Oral Medicine Specialists Research Articles

How general dentists could manage a patient with oral lichen planus.

BackgroundThe literature hardly contains information on how patients suffering from oral lichen planus could be managed by dentists.Material and MethodsBased on the limited available literature and particularly on the long-term clinical and histopathological experience of one of the authors, suggestions on how dentists could manage patients with oral lichen planus have been put forward. Results: In most cases, the dentist should be able to establish a correct diagnosis.ResultsIn most cases, the dentist should be able to establish a correct diagnosis. Occasionally, the dentist may call upon a specialist, usually an oral medicine specialist or an oral and maxillofacial surgeon for confirmation of the diagnosis, possibly a biopsy procedure, and management of the patient in case of severe symptoms. Proper patient information is of utmost importance in the management.ConclusionsGeneral dentists can be expected to manage the majority of patients with oral lichen planus. Some patients may need to be referred for diagnostic purposes to a specialist; this is also the case for the rare patient with severe symptoms, possibly requiring systemic treatment. Key words:Oral mucosal disease, oral lichen planus.

Post- Graduate Dental Education: The Ghanaian Experience

Background: The maintenance of standards in dental post-graduate education requires adequate and equal distribution of specialists in all aspects of dentistry. Aim/objective: The primary aim of this study was to determine the factors that influence the choice of field of specialization in dentistry and to identify current trends of specialization in Dentistry. Methods and materials: A well-structured Google form questionnaire was designed and submitted to Residents (current trainees and Members) through their emails. The data collected included area of specialty, training Centre and the factors that influenced the choice of specialty. Results: Since the inception of the GCPS, which had its first Membership graduation in 2007, 902 Members and 76 Fellows had been trained as of October 2017. In Dental surgery, a total of 40 Members and 7 Fellows had been trained which represented 4.43% and 9.21% respectively of the total trained by GCPS. The majority reason for the choice of a particular specialty in dentistry was “Interest/Passion”31(22.14%) followed closely by the “Availability of trainers”27 (19.29%). The least recorded reason was for “Academia” 8(5.71%). Conclusion: Majority of these specialist/Members were in the Oral and Maxillofacial and Restorative Dentistry and then followed by orthodontics. The major reasons for choosing a particular specialty in Dentistry were “Passion/Interest” followed closely by “Availability of trainers” and “financial gains”. There was not a single trained Specialist in Community Dentistry, Oral Medicine and Paediatric Dentistry. Majority of our Residents were sponsored by GHS followed by the Teaching Hospital. The least sponsors of Resident training were the two Dental schools and the CHAG.

Different Oral and Orolabial Appearances in Groups of Children with Down Syndrome in Babylon City-Iraq

Down syndrome (DS) is one of the important genetic or chromosomal defects involving different organs; one of these organs is orofacial apparatus. The aim of the study was to determine the incidence of lip and oral soft lesions among groups of children with DS in Babylon-city in Iraq. Fifty (50) children with DS, and these subjects were matched with same ages, genders with others healthy schoolchildren as controls. This study was applied from January to July 2017 in Babylon centers for disabled children/Babylon-Iraq, between the ages 4–17 years old. Three types of orofacial lesions were appeared in the DS, most of them were fissured tongue 43 (78.1%), lip fissures 35 (63.6%), and angular cheilitis 21 (38.1%), and these results compared with healthy controls. The presence of the above orofacial lesions in healthy controls were: fissured tongue 16 (25.4%), lip fissures 0 (0%), and angular cheilitis 1 (1.8%). The majority of DS children were associated with fissured tongue (in the midline), and the presence of lip fissures in both upper and lower lips. There was correlation between the presence of different types of lip lesions, fissures and angular cheilitis (p-value= 0.001). To the best of our knowledge this is the first study in Iraq that deals with oral and orolabial lesions in DS subjects. The orolabial lesions among DS subjects are remarkably high. Oral medicine or oral physician specialists should be aware of the orolabial features seen more frequently in this chromosomal abnormality.

