Entire Oral Cavity Research Articles

Chemotherapeutic Agents in Periodontics: A Review

"Selman Waksman" first used the term "antibiotic" in 1942 to refer to any material produced by a bacterium that inhibits the growth of other micro-organisms in high dilution. The pathogenic bacteria, the patient, and the medication are the three main components of the antibiotic periodontal therapy idea. Patients with attachment loss or with aggressive types of periodontitis or those with periodontitis linked with underlying medical conditions are the best candidates for systemic antimicrobial therapy. The three main objectives of Periodontal Therapy are disrupting biofilms, suppressing potential periodontal pathogens throughout the entire oral cavity, and halting the illness. The microbial etiology of inflammatory periodontal disease provides the rationale for the use of antibiotic medication in periodontal therapy. This idea is predicated on the idea that a certain bacterium causes destructive periodontal disease and that antibiotic agents can be present in humans in doses greater than those required to kill or inhibit infections. Keywords: Antibiotics, Systemic drug delivery, Local drug delivery, Periodontal therapy.

Effects of eating disorders on the oral cavity

This article focuses on bulimia, also known as an eating disorder disease, but it is not just an eating problem, but a type of preventative compulsion that can have a significant impact on the tissues and symptoms that worsen the entire oral cavity.. It is very important to know these pathologies so that the dentist can manifest these symptoms early and the clinical picture can be treated with an adequate and correct treatment plan depending on the patient. There are poor dietary patterns in the world, one of which is eating disorders (EDs), which cause severe malnutrition with consequences for the development of dental, psychological and social health. Eating disorders, such as anorexia and bulimia, are serious illnesses that arise from both the physical and oral health of sufferers. These disorders can have a significant impact on the tissues and symptoms persist throughout the oral cavity. It is essential that health professionals, including dentists, become more familiar with these pathologies in order to develop symptoms early and provide an appropriate and specific treatment plan for each patient. Next, this study will be deepened, we will address the issue of oral health in people who suffer from eating disorders such as anorexia and bulimia; The most important manifestations that have caused these diseases in budental disease are: dental erosion, caries, periodontal, mucosal alterations, etc. For each one we can find a definition, what are their causes, what sign or symptom they cause.

Oral mucosa - an examination map for confocal laser endomicroscopy within the oral cavity: an experimental clinical study

ObjectivesConfocal laser endomicroscopy (CLE) is an optical method that enables microscopic visualization of oral mucosa. Previous studies have shown that it is possible to differentiate between physiological and malignant oral mucosa. However, differences in mucosal architecture were not taken into account. The objective was to map the different oral mucosal morphologies and to establish a “CLE map” of physiological mucosa as baseline for further application of this powerful technology.Materials and methodsThe CLE database consisted of 27 patients. The following spots were examined: (1) upper lip (intraoral) (2) alveolar ridge (3) lateral tongue (4) floor of the mouth (5) hard palate (6) intercalary line. All sequences were examined by two CLE experts for morphological differences and video quality.ResultsAnalysis revealed clear differences in image quality and possibility of depicting tissue morphologies between the various localizations of oral mucosa: imaging of the alveolar ridge and hard palate showed visually most discriminative tissue morphology. Labial mucosa was also visualized well using CLE. Here, typical morphological features such as uniform cells with regular intercellular gaps and vessels could be clearly depicted. Image generation and evaluation was particularly difficult in the area of the buccal mucosa, the lateral tongue and the floor of the mouth.ConclusionA physiological “CLE map” for the entire oral cavity could be created for the first time.Clinical relevanceThis will make it possible to take into account the existing physiological morphological features when differentiating between normal mucosa and oral squamous cell carcinoma in future work.

