Oral Medicine Specialists Research Articles

Provision of oral medicine in Scottish oral and maxillofacial surgery units: where are we and where are we going?

Introduction Oral medicine (OM) care occupies a significant quantity of oral and maxillofacial surgery (OMFS) outpatient clinical time. This survey aims to examine the current provision of OM care in OMFS units and explore opinions on how to improve the delivery of OM services across Scotland.Method An anonymous online questionnaire was distributed to all (33) OMFS consultants in Scotland. A range of questions were asked, covering place of work, formal OM training, proportion of time spent delivering OM clinical care, referral practices and support for a managed clinical network (MCN) in Scotland.Results A total of 18 (55%) OMFS consultants completed the survey. The majority of respondents (72%) worked in a university teaching hospital (UTH) setting. While none of the respondents were on the OM specialist register, most (72%) had received formal training in OM during their OMFS specialty training. Time dedicated to OM in outpatient clinics varied between less than 20% and 20-40% of clinical time. The majority of respondents (50%) referred 1-2 patients per month to OM. Most OMFS consultants (72%) felt that local OM services should be expanded and 78% would support the inclusion of OM specialists as part of the OMFS outpatient clinic team.Conclusion This study highlights the significant contribution to OM care within OMFS units in Scotland and emphasises the need for close collaboration between specialties. There is support for OM specialists to form part of the OMFS clinical team in UTHs or district general hospitals. Additionally, there is widespread support for the development of a MCN model of OM care in Scotland.

Development and validation of the Oral Lichen Planus-Disease Activity Scale: a novel tool for comprehensive clinical assessment.

To develop and validate the Oral Lichen Planus-Disease Activity Scale (OLP-DAS) for assessing overall disease activity of OLP. The OLP-DAS was created by refining the Thongprasom criteria, incorporating inputs from the literature and expert review, and integrating pain assessment. Content validity was evaluated in a virtual meeting with 8 Oral Medicine specialists. Reliability and validity of the final version were examined. Seventeen OLP subjects were assessed for disease activity by 10 investigators using the OLP-DAS, Oral Disease Severity Score (ODSS), OLP-Investigator Global Assessment (OLP-IGA), and Reticular-Erythema-Ulcerative (REU) scale. Convergent validity was assessed by rating 160 OLP subjects using the OLP-DAS, ODSS, and OLP-IGA. Inter-rater and intra-rater reliability, along with convergent validity, were analyzed using intraclass correlation coefficients (ICCs) and Spearman's rank correlation coefficients (rs). The final OLP-DAS achieved excellent content validity indices. Inter-rater and intra-rater ICCs for total OLP-DAS scores were 0.93 and 0.96, respectively. Total OLP-DAS scores exhibited strong positive correlations with the ODSS and OLP-IGA (rs = 0.94 and rs = 0.76; P < 0.001, respectively). The OLP Severity Index (OLP-SI), a component of the OLP-DAS, showed very strong positive correlations with OLP disease activity parameters of the ODSS (rs = 0.90; P < 0.001). The OLP-DAS is a valid and reliable clinician-reported outcome measure (CROM) for evaluating OLP disease activity. The OLP-DAS, as a standardized CROM for OLP, is valuable for both routine clinical assessments and research applications.

A study of risk factors associated with the presence of oral potentially malignant disorders: a community-based study from Northeastern Thailand