Mucous Membrane Pemphigoid with Ocular Involvement: The Clinical Phenotype and Its Relationship to Direct Immunofluorescence Findings

This study explored the validity of the First International Consensus on Mucous Membrane Pemphigoid (MMP) guidance, which recommends that clinically indistinguishable patients, who have direct immunofluorescence (DIF)-negative biopsies, be excluded from a diagnosis of MMP. Misdiagnosis, or delayed diagnosis, of MMP with ocular involvement leads to the inappropriate use of topical therapy, the standard of care for causes of cicatrising conjunctivitis other than MMP, rather than systemic immunomodulatory therapy, resulting in irreversible clinical deterioration in patients with MMP. Prospective, cross-sectional study. Patients meeting the clinical criteria of ocular MMP, including those with positive and negative DIF findings. A case report form was used to collect the demographic details, the clinical history, and the results of a detailed clinical assessment by ophthalmologists, otolaryngologists, dermatologists, and oral medicine specialists. All anatomic sites potentially affected by MMP were examined apart from the esophagus (and larynx in a subset). The DIF results were recorded. Differences between DIF-positive and -negative patients in demography, sites of involvement, and disease severity as determined by the degree of conjunctival scarring (using Tauber staging), central corneal disease (vascularization, scarring, ulceration, and conjunctivalization), history of conjunctival or lid surgery, and requirement for systemic immunotherapy at the time of screening. A total of 73 patients with ocular MMP were recruited, of whom 20 of 73 (27.4%) had ocular-only disease. There was no significant demographic or clinical difference between patients with positive and negative DIF results. This finding included differences in disease severity for which the only significant difference was that of more severe central corneal disease in DIF-negative patients. Asymptomatic disease at different sites was frequent. These findings do not support the classification of DIF-negative patients, meeting the clinical criteria for ocular MMP, as having a different disease. This category of patients should be accepted as having DIF-negative MMP, for clinical management purposes, with patients having inflamed eyes being treated with systemic immunomodulatory therapy. The frequent finding of asymptomatic ocular, oral, and nasopharyngeal MMP is clinically significant and implies that these sites should be routinely screened in asymptomatic patients.

Oral findings in chronic kidney disease. A cross-sectional study in Shiraz, Iran

Background: In hemodialysis patients, there are some oral hard and soft tissue changes. Objectives: The aim of this single-center, cross-sectional study was to evaluate oral findings in hemodialysis patients. Patients and Methods: A total of 144 patients participated. Of them, 28 patients (19%) had diabetes mellitus (DM), 17 patients (12%) had systemic lupus erythematosus (SLE), and 15 patients (10%) had severe hypertension. The oral cavity was inspected by an oral medicine specialist using proper light, mirror and explorer. The lips, cheek, tongue, palatal mucosa, floor of the mouth, gingiva, pharyngeal fauces, dentures, teeth and occlusion were checked. The significance level was P<0.05. Results: Around 78% of the studied population had oral manifestations. The most diagnosed finding in hemodialysis patients was dryness of the mouth followed by tooth loss due to mobility and poor oral hygiene. Diabetic cases showed numerous oral symptoms than nondiabetic subjects. Conclusions: Oral lesions in hemodialysis patients is a prominent finding and untreated lesions may cause severe side effects.

Multicentric Bone Lesions Due to Parathyroid Disease: A Case Report

Introduction: Hyperparathyroidism is an endocrine disorder that could create parathyroid hormone hypersecretion conditions, propitious for bone tumors development. Although is not frequent, maxillary bones may be involved in the pathogenesis of these lesions. PATIENTS AND METHODS: In this case, a 56-year-old female is reported. An Hyperparathyroidism was diagnosed due to multiple maxillary and extra-maxillary multicentric bone lesions, with a predominance of giant cells, linked to her endocrine disorder. Discussion: The diagnosis of a Hyperparathyroidism Brown Tumor must meet serological, clinical and histopathological criteria. The multifocality of the lesions is the most remarkable clinical aspect in this case. For an adequate treatment of this entity is necessary an interdisciplinary and coordinate work between different areas of healthcare physicians and Oral Medicine specialist.