A Two Year Multidisciplinary Treatment for Malocclusion Caused by Generalized Aggressive Periodontitis

This report is presented multidisciplinary treatment for malocclusion due to generalized aggressive periodontitis and emphasized the importance of perfect retention with both ways of retainers (plastic and metal) for two years period. This clinical case demonstrates a relapse, which is the return of some teeth to their original position after a year and a half due to the non-use of plastic retainers on the upper jaw, despite the presence of a fixed wire retainer. The patient was a 49-year-old woman who turned to the clinic with the chief complaint of displacement in the anterior tooth. An oral examination revealed pathological tooth mobility throughout the entire oral cavity due to severe loss of periodontal support. Crowding in the mandibular anterior teeth were also observed. The goal of subsequent treatment was to enhance aesthetics while preserving most of the natural teeth and to achieve ideal inclination by aligning the teeth.

Cell proliferation and apoptosis in canine oral papillomatosis.

This study was aimed at the evaluation of cell proliferation, p53 level and apoptotic index by immunohistochemical methods in canine oral papillomatosis. The study material comprised of tumor tissue samples taken from six dogs being admitted to the Pathology Department of Faculty of Veterinary Medicine, Kafkas University, Kars, Türkiye. Choice of immunohistochemical staining was avidin-biotin peroxidase method.Cases of canine oral papillomatosis, determined to have been caused by canine papillomavirus-1, were found to have a rather high cell proliferation index. Furthermore, all cases were immunohisto-chemically demonstrated to carry a mutant p53 gene. Despite the mutation of p53 gene, the shift in the Bax/Bcl-2 ratio of dogs diagnosed with tumor was in favor of the pro-apoptotic Bax gene. The apoptotic mechanism was determined to occur through both the caspase-dependent and caspase-independent pathways. While the lesions occupied the entire oral cavity in some cases, histopathologically, malignant transformation was not detected in any of the six cases.

A Pilot Study of Head and Neck Cancer Patients Treated Daily with an Intraoral Photobiomodulation (PBM) Device while Undergoing IMRT Demonstrates Tolerability, Safety, and Preliminary Efficacy for Reducing the Impact of Oral Mucositis

Radiotherapy (RT) when given for head and neck cancer (HNC) causes acute and chronic adverse events (AEs). Oral mucositis (OM) is a significant AE and can impact cancer treatment (interruptions and/or early termination), increase opioid usage, impact diet (dysgeusia, dysphagia, inadequate nutritional intake), and cause depression. Pharmacological options are limited; however supportive care treatment guidelines (MASCC, WALT) recommend photobiomodulation (PBM) therapy for the prevention/treatment of OM. PBM is the use of non-ionizing light in the visible and near-infrared light spectra to modulate biological systems, such as wound healing. Current PBM protocols for OM prevention involve laser-based treatments using spots that are technique sensitive and time consuming. The (Sponsor) Phototherapy System uses an LED-based intraoral mouthpiece to deliver a dosage of 6 J/cm2 to the entire oral cavity, soft palate, uvula, retromolar trigone, and portions of the oropharynx in a daily 10-minute treatment. Per sponsor protocol, this medical device is used daily in the radiation therapy clinic without proximate physician supervision. A pilot study was performed at 7 centers (5 academic) to assess feasibility. HNC participants receiving chemotherapy and IMRT with a minimum of 30Gy to greater than one oral site received a 10-min PBM treatment prior to daily RT. Pain medications and mouthwashes were permitted. PBM treatment was delivered at the radiation clinic throughout the entire duration of IMRT. Device safety (daily) and OM (weekly) evaluations were completed, and participant status was reviewed for primary and secondary outcomes at week six. OM was graded according to the Oral Mucositis Index (OMI), NCI, and RTOG scales. A total of 40 patients were enrolled, 3 withdrew consent and 3 did not complete 80% of PBM treatments. A total of 1227 of 1271 study treatments were completed in full and no device-related adverse events were reported. At week 6: Participants averaged of 8.74/60 on the OMI; NCI/RTOG grades ranged from 0-3. Grade distribution was 0 (1/1), 1 (5/5), 2 (9/8), 3 (19/20) respectively. A total of 52% of salivary flow was retained. Participants reported they could swallow solids for 24.3/30 treatments (avg). Thirteen of 34 patients retained the ability to swallow solids throughout. PBM has been recommended to prevent/treat OM; however, current options are technique sensitive and time consuming for physicians. The (Sponsor) Phototherapy System shows encouraging results in a pilot cohort, is well tolerated for daily treatments in a clinic setting and is safe without apparent device-related adverse events. This device presents a promising alternative for PBM delivery and is currently being evaluated for safety and efficacy in a double-blind randomized clinical trial (NCT03972527).

