, this was not mirrored in multiple regression analysis. Despite the high rate of restorative treatment with an acceptable failure rate, OHRQoL is reduced in children with MIH. Many teeth affected by MIH remain sensitive. Further studies are needed to assess the benefits of different restorative options.

Oral Toxicities of PSMA-Targeted Immunotherapies for The Management of Prostate Cancer

IntroductionProstate Specific Membrane Antigen (PSMA)-targeted radionucleotide therapy has been shown to cause dry mouth, but the oral manifestations of PSMA-targeted immunotherapy have not been extensively studied. The aim of this study was to describe and quantify the oral manifestations of PSMA-targeted immunotherapies (bispecific antibodies or Chimeric Antigen Receptor T cell therapies) in the management of metastatic castration resistant prostate cancer. Patients and MethodsWe performed a retrospective analysis of the oral toxicities of PSMA-targeted immunotherapies of the patients seen at a single institution's cancer center between 2020 and 2023. Descriptive statistics were used to summarize the data. ResultsIn a total of 19 patients treated with PSMA-targeted immunotherapies between 2020 and 2023, 9 patients (47%) experienced the following oral toxicities: xerostomia (n = 6; 32%), mucositis (n = 2; 10%), dysgeusia, dry throat and teeth sensitivity in (n = 1 each; 5%), respectively. Oral infections, such as candidiasis and herpes simplex, were not observed in any patients. Mucositis was managed with salt rinses and resolved within few months from onset. Xerostomia persisted in all the patients (median: 306 days, range: 98-484 days) among those who reported dry mouth at the time of data collection, despite treatment with salivary stimulants (n = 5; 83%). Dysgeusia was also persistent, although it was not specifically treated. ConclusionsPatients treated with PSMA-targeted immunotherapies for prostate cancer can present with various short-term and long-term off-tumor on-target oral toxicities including xerostomia and dysgeusia that may affect quality of life. This study serves as a foundation to future prospective studies with a larger sample size and also helps oncologists managing prostate cancer patients with targeted immunotherapies to familiarize common oral toxicities. Furthermore, we emphasize the importance of oral medicine consultation for a comprehensive oral examination and management of oral complications.

Delayed diagnosis of Lemierre’s syndrome in a patient with severe coronavirus disease 2019: importance of comprehensive oral and neck examination – a case report

BackgroundGiven the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre’s syndrome, which involves symptoms resembling COVID-19-related throat manifestations.Case presentationA 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre’s syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications.ConclusionThis case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.

Prevalence of metabolic syndrome and its association with oral health: First results from the Kurdish cohort study.

Investigate the association between oral and dental health (ODH) and metabolic syndrome (MetS) in adults aged 35-70 years. The study utilized data from the enrollment phase of Dehgolan prospective cohort study in the west of Iran. A cross-sectional assessment was conducted on a total of 3996 participants, involving a comprehensive oral examination and the assessment of their oral hygiene behavior (ODH). MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III. Logistic regression used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics. MetS was more prevalent among those who not daily brushing and flossing. Participants with missing teeth (MT) show higher prevalent of MetS. Being female, lower age, illiteracy, family history of diabetes, low physical activity, and salt at table were independently associated with increase odds of MetS (p < 0.05). Odds of MetS were significantly decreased with use flossing (OR = 0.75; CI = 0.60-0.93), decayed (OR = 0.83; CI = 0.72-0.97), filled (OR = 0.84; CI = 0.71-0.99), and increased with MT (OR = 1.45; CI = 1.16-1.81) as long as adjusted for ODH factors. When other potential confounder such as sociodemographic, personal and nutritional habits were adjusted, daily flossing was the only factor that still statistically decreased (OR = 0.79; CI = 0.62-0.99) the odds of MetS. Daily flossing was the only factor that independently associated with MetS. Relationship of other ODH factors with Mets were confounded by sociodemographic characteristics of the participants.