Multicentric Bone Lesions Due to Parathyroid Disease: A Case Report

Introduction: Hyperparathyroidism is an endocrine disorder that could create parathyroid hormone hypersecretion conditions, propitious for bone tumors development. Although is not frequent, maxillary bones may be involved in the pathogenesis of these lesions. PATIENTS AND METHODS: In this case, a 56-year-old female is reported. An Hyperparathyroidism was diagnosed due to multiple maxillary and extra-maxillary multicentric bone lesions, with a predominance of giant cells, linked to her endocrine disorder. Discussion: The diagnosis of a Hyperparathyroidism Brown Tumor must meet serological, clinical and histopathological criteria. The multifocality of the lesions is the most remarkable clinical aspect in this case. For an adequate treatment of this entity is necessary an interdisciplinary and coordinate work between different areas of healthcare physicians and Oral Medicine specialist.

The use of topical steroid preparations in oral medicine in the UK.

Topical corticosteroids (TCs) are the most commonly prescribed drugs in oral medicine practice. Use in management of immune-driven inflammatory oral mucosal disease is predominantly off-label and poorly supported by evidence, yet oral medicine specialists have considerable collective experience of prescribing, administering and managing these medications. TCs are also prescribed by others in healthcare including general dental practitioners. Successful TC use is influenced by accurate diagnosis, TC choice (potency and formulation), patient acceptability (including ease of use, taste and texture), frequency of application, duration of treatment, adverse effects, patient support and medication regulations and access. The aim of this review is to provide an overview of TC use in oral medicine practice. Recommendations are based on collective experience to help selection of the appropriate TC to maximise therapeutic efficacy and minimise the potential for adverse effects. This is within an understanding of medicines regulation and preparation availability when prescribing in both secondary and primary care.

Role of oral medicine specialist in palliative care

Oral cancer, the sixth most common malignancy, is a major cause of cancer morbidity and mortality worldwide. The leading etiological factor behind this is consumption of tobacco by Indian population. Palliative care is an imperative need worldwide for people with cancer. It is a multidisciplinary approach consisting of specialists in various fields of medicine; but the role of oral physician in palliative team is oblivious. Oral care is considered one of the most basic of nursing activities but it may be compromised in cancer patients either as a result of the disease itself or due to the various therapeutic modalities. The course of palliative care should be broadened by providing education to clinicians, patients, and families with regard to the elements and appropriateness of palliative care.

Acute Necrotising Sialometaplasia

Introduction Acute Necrotising Sialometaplasia (ANSM) is a benign, rare and self-limiting inflammatory condition of salivary gland tissue which classically presents as a unilateral necrotic ulcer on the hard palate. The primary aetiology is trauma of minor salivary gland tissue which has been reported to occur following local anaesthetic infiltrations, surgery, heavy smoking, excessive alcohol consumption and violent vomiting such as in patients with bulimia. The most significant issue is that is may, both clinically and histologically, mimic malignancy which could potentially result in an incorrect diagnosis and unnecessary treatment. ANSM is self-limiting and usually heals spontaneously between 3-12 weeks without complication. Case description A 43-year-old Caucasian female was referred to the Oral and Maxillofacial Surgery department by her general practitioner following an eight-day history of a painful ulcer on the hard palate. Her medical history was unremarkable, and she was a non-smoker with a low alcohol consumption. On examination, there was a 1.0x1.5cm diameter 'punched out' ulcer on the left posterior hard palate which extended down to bone. An urgent incisional biopsy was undertaken which confirmed a diagnosis of ANSM and excluded dysplasia. The patient was reassured and subsequently discharged at an eight-week review following resolution of the lesion. Results and conclusions ANSM can present a diagnostic dilemma as it mimics malignancy both clinically and histologically. It is therefore vital that practitioners have an awareness of the condition and appreciate its benign and self-limiting nature to avoid unnecessary surgical intervention and patient distress. An urgent referral to a specialist in Oral and Maxillofacial Surgery or Oral Medicine is vital such that an incisional biopsy can be undertaken to confirm a diagnosis and exclude malignancy. Take-home message Clinicians should be aware of ANSM and understand the importance of an urgent referral to a specialist to exclude malignancy.