Lesões na cavidade oral decorrentes de pontas excessivas de esmalte dentário em cavalos de tração em município do extremo oeste maranhense

Excessive enamel dental points, resulting from irregular tooth wear, are considered the most frequent disorder in equine dentistry. The objective was to evaluate the oral cavity of traction horses, diagnosing the excessive points of dental enamel on the premolars and molars, identifying the main injuries caused by them and their impacts. The procedures were carried out in the city of Imperatriz - MA, where 40 traction horses were evaluated. Information was collected from the owners, a general physical examination of the animals was carried out, followed by a dental evaluation and an evaluation of the entire oral cavity. The main clinical signs detected as indicative of dental irregularity were refusal of food offered, acceptance of only half of the amount of food provided, food falling out of the mouth during mastication, decreased lateral excursion of the mandible, refusal to use bits and loss of weight. In this way, it becomes evident that the evaluation of the oral cavity of horses is of great importance, since the presence of excessive points of dental enamel can cause lesions in the oral mucosa, which cause pain, alteration of the biomechanics of mastication, discomfort during work, a decrease in performance and, consequently, a decrease in the quality of life of these animals.

ORAL LICHEN PLANUS: CASE REPORT

Lichen planus is a chronic and T cell–mediated inflammatory disorder of the skin and mucous membranes. This case report describes a case of oral lichen planus in an 82-year-old female patient. The patient's history revealed severe pain and burning sensation in the entire oral cavity. On intraoral examination, diffuse lesions in the form of erythematous areas were seen interspersed within white keratotic areas present on the lateral border of tongue and buccal mucosa bilaterally. Based on the patient's history and clinical findings, the lesion was provisionally diagnosed as oral erosive lichen planus. Histopathologic examination of the biopsied tissue confirmed the diagnosis of lichen planus. The patient was treated with systemic corticosteroid. Complete remission of lesions was observed after 2 months of treatment. The patient was monitored continuously and at 8 months of follow-up did not present exacerbation of the lesions.

Biodegradable Polylactide-co-Glycolide-Chitosan Janus Nanoparticles (JNP) for the Local Delivery of the IL-6R Receptor Antagonist, Tocilizumab, for Oral Squamous Cell Carcinoma (OSCC) Chemoprevention

<h3>Introduction</h3> Risk factor behavior e.g. smoking with/without alcohol or diseases associated with DNA repair deficits e.g. Fanconi anemia (FA) render the entire oral cavity at risk to develop OSCC. While systemically- delivered chemopreventives should conceivably provide oral mucosal field-coverage, bioavailability issues and drug-related toxicities generated disappointing outcomes. In contrast, local delivery formulations can deliver therapeutically-relevant levels without systemic side-effects. This proof of concept study determined whether Janus nanoparticles are a viable field-coverage chemopreventive strategy. Due to IL6's vital role in OSCC de- velopment, tocilizumab was selected as the payload chemopreventive.Methods:1) Formulation of tocilizumab- containing PLGA-chitosan nanoparticles (electrohydrodynamic co-jetting), 2) Determination of keratinocyte [FA- OSCC and E6/E7 transduced (epi) human cell lines] Internalization via confocal microscopy and fluorescent- activated cell sorting (FACS), 3)Assessment of nanoparticle-delivered tocilizumab immunoreactivity (tocilizumab ELISA), 4)Evaluation of fluorescenttagged nanoparticle penetration of oral mucosal explants (fluorescent mi- croscopy). Results:1) JNP were successfully formulated to achieve 65% tocilizumab loading and subsequent re- lease of immuno-reactive tocilizumab (ELISA confirmed)., 2) Qualitative (confocal microscopy) and quantitative (FACS) analyses confirmed human keratinocyte nanoparticle internalization in a time-dependent fashion. Notably, even the shortest co-incubation FACS time point (1 h) revealed appreciable internalization (75% and 73% of epi and FA-OSCC cell populations, respectively)., 3) Fluorescent-tagged nanoparticle studies revealed 85% of the mucosal explants (11/13) demonstrated particle penetration past the stratum corneum while 38% (5/13) contained nanopar- ticles in the basilar third of the epithelium. <h3>Conclusions</h3> One of the mechanisms by which nanoparticles penetrate stratified epithelium is energy dependent (transcytosis). It is therefore probable that JNP optimization combined with in vivo analyses in ATP-replete tissues will enhance nanoparticle transport to the targeted, proliferative ep- ithelial cells. Previously, our lab has shown that local injections of tocilizumab significantly reduced OSCC tumori- genesis in vivo. Studies are currently ongoing to determine the OSCC chemoprevention efficacy of locally injected, sustained-release tocilizumab JNP.