BackgroundThe principal objective of this study is to ascertain the connections between well-known risk factors of oral cancer, including smoking (cigarette and tobacco), alcohol consumption, betel quid chewing, irritations in the oral cavity, history of head and neck cancer, and history of working outdoor more than 4 days/week, and the presence of OPMDs within the Thai population.Method349,318 subjects were recruited for initial screening, then 1,483 subjects who had at least 1 risk factor and a suspicious lesion underwent comprehensive oral examinations followed by a clinical diagnosis and then received initial treatment from either oral surgeons or oral medicine specialists. Among these subjects, individuals with at least 1 risk factor and with a clinical diagnosis of OPMDs were classified as cases, while those with at least 1 risk factor but without OPMDs were categorized as controls. The case group comprised a total of 487 subjects, whereas the control group consisted of 996 subjects. Exclusion criteria were known cases of currently having oral cancer or OPMDs.ResultsThe outcomes of the multivariate analysis revealed that among the variables assessed, betel quid (adjusted OR 5.12 [3.93–6.68], p < 0.001) and smoking (adjusted OR 1.46 [1.08–1.97], p = 0.013), there were an association with the presence of OPMDs. Conversely, alcohol drinking, having irritations in the oral cavity, a history of head and neck cancer, and a history of working outdoors more than 4 days/week were not associated with the presence of OPMDs. Furthermore, we also study the synergistic effect of alcohol drinking, irritations in the oral cavity, history of head and neck cancer, and history of working outdoors more than 4 days/week using subgroup analysis. The analysis showed that alcohol consumption combined with smoking or betel quid chewing expressed a significantly increased risk of OPMDs, from 1.46 to 2.03 (OR 2.03 [1.16–3.56], p = 0.014) and from 5.12 to 7.20 (OR 7.20 [3.96–13.09], p < 0.001).ConclusionSmoking and exposure to betel quid were a significant risk factors for the presence of OPMDs. The combination of alcohol with smoking or betel quid chewing was also found to increase the risk of OPMDs in this Thai northeastern population.

Decision-Making in Endodontics Prior to the Surgical Removal of Large Cysts Involving Vital Teeth.

Introduction Maintaining pulp vitality is crucial; however, treatment options forlarge lesions may hinder the vitality of the teeth involved within the lesion.Some clinicians are not updated about the diagnostic terminology of the American Association of Endodontists (AAE) which may affect their decision-making. In the literature, there was no absolute treatment to manage such cases. The purpose of this study is to explore different opinions, identify the evidence of practice and treatment options to help in decision-makingand assess if clinicians are acknowledged by the AAE guidelines. Materials and methods This cross-sectional study was conducted through a qualitative survey designed to interview randomly selected endodontists, oral maxillofacial surgeons, oral medicine specialists, oral pathologists, and general partitioners to record their decisions and management about a structured case scenario. Atotal of 120 participants were included in the study.The interviewswere conducted bya single investigator, and the answers were recorded by another investigator. Finally, the responses of the interviewees were collected using Google Forms (Google, Mountain View, California). Results We found that there are dissimilarities between the different groups in decision-making concerning the management of teeth involved in large cystic lesions. Regarding the AEE guidelines, almost all the endodontics and general dentists were aware of the guidelines when compared with the other groups. Conclusion The management of teeth involved in large cystic lesions is controversial. Furthermore, the AEE guidelines are not a common language between the different disciplines. Randomized clinical trials are needed to investigate the prognosis and management of teeth associated with large cystic lesions.

Incidence of Carotid Atheroma in Patients Received Radiotherapy in Neck Field-A Case Series Study

Introduction: Atheroma is a condition that affects various blood vessels, primarily forming at junctions of moderate to large vessels, such as the carotid artery, where it is known as carotid atheroma (CA). Atheroma can lead to myocardial infarction or stroke. Previous studies have shown that head and neck radiotherapy can induce CA, even in young patients. Early diagnosis of atheroma in panoramic views can help prevent ischemic attacks in the brain and potentially save lives. Case Presentation: Thirty-six patients were referred to Semnan Dental School for dental screening by a hematologist-oncologist. An oral medicine specialist ordered panoramic radiographs for each patient, and radiopaque lesions were detected in the para-spinal region in four patients. These lesions were diagnosed as Carotid Atheroma by an Oral and Maxillofacial Radiologist, and this case series was reported. Conclusions: Radiotherapy is a component of treatment for head and neck malignancies and can cause atherosclerosis in carotid junctions. Dentists should monitor panoramic views of patients receiving radiotherapy for any signs of suspicious lesions. If carotid atheroma is detected, the patient should be referred to a cardiovascular specialist for further evaluation and treatment.

Inclusion of clinical photographs with general dental practitioner electronic referrals of patients with oral mucosal disease to secondary care: a service review.