Dental patch testing in patients with undifferentiated oral lichen planus.

Distinguishing between oral lichen planus (LP) and lichenoid reactions to dental restorations can be impossible on clinical and histopathological grounds. Epicutaneous patch testing is an investigation that may guide patients and physicians in making timely and costly decisions to replace or cover existing dental restorations. This study aimed to assess the role of epicutaneous patch testing with a battery of dental allergens in patients with undifferentiated oral LP. A retrospective review of the medical records of patients with biopsy-proven oral LP referred by an oral medicine specialist and who presented for dental epicutaneous patch testing at a dermatology clinic in Perth, Western Australia between 2009 and 2016 was performed. In total, 68 patients were included, of whom 54 (79%) had positive patch tests. Gold 26 (48%), mercury 24 (44%), nickel 22 (41%), copper 19 (35%), potassium dichromate 14 (26%) and methylhydroquinone 13 (24%) were the most common allergens for which patients tested positive. Hypothyroidism and non-steroidal anti-inflammatory drugs were associated with negative patch tests (P=0.01 and 0.04, respectively). Smoking history, other medications and comorbidities, the location of the dental restorations and unilateral or bilateral disease were not significantly associated with the patch test results. Restorations were removed in 23 patients: 21 of these (91%) had positive epicutaneous patch tests. Of the 20 patients followed up, 19 (95%) experienced some improvement, among whom 11 (58%) had complete remission. Epicutaneous patch testing disclosed a high proportion of relevant positives. This guided the clinical decision to change dental restorations, with high rate of clinical improvement.

Efficacy of Panoramic Radiography in the Detection of Osteoporosis in Post-Menopausal Women When Compared to Dual Energy X-Ray Absorptiometry.

Objective:It is a well-known fact that osteoporosis affects the people with old age and remains unnoticeable until the patient presents with fracture. Various studies in the literature reveal that panoramic radiographs may prove to be beneficial in the detection of Osteoporosis in patients. Henceforth this present study was aimed to validate the use of Klemetti Index (KI) on panoramic radiographs so as to detect osteoporosis in the patients at an early stage.Methods:60 postmenopausal women were selected. A panoramic radiograph was taken to grade their mandibular cortex on the basis of Klemetti Index. All the panoramic radiographs were evaluated by 5 different Oral Medicine and Radiology specialists. Later all the patients were subjected to dual energy X-ray absorptimetry (DEXA) scan for bone mineral density evaluation. The results were evaluated statistically.Results:The average accuracy of the five observers to demonstrate normal bone, osteopenia and osteoporosis when compared to DEXA scan was 58.08%, 63.3% and 64.74% respectively. The observations of the 5 observers on the basis of KI were not statistically different from the BMD evaluation done with the help of DEXA Scan.Conclusion:Panoramic radiographs can be used as a screening tool for the evaluation as well as early detection of osteoporosis with the usage of Klemetti Index.

Tongue lesions and anomalies in a sample of Yemeni dental patients: A cross-sectional study.

Background: Tongue examination helps considerably in diagnosing the underlying health state of the patient, especially in the cases of chronic diseases. The aim of this study is to determine the prevalence and association of tongue lesions with risk factors among Yemeni dental patients. Materials and methods: An oral medicine specialist examined all 713 patients attending the dental polyclinics at the University of Sciences and Technology (Sana’a, Yemen). The examination sheet was designed to include information related to patient characteristics, medical history, dental history, habits, and tongue lesions. Results: The prevalence of tongue lesions among the examined participants was 76.5%. The prevalence rate was 83.4% for males and 69.2% for females. Fissured tongue was the most common condition. Logistic regression analysis indicated that older age (p<0.001), gender (p=0.007), khat chewing (p<0.001), and smoking (p=0.001) were associated with fissured tongue; gender (p<0.001), khat chewing (p<0.001), and smoking (p<0.001) were associated with hairy tongue; and older age (p<0.001), khat chewing (p=0.001), and smoking (p=.021) were associated with coated tongue. Conclusion: The prevalence of tongue lesions among this sample of Yemeni population was 76.5%; fissured tongue and hairy tongue were the most prevalent lesions. Khat chewing, smoking, and older age were the associated risk factors for many of studied lesions and anomalies.