Understanding the microbial biogeography of ancient human dentitions to guide study design and interpretation.

The oral cavity is a heterogeneous environment, varying in factors such as pH, oxygen levels, and salivary flow. These factors affect the microbial community composition and distribution of species in dental plaque, but it is not known how well these patterns are reflected in archaeological dental calculus. In most archaeological studies, a single sample of dental calculus is studied per individual and is assumed to represent the entire oral cavity. However, it is not known if this sampling strategy introduces biases into studies of the ancient oral microbiome. Here, we present the results of a shotgun metagenomic study of a dense sampling of dental calculus from four Chalcolithic individuals from the southeast Iberian peninsula (ca. 4500-5000 BP). Interindividual differences in microbial composition are found to be much larger than intraindividual differences, indicating that a single sample can indeed represent an individual in most cases. However, there are minor spatial patterns in species distribution within the oral cavity that should be taken into account when designing a study or interpreting results. Finally, we show that plant DNA identified in the samples is likely of postmortem origin, demonstrating the importance of including environmental controls or additional lines of biomolecular evidence in dietary interpretations.

Identification of plasma hsa_circ_0000190 and 0001649 as biomarkers for predicting the recurrence and treatment response of patients with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is a type of malignancy characterized by high relapse and recurrence rates in the late stage despite optimal surgical intervention and postoperative chemoradiotherapy. Because the management of relapse following definitive treatment is challenging, accurate risk stratification is of clinical significance to improve treatment outcomes. Circular RNAs (circRNAs) are noncoding RNAs featured with cell-type specificity and high stability, owing to their circular structure, making these molecules excellent biomarkers for a variety of diseases. The levels of hsa_circ_0000190 and 0001649 in plasma samples from 30 healthy controls and 66 OSCC patients were determined by droplet digital polymerase chain reaction. The same primer sets were used with PCR to examine the expression of these two circRNAs in cancerous and adjacent normal tissues. A receiver operating characteristics curve was generated to evaluate the diagnostic value. The Kaplan-Meier method with a log-rank test was used for survival analysis. We identified two circRNAs as potential biomarkers for OSCC, showing that the plasma level of hsa_circ_0000190 was significantly decreased in the late stage and marginally correlated with the development of second primary OSCC. We also found that the decreased plasma hsa_circ_0001649 was correlated with the recurrence and poor prognosis of patients. Additionally, we found that high plasma hsa_circ_0000190, but not hsa_circ_0001649, possibly predicted a better response of patients to induction chemotherapy. Our study demonstrated the potential of biomarkers in plasma to inform not just the tumor but the entire oral cavity, thereby offering a prediction for early recurrence and second primary OSCC. The plasma circRNAs remain valuable for OSCC, albeit the easy accessibility to the oral cavity.