The ISAC Paradigm to Tame Oral Cancer in Saudi Arabia: A Quasi-experimental Study

Late detection of oral cancer (OC) cases in Saudi Arabia is concerning. It reduces survival rate and complicates treatment. The ISAC intervention was developed to bridge the gaps observed in dentists’ practice of OC examination and patient education. The ISAC stands for I, informing patients of OC screenings; S, screening for OC; A, advising high-risk patients to quit risk factors; and C, connecting patients to advanced services. This study tested the potential effect of the ISAC in influencing dentists’ cognitive and behavioral skills, to enhance early detection and prevention of OC. A quasi-experimental study was conducted among dental interns (DIs) at dental setting to test the effect on comprehensive oral cancer examination score (COCE), awareness, self-efficacy, descriptive-norms, and self-reported behavior. Data were collected through triangulation of methods pre and post the intervention at two-months. Multiple linear mixed effects regression models were utilized for data analysis. Between October 2020 and April 2021, 47 DIs participated in the study. The final model showed the significant effects of time (ISAC) on COCE (95% CI = 25.12–29.42, P < .001). DIs had a significant improvement in awareness, self-efficacy, descriptive norms, and self-reported behavior. The findings showed promising effects of the intervention toward the early detection and prevention of OC. Dentists, dental organizations, and policymakers in areas with a high risk of OC could benefit from the current intervention which contributes to capacity building and improved community health. A pragmatic study with a robust design is needed to test the effectiveness of the intervention on a wider scale.

Evaluation of Dental and Periodontal Health Status in Leprosy Patients during Three Different Stages of Drug Regimen: A Cross-sectional Study

Introduction: The prevalence of oral lesions in leprosy patients and the risk of developing them with the disease are considerably high. Multidrug Therapy (MDT) can effectively treat leprosy, but its effectiveness is heavily dependent on early detection, when chronic disability might be avoided. Poor oral hygiene combined with weakened immunity increases the risk of developing oral lesions in leprosy patients and impacts their overall health. Aim: To evaluate the oral, dental and periodontal findings in patients during three different stages of drug regimen. Materials and Methods: A cross-sectional study was conducted on 150 known leprosy patients from four leprosy facilities in the Vidarbha area, Maharashtra, India. Comprehensive oral examination was performed from July 2022 to September 2022, including the Decayed, Missing, Filled Teeth (DMFT) index, assessment of Non-Carious Cervical Lesions (NCCLs), Plaque Index (PI), Papillary bleeding Index (PBI) and complete periodontal examination by measuring Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL). Descriptive statistics were done utilising SPSS version 23. The Analysis of Variance (ANOVA) test was used to check the mean difference between the three groups. The statistical significance established was p&lt;0.05. Results: The evaluation revealed the prevalence of decayed teeth as 103 out of 150 (68%), that of a missing tooth was 93 out of 150 (62%). NCCLs were found in 80 out of 150 with the prevalence of abrasion as seen in 51 (63.7%) patients and 38 patients (47.5%) for abfraction, and 18 out of 80 patients (22.5%) for erosion. Comparing the PI and PBI between the groups, significantly higher scores were observed in patients who had not undergone treatment (p-value &lt;0.01). CAL was found to be statistically significant with higher scores in patients who had completed their treatment (p-value &lt;0.001). Conclusion: The findings of the present study indicate that the NCCLS and the DMFT scores were higher in the untreated group. However, there was increased attachment loss in treated patients, which can be supplemented to the drug therapy prescribed for leprosy

Fellatio associated palatal petechiae: An accidental finding

Objective: Oral lesions can develop from variable etiological factors. So it is of utmost importance to obtain a comprehensive history and oral examination. Fellatio is commonly practiced sexual act, in which the penis is placed into the mouth of another person and may result in submucosal hemorrhage of the palate. The lesions are asymptomatic and typically appear on the soft palate. Description: In this report we report a case of a 57 year old woman who presented with an incidental erythema- tous lesion about 3 cm with a clear centre on her soft palate during her dental visit. Conclusion: As the patients may be unaware of the etiology of the lesions and when they hesitate to provide the details of the sexual history, it is important that the clinician should have a high index of suspicion based on the patient’s clinical presentation.

Oral hypofunction and association with need for daily assistance among older adults in long-term care.

BackgroundOral hypofunction (OHF) is related to occlusal status and bite force. It has specific symptoms and varying degrees of severity.ObjectivesOHF was determined with five signs. The relationships between OHF and need for assistance in oral hygiene, moving, eating and occlusal status in older adults living in long‐term care (LTC) were examined.MethodsA comprehensive clinical oral examination was conducted on 393 residents who lived in LTC in Helsinki, Finland. The five signs to determine OHF were mouth dryness, visible food residue on oral or denture surfaces, ability to keep the mouth open during examination, clearness of speech, and diet of pureed or soft food. Score points of 0–2 were given for each sign, and the sum was categorised as mild, moderate or severe OHF. Participants were divided into three groups accordingly, and occlusal status was determined based on contact units. In addition, nurses collected background information on number of medications and level of cognition. Need for assistance was based on oral hygiene, moving and eating.ResultsOf participants (n = 319), 21% showed severe and 41% moderate OHF. Occlusal status differences between the OHF groups were significant. OHF severity associated linearly with increased severity of cognitive impairment and increased need for assistance in oral hygiene, eating and moving.ConclusionsOHF score based on the five signs can be used to determine OHF severity. OHF was common and associated with occlusal status, cognitive impairment and need for assistance in oral hygiene, moving and eating in older adults living in LTC.