Assessing Oral Cancer Awareness Among Dentists.

The aim of this study was to assess oral cancer awareness among dentists who attended 101st FDI World Dental Congress, İstanbul, Turkey. Among 170 dentists who agreed to participate, there were 13 oral surgeons, 6 restorative dentists, 4 endodontists, 4 orthodontists, 6 periodontists, 5 pedodontists, and 14 prosthodontists. Knowledge of oral cancer risk factors and diagnosis procedures, dentists' attitude towards oral cancers, management practice regarding oral cancer, and oral cancer information sources were assessed using 25 questions. The data were analyzed with IBM SPSS Statistics 22.0 program. Among 170 participant dentists, there were 69 (40.6%) male dentists and 101 (59.4%) female dentists. Largest number of them identified tobacco (98.8%) and alcohol usage (91.2%), prior oral cancer lesions (95.3%), viral infections (90.0%), UV exposure (86.5%), and betel quid chewing (80.6%), and lower numbers reported older age (56.5%) and low consumption of fruit and vegetables (52.4%). Oral medicine specialists scored marginally higher in indicating erythroplakia and leukoplakia most likely to be precancerous and squamous cell carcinoma as the most common form of oral cancer (p<0.01). This study highlighted the importance of improved educational methods for dentists on oral cancer detection and prevention.

The Importance of Accurate Anamnesis in Determining Suspected Drugs Causing of Oral Manifestation of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (Case Report)

&lt;p class="AbstractContent"&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Stevens - Johnson Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are drug hypersensitivity life-threatening disease that involve skin and mucous membrane. Oral manifestation occurs in almost all the patients of SJS-TEN.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Case report:&lt;/strong&gt; A 52-years-old SJS-TEN female patient was referred from department of dermatology and venereology of RSCM hospital, Jakarta to the department of oral medicine, because of the painful ulcers in the mouth and difficulty to eat. Severe loss of integrity lesions was found in lips and oral mucosa. The causing drugs cannot be identified earlier because of challenging condition during anamnesis. The leading clue of suspected causative drugs was conducted by oral medicine specialist with in depth anamnesis of thorough patients’ medical history. Allergic test after six-week period after the patient first visit shows positive result of carbamazepine and amitriptyline hypersensitivity.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Discussion&lt;/strong&gt;: The delayed in determining causing drugs in this case were because of several causes, especially lack of information gain during anamnesis. In the condition when the operator cannot obtain sufficient information due to patient condition, it was very important to have an excellent communication in the collaborating medical team and patient family as well as constantly obtaining new important information during the ongoing treatment. Since the appropriate and successful treatment was depending in determining an exact cause, the anamnesis plays a critical role in this case.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Accurate anamnesis by operator was an important part regarding the successful management of patient with SJS-TEN since the disease has an enormous impact in patient’s quality of life.&lt;/p&gt;

Differential Diagnosis between Chronic versus Aggressive Periodontitis and Staging of Aggressive Periodontitis: A Cross-sectional Study.

Background:Differentiating between chronic periodontitis (CP) and aggressive periodontitis (AgP) is challenging. The aim of this study was to assess the variations in diagnosis between CP versus AgP and the staging of AgP based on the disease-staging index for AgP among periodontists, specialists in oral medicine, and general dental practitioners (GDPs).Materials and Methods:Fifteen cases diagnosed as either CP or AgP were included in a “case document” and sent electronically to 75 respondents. Case document included a detailed history with periodontal charting, clinical features, images, and radiographs for all the cases. Diagnosis and staging for the case (if diagnosed as AgP) were requested. A reordered case document (cases in a different sequence) was again sent to respondents after a gap of 1 month.Statistical analysis:Descriptive statistics including frequency and percentage were calculated. Pearson's Chi-square test was used to analyze the data collected.Results:For the “case document,” 10.17% of the responses were different from those of the authors for diagnosis, whereas 4.48% of the responses were different from those of the authors for the staging of AgP. The agreement in the overall responses was in the range of 0.69–0.84, which was considered good. Comparison of the responses for diagnosis showed statistically significant (P = 0.009) difference between specialists in oral medicine and GDPs.Conclusions:Variations exist among respondents regarding the diagnosis of CP versus AgP. Staging of AgP based on the listed criteria showed low variations.

Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series.

BackgroundThe oral cavity has been frequently described as the only site of involvement or as the first manifestation of mucous membrane pemphigoid (MMP), being the gingival tissues often involved, but usually this has been effusively detailed in limited case series. This is a retrospective evaluation of the gingival involvement in 182 Italian patients with oral MMP.Material and MethodsThe diagnosis of MMP was established by both clinical morphology and direct immunofluorescence finding. Patient information (age, gender, risk factors and medical status) and parameters of manifestation (lesions’ distribution, site and type) were detailed.ResultsThe mean age was 62 years for women (n=137) and 67 years for men (n=45). Patients had several sites of oral involvement; the gingiva was the most common one, affecting 151 patients (82.96%; 119 f - 32 m). Female subjects had more possibilities to develop gingival lesions than male patients (P = 0.005). Sixty-five patients (35.7%; 58 f - 7 m) had pure gingival involvement. Patients with lower gingival involvement statistically had more complaints (P = 0.006).ConclusionsThis report is one of the largest about predominantly oral MMP cases, detailing the very frequent gingival involvement; this could be crucial not only for oral medicine specialists but also for primary dental healthcare personnel and for periodontists. Key words:Mucous membrane pemphigoid, gingival status, clinical features.

Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome

Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The...

The Global Footprint of Oral Medicine Specialists: The University of Pennsylvania Experience

The aim of this study was to analyze the global footprint of oral medicine specialists who graduated from the University of Pennsylvania oral medicine residency program. In 2016, a cross-sectional electronic survey was distributed to 53 graduates of that program, asking about their current geographical location and professional status. Of those 53 graduates, 23 (43%) completed the survey with 22 reporting their current location and 21 reporting their current professional status. The results showed that 17 graduates were located within the U.S., and five were located internationally. Twelve graduates were in full-time academic positions, three were in part-time academic positions/part-time private practice, three were in full-time private practice, two were in postdoctoral training programs, and one was not employed. This study found that oral medicine specialists trained at the University of Pennsylvania were located both domestically and internationally. The majority held faculty positions at academic institutions with fewer involved in private practice. This program may thus be considered a source of future dental academicians.

Use of clinical practice guidelines by dentists: findings from the Japanese dental practice‐based research network

The objectives of this study were to: (1) examine differences in the use of dental clinical practice guidelines among Japanese dentists, and (2) identify characteristics associated with the number of guidelines used by participating dentists. We conducted a cross-sectional study consisting of a questionnaire survey in Japan between July 2014 and May 2015. The study queried dentists working in outpatient dental practices who are affiliated with the Dental Practice-Based Research Network Japan (n = 148). They were asked whether they have used each of 15 Japanese dental clinical guidelines. Associations between the number of guidelines used by participants and specific characteristics were analysed via negative binomial regression analysis. The mean number of guidelines used by participating dentists was 2.5 ± 2.9 [standard deviation (SD)]. Rate of use of guidelines showed substantial variation, from 5% to 34% among dentists. The proportion of dentists that used guidelines was the highest among oral medicine specialists, who had the highest proportion for 10 of 15 guidelines. Negative binomial regression analysis identified three factors significantly associated with the number of guidelines used: 'years since graduation from dental school', 'specialty practice' and 'practice busyness'. These results suggest that the use of clinical practice guidelines by Japanese dentists may still be inadequate. Training in the use of the guidelines could be given to dental students as undergraduate education and to young clinicians as continuing education.