Effects of oral wound on the neutrophil lineage in murine bone-marrow: Modulation mechanism hindered by chlorhexidine

ObjectiveThe oral cavity undergoes frequent stress caused by repeated mechanical trauma, and the constant contact of the injured oral mucosa with bacteria leads to the production of various pro-inflammatory cytokines and chemokines. Neutrophils play essential roles in the acute inflammation against the invasive microbiota, and compromised neutrophil recruitment hinders the bacterial clearance and worsens periodontitis. In this study, we aimed to explore whether wounding at the oral cavity would have an impact on the neutrophil lineage, and, if so, whether microbial contamination of the wounded surface plays significant roles. MethodsWe developed a surgical model of an oral wound (palate wound), by a small incision in the hard palate of the mice. We also evaluated the effect of chlorhexidine on oral wound-induced neutrophilia of bone-marrow. ResultsWe demonstrated an increased neutrophilia in the bone-marrow of the oral wound group, as well as decreasedex vivoneutropoietic potential, in both IL-3 and GM-CSF-driven bone-marrow cultures. Washing of the entire oral cavity with chlorhexidine before surgery abolished the bone-marrow neutrophilia in the oral wound group and increased neutropoiesis in culture, relative to the saline-treated oral wound control group. Co-located treatment (both chlorhexidine treatment and wound on the right side of the palate) resulted in significantly reduced bone-marrow neutrophilia, compared to the mismatched treatment (chlorhexidine treatment and wound on opposite sides of the palate). Neither neutrophilia nor decreased neutropoiesis were dependent on glucocorticoid signaling. ConclusionsThe prophylactic use of chlorhexidine ameliorates the neutrophilic response on the bone marrow, restoring the neutrophil numbers.

Airway Management in Huge Ranula

Airway management in the presence of a large intraoral swelling is always challenging. We report a young boy with a huge ranula occupying the entire oral cavity and protruding from the mouth. Our planned and strategic approach in a resource-limited setting included prior consultation with the ENT surgeon for aspiration of swelling if needed before intubation. Good topical airway anaesthesia followed by gentle videolaryngoscopy resulted in successful airway management.

Clinicopathologic evaluation of oral squamous cell carcinoma in a young dog

Canine oral papillomas is a benign tumor of young dogs and caused by papillomavirus. The possible role of papillomavirus infection in the development of oral squamous cell carcinoma has recently been studied, but it has not been elucidated in veterinary medicine yet. One-year-old, mixed, spayed, a female dog was presented with severely disseminated oral lesions, lethargy, and weight loss. Physical examination of the patient revealed severely disseminated oral papillomatous lesions in the entire oral cavity and the complete blood test showed mild non-regenerative anemia and pancytopenia. In addition, the patient was found seropositive by the SNAP 4Dx Plus test for Ehrlichia canis. Histopathologic examination of oral lesions was performed using Hematoxylin and Eosin (HE) staining and immunohistochemistry for p16 antibody which increases in infections caused by papillomavirus. Histopathology revealed the histologic features of oral papilloma in association with squamous cell carcinoma. Cytoplasmic and nuclear positive reactions for p16 protein were observed within the neoplastic cells in the immunohistochemical examination. Thereafter, the dog was treated with combined therapy of vincristine, antibiotic, radiotherapy, and high doses of vitamin C. After long-term treatment, the dog completely recovered from the lesions. In this report, it was aimed to present a possible role of papilloma in the development of oral squamous cell carcinoma with the clinical, histopathological, immunohistochemical findings and treatment procedure.

Az igazságügyi fogorvosszakértés múltja, jelene és jövője

Forensic dentistry dates back more than 200 years. Yet Oscar Amoedo, a Cuban-born dentist, is considered the father of forensic dentistry. He emphasized the dentists’ role in humans’ identification and laid down the general principles of dental identification in his dissertation in 1989. Dental experts must have interdisciplinary knowledge to do his or her job. From the teeth development through the type of materials of various restorations and the appearance of specific diseases, he/she has to consider the entire oral cavity. As it happens today, for the last 60-70 years too, the victim’s dentist testified the positive match by the dental identification. Nowadays, there are available plaster models, paper or digital based patient records, x-rays to support forensic dentistry. In the future, digital technology will make identification even faster and more accurate, and based on the patients’ 3D digital models, CBCT images, or palate samples, artificial intelligence (AI) guided computers will be making identifications even without any human assistance.