Dental Evaluation Prior to Cancer Therapy.

A comprehensive oral examination and dental care prior to the start of cancer therapy is the standard of care in many cancer centers. This is because good oral health will likely minimize the undesirable complications such as opportunistic infections during cancer therapy. As the considerations differ between anti-neoplastic regimens, this chapter discusses the indications and rationale when planning and executing a treatment plan for patients undergoing various cancer therapies.

Association of Dental and Prosthetic Status with Oral Health-Related Quality of Life in Centenarians.

To date, there is little evidence on centenarians’ dental and prosthetic status or their oral-health-related quality of life (OHRQoL). Therefore, the aim of this study was to assess possible associations between sociodemographic and oral health factors, including prosthetic needs in this special age group and their potential influence on OHRQoL. Persons born before 1920 were recruited from population registries in south-western Germany. Fifty-five centenarians participated and underwent a comprehensive oral examination. Cognitive capacity was evaluated using the short Mini-Mental State Examination (S-MMSE, max. 21 points). At an S-MMSE > 10, an analysis of OHRQoL by means of the Geriatric Oral Health Assessment Index (max. ADD-GOHAI score 60 points) was performed (n = 43). Bivariate statistics and a linear regression model were used after variable selection to analyze data. Centenarians presented with a mean (SD) of 22 (7.2) missing teeth. Complete (65.5%) or partial dentures (21.8%) in at least one jaw were most common. One-third of the dentures needed repair/replacement; 16% of the centenarians presented with denture sores. In 60% of cases, OHRQoL was rated unsatisfactory (ADD-GOHAI < 57). Trouble biting or chewing resulted in the lowest levels of OHRQoL. Fewer remaining teeth, reduced functional capacity and removable prostheses correlated with an impaired OHRQoL (rs = −0.36, p = 0.01; rs = −0.34, p = 0.01; rs = −0.29, p = 0.03, respectively). After variable selection, the final linear regression model included only the number of missing teeth, the associated ADD-GOHAI score decreasing by 0.3 points per missing tooth. In conclusion, tooth loss and removable prostheses in need of repair or replacement are highly prevalent in centenarians. These factors seem to modulate OHRQoL negatively, assumedly due to impaired chewing function. Larger confirmatory studies are needed to validate these first results.

Dentists' Attitudes Toward Dental Implant Maintenance in Thailand.

As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients. The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients. A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform. Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life. While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment. The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.

Oral Health Assessment in Children and Adolescents with Type 1 Diabetes

Abstract: Objective: To assess oral health status in relation to diabetes-related variables in a cohort of children and adolescents with type 1 diabetes mellitus (T1DM). Study design: Eighty-eight children and adolescents with T1DM (median age: 12 years; range: 6-17 years) had received a comprehensive oral health examination performed by a single dentist and included, simplified oral hygiene index (OHI-S), gingival-index (GI), dental caries indices (DMFT and dft) and stimulated salivary flow rate (SSFR; ml/min). Results: Significantly higher frequency of patients had fair oral hygiene and moderate gingivitis (P<0.001). Significantly lower stimulated salivary flow rate was detected in patients within late childhood group (P=0.038). Increased prevalence of permanent dental caries was observed in late adolescent period (P=0.001). There was significant increase in primary dental caries in children diagnosed with diabetes before six years (P=0.004). Patient´s age was positively correlated with SSFR, gingival-index and DMFT-index. DMFT-index was positively correlated with T1DM duration and HbA1c level. There was significant positive correlation between OHI-S and GI. Conclusion: Children and adolescents with T1DM displayed unfavorable oral health profiles that have been strongly linked to patient´s age, age at onset and duration of T1DM and level of metabolic control. Regular recall dental visits must be considered.