Introduction This service evaluation reviewed how the inclusion of photographs in dentist referrals to an oral medicine specialist service can improve the service for triage, prioritisation and diagnosis.Materials and methods Data were prospectively collected from e-referrals over a four-month period. Any change in appointment prioritisation resulting from review of photographs at the vetting stage was recorded.Results Only 29.5% (82 of 367) of referrals included a photograph. Of these, 5% were 'rejected with advice' since the photograph indicated the patient did not require a secondary care appointment. Additionally, 14% of all referrals were upgraded in urgency, five of which were due to concerns of malignancy, and three of five were upgraded solely based on the photographs as they showed features of possible malignancy, where the written element of the referral did not describe nor raise such concerns.Discussion and conclusions Including a photograph with a referral can often make up for inaccurate or insufficient written content, allowing appropriate and safe prioritisation, especially where the referrer has failed to recognise possible malignancy. Photographs can also prevent unnecessary referral upgrades, ensure an appointment is necessary and can be invaluable as a baseline comparator.

A cross-sectional survey assessing clinicians' perspectives towards redesigning the surveillance model for head and neck cancer: can we do better?

Service delivery of post-treatment surveillance in head and neck cancer (HNC) varies across institutions in Australia. To better understand current practices and develop protocols that maximize service capacity or incorporate emerging technologies, especially in under-resourced regional and remote communities, it is important to obtain the perspectives of clinicians that regularly manage patients with HNC. This cross-sectional study utilized an online survey distributed via email to specialists recruited from HNC-associated networks across Australia. The survey captured information on current practices and explored clinician perspectives towards re-designing the current surveillance model to incorporate telehealth or patient-reported outcome measures (PROMs). Quantitative data was analyzed using descriptive statistics while open-ended survey comments were analyzed using a content analysis approach. Forty participants completed the survey (25 surgeons, 9 medical oncologists, 5 radiation oncologists and 1 oral medicine specialist). Most clinicians used either institution-specific guidelines (44%) or National Comprehensive Cancer Network guidelines (39%), with the remaining 17% using surveillance intervals based on patient symptoms. Following treatment, 53% of participants imaged patients only when there was clinical suspicion of recurrence or new symptoms. Planned surveillance imaging was conducted at 6 or 12-monthly intervals based on the HNC subtype. Fifty-seven percent of clinicians were open to redesigning the surveillance model, specifically in low-risk patients who did not require nasoendoscopic examination. Seventy-one percent had concerns regarding the feasibility of telehealth appointments, citing disparities in digital health equity. Additionally, 61% felt PROMs are currently underutilized and were open to incorporating HNC-specific PROMS into surveillance. Open-ended responses indicated that within the current surveillance model, "fragmented service provision" and "administration issues" were significantly impacting on timing of care. Surveyed HNC clinicians feel that current post-treatment surveillance can be fragmented and potentially lead to delayed care. They are open to incorporating PROMS to assist in surveillance scheduling, especially in low-risk patients.

Knowledge, Attitudes, and Practices Towards Oral Cancer Among Dental Practitioners in the Northeastern Region of India: An Online Cross-Sectional Survey.

This study aimed to review the overall knowledge of oral cancer based on its clinical presentation as well as associated risk factors, attitudes towards oral cancer examination, and practices among dentists in the northeastern region of India. A total of 300 dentists practicing in various parts of the northeastern region participated in this online cross-sectional study. A questionnaire consisting of 26 questions was mailed to the dentists requesting them to fill in the survey form. Based on their responses, knowledge of the risk factors of oral cancer, information on attitudes towards oral cancer examination, and clinical practices were attained. The data was analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Descriptive statistics was used for demographic variables. Unpaired t-test and one-way ANOVA were used to compare the mean knowledge scores with demographic variables. The level of significance was set at P<0.05. Overall, the knowledge of the risk factors of oral cancer was low among dentists. The majority were not familiar with the proper physical oral examination steps and considered oral medicine specialists to have a vital role. This study revealed areas in which the knowledge, attitudes, and practices were good to below average and identified areas where improvement is required. Gaps in dentists' knowledge of oral cancer could be identified; dentists displayed substandard knowledge of the clinical presentation as well as risk factors of oral potentially malignant disorders.

Dentist Involvement in the Treatment of Radiation-Induced Oral Mucositis-A Pilot Cross-Sectional Study.