Oral submucous fibrosis in Asian countries.

Oral submucous fibrosis (OSF) is a chronic, insidious, and progressive oral mucosal disease that affects entire oral cavity and sometimes pharynx. This oral potentially malignant disorder has a high rate of malignant transformation (7%-30%) to oral squamous cell carcinoma (OSCC), posing global problems for public health. Due to enormous efforts dedicated to this disease in the past decades, there have been significant advances in identification of its etiology and pathogenesis as well as development of corresponding therapeutic approaches, in spite of several challenges. This study reviewed the existing literature concerning OSF in Asian countries, encompassing its etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatments. For improving treatment of OSF, the multifactorial etiology analysis, incorporation of effective molecular pathways, cytokines and cells for mechanism illustration, and integration of multidisciplinary modalities were also expounded to guide future research and clinical practice.

AGE SPECIFIC CHARACTERISTICS OF ORAL HYGIENE LEVEL OF SCHOOLCHILDREN

One of the most important reasons of dental caries appearance in children is improper oral hygiene which results in the accumulation of plaque containing significant amount of pathogenic microflora. Its vital activity products cause demineralization of tooth hard tissues. This is relevant for children of all ages but the most important in first years after teething as teeth are poorly mineralized and have tendency to the appearance of carious process.&#x0D; Totally 412 children aged 6 to 16 years old attending organized children's collectives (schoolchildren from 1st to 11th year of studying) were examined. Oral cavity examination was carried out according to the generally accepted method. The level of oral hygiene was determined by Fedorov-Volodkina’s and Green-Vermillion’s indices. The research was conducted in the each age period separately and in age groups corresponding to 6-9 years (group I - elementary school), 10-13 years (group II - secondary school), 14-16 years (group III - high school). Statistical processing of the obtained data was carried out using the Student’s method. The results were considered significant at p &lt;0.05.&#x0D; Analysis of oral hygiene level according to Fedorov-Volodkіna’s technique revealed that children aged 6 to 9 years (I group) had “unsatisfactory” oral hygiene level. The research of each age period reveals that only children of 9 years old take care after their oral cavities properly. We have detected significant differences of oral hygiene level of children with caries and with intact teeth. The worst oral hygiene level was observed in children of 6 years old affected by caries.&#x0D; In children 10-13 years old (Group II) the average index of oral hygiene is 2.20 ± 0.08 points which corresponds to unsatisfactory level. This is a slightly better index comparing to the previous age group. At the every age, the hygiene index in children affected by caries is worse comparing to those who aren’t affected by it (p &lt;0,05). In children from the high school affected by caries the level of of the oral cavity hygiene ranges from 2,27 ± 0,09 in 11 years to 2,60 ± 0,21 in 10 years. These results correspond to the unsatisfactory level, but probable age differences were not discovered. Children without caries have “satisfactory” level of oral hygiene in 10 years and 11 years old and “good” level at 12 and 13 years. Thus, we observe the improvement of oral hygiene level in children with increasing of their age, especially for those with intact teeth comparing to the primary schoolchildren.&#x0D; High school children (Group III) also had an unsatisfactory average hygiene index (2.34 ± 0.10 points) and unsatisfactory rates of caries for children, which corresponded to the indices of I and II observed groups. In children who had no carious lesions detected the level o oral f hygiene at 14, 15 and 16 years was “good”. This fact indicates improvement of manual skills on oral health care of high school children.&#x0D; For more objective study concerning the oral hygiene cavity of different children, the Green-Vermillion’s index was also used. It makes possible assessment the state of the entire oral cavity.&#x0D; The average index of oral hygiene in children of the Ist group corresponds to the average value and is evaluated as “satisfactory” state of oral hygiene (Table 2). In children with caries (1.29 ± 0.09 points) and with intact teeth (0.99 ± 0.04 points) we observe the corresponding clinical situation. Significant changes were found in children of 9 years with intact teeth comparing to 6, 7 and 8 years old children. Thus, we observe an improvement of oral hygiene skills in children from elementary school.&#x0D; Children without caries lesions of the ІІnd and ІІІrd research groups have “satisfactory” and “good” of oral hygiene level. For those with caries in all age periods the result is “satisfactory”. The index of oral hygiene for children with and without caries have significant difference.&#x0D; In order to assess the level of oral hygiene objectively the preference should be given to Green-Vermillion’s index. Particular attention should be paid to the level of oral hygiene of children from elementary school pupils, since it is worse comparing to the oral hygiene level of children from secondary and high school. We do not observe a significant improvement in oral hygiene in senior children comparing to ones from secondary school. This causes the necessity in constant education and control over oral cavity care in schoolchildren.