THE EFFECT OF OVARIECTOMY ON WOMEN’S PERIODONTAL STATUS: A PILOT STUDY

Objective: To determine the effect of bilateral oophorectomy on the periodontal status of otherwise healthy women when compared with normal controls.&#x0D; Study Design: Mixed-method study.&#x0D; Place and Duration of Study: Riphah International University, Islamabad, from Apr to Sep 2016.&#x0D; Methodology: A total of 24 women with and without oophorectomy procedures were recruited. Twelve women who has undergone radical hysterectomies at least 6 months prior to the evaluation were recruited for this investigation. These women underwent a comprehensive oral examination with detailed documentation of their periodontal status following a thorough medical/dental history. An age- and sex-matched control population underwent a similar examination.&#x0D; Results: Statistically significant results were noted for probing, color, consistency, texture and contour of gingiva with the p-value of 0.007, 0.001, 0.002, 0.005 and 0.037 when the results were compared with the control population.&#x0D; Conclusion: Bilateral oophorectomy does not compromise the periodontal health of otherwise healthy women.

ORAL SECONDARY SYPHILIS IN PEOPLE LIVING WITH HIV: A 16-YEAR EXPERIENCE IN MEXICO CITY

Background The increase in syphilis rates worldwide, particularly in people living with HIV (PLWH), as well as the challenging diagnosis that secondary syphilis represents, make essential the accurate recognition of its manifestations, particularly in easy-access sites like the oral mucosa. Objective To describe the clinicopathologic spectrum of oral secondary syphilis (OSS) in PLWH. Methods A cross-sectional and descriptive study that included PLWH with OSS from 3 HIV referral centers in Mexico City (2004-2020). Demographic and clinical data were obtained. A comprehensive oral examination was done. OSS was diagnosed following established criteria. Histopathologic/cytological procedures were performed to rule out specific oral lesions. In all patients, Venereal Disease Research Laboratory tests were assessed and, if possible, a confirmatory fluorescent treponemal antibody test or biopsy was performed. Statistical analysis was performed using SPSS v25. Results Forty-seven PLWH with OSS (97.8% male, median age: 32 years, 63.8% with acquired immunodeficiency syndrome) were included. Thirty-five were receiving combination antiretroviral therapy (74.5%; median of 1146 [Q1-Q3: 337.5-1971] days) with a median CD4+ count of 385 (Q1-Q3: 223-664) cells/mm3 and a Log10 HIV viral load of 4.1 (Q1-Q3: 3.7-5.3) copies/mL. Forty had a complete clinical-serological diagnosis (85.1%; 17 had histopathologic confirmation) and 7 had a clinical-histopathologic diagnosis. Twenty-nine individuals presented 1 lesion (61.7%), and mucous patch was the most common type mainly on oropharyngeal mucosa, followed by ulcers and macular lesions. Ten patients presented maculopapular dermatosis (21.3%). Conclusions In PLWH, oral lesions, particularly mucous patch and/or ulcers on the oral and oropharyngeal mucosa, must alert specialists to consider a diagnosis of syphilis and perform a comprehensive panel of confirmatory tests.

What do we learn from the clinical and biological evaluation of the oral cavity in centenarians?

The number of centenarians is rapidly increasing worldwide and so are the studies on this segment of the population. A general consensus in the literature is that healthy longevity is an outcome of multiple factors, but the interrelationship between good oral health and healthy aging remains not fully understood. As part of the “CaT: Centenari a Trieste” study, a population-based cohort study set in Trieste, Italy, we report here the results of subjective self-reported oral health parameters and objective clinical and biological oral variables and their association with cognitive impairment in 25 centenarians enrolled in the study from September 2017 to May 2019. Oral health-related variables were recorded by means of a self-evaluation questionnaire and a comprehensive oral examination of teeth, prostheses and mucosae conducted by a trained dentist. In addition, 6-n-propylthiouracil (PROP) taste perception and salivary oxidative stress markers, specifically the Total Oxidative Status and Ferric Reducing Ability of Saliva, were measured. Finally, the oral data obtained were compared with the presence or absence of dementia in the enrolled subjects. The centenarians included in our study were generally satisfied with their oral health. Among the causes of discomfort, the most prevalent were difficulties in chewing and biting, with few subjects describing a correlation between their oral health and psycho-social issues. We evaluated possible relations of clinical and biological variables to the likelihood of being demented and did not find significant associations. We found a higher though not statistically significant mean salivary flow and antioxidant capacity of saliva in non-demented subjects. When evaluating the PROP taste perception profile, we found a higher proportion of supertasters compared with previous studies and different taste perception profiles according to dementia. Despite the relatively small number of participants, we believe that our study contributes to a better understanding of the clinical and biological profile of the oral cavity in subjects aged over 100 years, encouraging the inclusion of a comprehensive evaluation of the oral cavity in centenarian studies performed worldwide.

Self-rated oral health and frailty index among older Americans.

To assess the association between self-rated oral health and frailty index among older American adults aged 60years and over. Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates. A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates. Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.