Objectives: Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area. This paper aims to determine the occurrence and characteristics of OM in patients with head and neck cancer (HNC), as well as the involvement of dentists/oral medicine specialists in treating such patients. Methods: This study was conducted at the Department of Otorhinolaryngology and Department of Oral Medicine, University Hospital Center Zagreb, from April to August 2022, on patients irradiated in the head and neck area. A unique OM questionnaire was created on the incidence, characteristics, oral care, and involvement of dentists in the overall care. Results: Thirty patients filled out the questionnaire. Of the 22 patients who had developed OM, 14 had grade-three OM. Ten patients were treated for OM in line with the instructions of an oral medicine specialist, eight based on the instructions of a specialist responsible for monitoring of the underlying disease, and four were not treated at all. Sixteen patients had not been referred to a dentist before the start of RT. Conclusions: These results showed insufficient care and treatment of OM, as well as insufficient involvement of dentists in the oncology team.

Assessing the knowledge and awareness of US oncologists regarding the specialty of oral medicine

ObjectivesThis cross-sectional study aimed to assess the awareness among United States (US) oncologists about oral medicine (OM) as a specialty of dentistry, and their collaboration with OM providers. MethodsAn online survey was conducted, inviting 1350 US oncologists, with data collected on demographics, practice background, comfort level with diagnosing and treating oral conditions, referral practices for oral conditions, and more. ResultsOf the invited 1350 oncologists, 192 responded (14% response rate). Among respondents, 46% were familiar with the OM specialty. Of these, 73% had previously sought consultation from OM specialists. The primary reasons for referral included dental clearance before initiating chemotherapy (38.5%), dental clearance before initiating radiotherapy (37%), and managing oral ulcers and oral potentially malignant disorders equally (32.2%). Regarding referrals to providers outside of OM, oncologists primarily referred patients with oral lesions to otolaryngologists (64.6%), followed by oral and maxillofacial surgeons (55.2%) and general dentists (45.3%). ConclusionOur study showed that over half of US oncologists were unfamiliar with the OM specialty. However, the referral rate to OM providers was high among oncologists who had prior OM knowledge. It is advisable to enhance the collaboration between OM and oncology specialists to ensure optimal care for patients with cancer.

HIV-Related Oral Mucosa Lesions: A Cross-Sectional Study on a Cohort of Italian Patients.

Human immunodeficiency virus (HIV) infection can be associated with oral mucosal diseases, including oral candidiasis and HPV infection, which are putative indicators of the immune status. This retrospective cross-sectional study was aimed at assessing the prevalence of HIV-related oral mucosal lesions in a cohort of Italian HIV+ patients regularly attending the Clinics of Infectious Diseases. One hundred seventy-seven (n = 177) patients were enrolled and 30 (16.9%) of them showed HIV-related diseases of the oral mucosa. They were mainly found in male patients over 35 years old, undergoing Combination Antiretroviral Therapy (cART), and with CD4+ count < 500/µL. Oral candidiasis was the most common HIV-related oral lesion. No significant correlations could be detected between the prevalence of HPV infection and other clinical parameters (lymphocyte count, cART treatment and viral load). HIV-related oral mucosal diseases can correlate with immunosuppression. Early diagnosis and management of oral lesions in HIV+ patients should be part of the regular follow-up, from a multidisciplinary perspective of collaboration between oral medicine and infectious disease specialists, in an attempt to reduce morbidity due to oral lesions and modulate antiretroviral therapy according to the patient's immune status.

Evaluation of the Relationship between Sublingual Varices and Hypertension.

Objectives: Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with sublingual varices. Due to the convenience in examining the sublingual area, the present study aimed to assess the relationship between sublingual varices and hypertension. Materials and Methods: In this descriptive-analytic study, 500 patients were categorized into two groups: those with sublingual varices and those without. Two oral medicine specialists assessed the lesions, and the blood pressure of all patients was measured while they were in a relaxed sitting position. Age and gender data were recorded for all participants. Statistical analysis included t-test, chi-square, and logistic regression, with significance set at P<0.05. Results: The frequency of sublingual varices was 21.8%. Mean systolic blood pressure was 139.68±19.01mmHg in patients with sublingual varices and 118.09±13.78mmHg in patients without the lesions (P=0.561). Mean diastolic blood pressure was 100.45±17.81mmHg and 80.31±12.08mmHg in patients with and without sublingual varices, respectively (P<0.001). Smoking was significantly more prevalent among patients who had the lesions (P<0.05). Gender (P=0.686) and age (P=0.875) showed no significant relationship with sublingual varices, while smoking and blood pressure levels were significantly associated with these varices (P<0.001). Conclusion: It is advisable to monitor and manage blood pressure in patients with sublingual varices who may not be aware of their blood pressure status. Our results showed that smoking could be one of the predictive factors for sublingual varices.