Assessment of oral mucositis degree due to cytostatic treatment in patients with malignant lymphomas

Abstract Introduction: Oral mucositis characterized by inflammation of the oral mucosa, ulcers, angular cheilitis, accompanied by pain in the maxillary facial area are symptoms of patients who have undergone cytostatic treatment, affecting over 75% of high-risk patients. Material and methods: From the total of 182 patients with hematological malignancies, we selected 59 patients, diagnosed with malignant lymphomas and treated at the Hematology Department of the Medical Clinic 1 in Tîrgu Mureș, between July 2013 and June 2016, analyzing the data in the data observation sheets. The study is a retrospective one. Results: In the group of patients studied, who were treated based on the aforementioned cytostatic plans, we found that the CVP + Rituximab plan frequently causes 1st and 2nd class stomatitis, with no patients with 3rd and 4th class stomatitis. The CHOP + Rituximab therapy plan in a total of 80 applications had complications of 1st and 2nd class stomatitis, much more frequent 1st class without stomatitis of 2nd and 4th degree. Grade III stomatitis occurs in two cases in the CHOP-Bleo belts. Introducing dental medicine in the context of medical multidisciplinarity in oncology hematology is a real necessity because the oral complications of chemotherapy treatments by their severity can lead to compromise of the treatment protocol by reducing the doses or even stopping the treatment Conclusions: Malignant hemopathies represent a significant percentage in dental disorders, and among them, the maximum severity belongs to the non-Hodgkin and Hodgkin malignant lymphomas. Stomatitis, also called gingivotoxic stomatitis caused by medication, is an acute oral complication, with erythema and edema of the entire oral cavity. The role of the dentist in the diagnosis, prevention and treatment of oral lesions, following the cytostatic therapy, is extremely important.

Giant Epulis of the Gum and Palate Area: A Case Report in Stomatology Department at Lom&amp;#233; University Teaching Hospital

Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.

The Collaboration between Clinical Therapy and Academic Study to Benefit Patients

Cancer chemotherapy-induced stomatitis may spread throughout a patient's entire oral cavity and decrease the patient's QOL. The therapy for stomatitis at Iwate Medical University Hospital (IMUH) includes dental treatment before chemotherapy, in addition to oral rinses or cryotherapy as a preventative measure. However, in our survey of doctors and nurses, the responses of patients "satisfied" with the present approach for stomatitis treatment reached only 5.1%. Therefore, we attempted treatment using an indomethacin spray, prepared as a hospital preparation, with pre-approval of the ethics committee and based on a previous report of its positive effect on patients at another hospital. We observed that the indomethacin spray succeeded in decreasing chemotherapy-induced oral pain, and its effect was maintained for 2 h in patients at IMUH. The ratio of female patients who rated indomethacin spray as good was higher than that of males. Comments from some patients included a complaint that the nozzle of the injection tip was too short; thus we increased the length of the nozzle from 2 to 7 cm. At present, indomethacin spray is being used to treat stomatitis patients at IMUH. Indeed, the indomethacin spray has been used since October 2011. It was used on 34 patients in 2016. In this review, we describe the collaboration between IMUH and the basic application of studies in our university laboratory.