Micronutrients status as a contributing factor in secondary burning mouth syndrome: A review of the literature.

Patients with burning mouth syndrome (BMS)experience an annoying feeling without clinical evidence of any mucosal lesion. Deficiency or excess of micronutrients is a common feature in secondary BMS. There is limited knowledge among oral healthcare providers regarding the significance of micronutrients in oral health, so the current review focuses on the critical role of these elements in oral health implications as secondary BMS. For the data collection, the authors searched for key terms without time limitation (1900-2021) in databases comprised of PubMed, Google Scholar, Scopus, Web of Science (SCI),and Embase. The total number of matched articles with inclusion criteria involved in this review article was 59 original articles. Among these, 20 randomized clinical trials (RCT),31case-control or Crossectional, and8 case reports/series are reviewed in this review article. One of the important etiological factors in patients with secondary BMS is micronutrientimbalance. The iron, zinc, vitamin B family, vitamin D deficiency and increased levels of homocysteine and oxidant agents were examined in secondary BMS patients. In addition, oral medicine specialists must consider the possible toxic effects of some elements in restorations and dental prostheses. Further studies, such as RCTs in the future, are recommended.

Past and future perspectives of oral medicine in the Nordic countries as a reflection of the global community

Headlines The nature of the diseases that oral medicine specialists diagnose and manage throughout the oral and maxillofacial region are diverse and closely related to other dental and medical specialties. This relatively young area of dentistry has expanded globally during the past decade as an independent discipline with postgraduate qualifying programmes being offered in several countries, as well as an increasing research community. With a growing proportion of elderly individuals in the population in general across the world, morbidity is likely to increase in terms of both general diseases and conditions in the oral and maxillofacial region. The types of diseases requiring treatment may also differ in the future due to a greater influx of immigrants to the Nordic countries. The wide variety of conditions encountered in a dental practice, as well as variations in the individual patient presentation and response to treatment, defines the need for careful evaluation and synthesis of practice recommendations to provide appropriate and effective management. The field of oral medicine still lacks clear guidelines for various conditions and treatments. Thus, further studies are required to improve patient healthcare. For the discipline of oral medicine, it will be reasonable to take a greater responsibility for the basic medical skills in the dental curriculum, as modern oral medicine is increasingly becoming the intermediate between oral health care and general medicine.

Non-endodontic periapical radiopaque jaw lesions: A mini review

Endodontic practice may be affected by periapical radiopaque/ hyperdense lesions. Oral medicine specialists and endodontists may have trouble diagnosing and treating radiopaque lesions. Inflammatory, non-inflammatory, neoplastic, dysplastic, metastatic or metabolic bone changes may occur. With the increased use of cone-beam CT, a detailed review of radiopaque lesions may help clinicians differentiate these lesions. Differentiating inflammatory, non-inflammatory and neoplastic disorders simplifies diagnosis and helps choose the best treatment. Aim: The aim of this review was to investigate the periapical radiopaque/hyperdense lesions. An extensive review of the literature was carried through. The literature search was conducted using MEDLINE (National Library of Medicine)-PubMed, Web of Science and Google scholar without restrictions concerning the date of publication. The inclusion criterion was that the article should be written in English, whereas the exclusion criterion was the opposite. This literature review covers radiopaque/hyperdense lesion differential diagnoses, clinical, radiographic, histological, and management issues. The effectiveness of root canal therapy is measured by the absence of pain, the absence or reduction of periapical lesions, and the restoration of tooth function. In endodontic practice, the diagnosis of periapical lesions is difficult because many of these lesions can mimic endodontic lesions, even when derived from different sources. For the diagnosis of periapical lesions in this scenario, a comprehensive clinical examination, in conjunction with clinical and radiographic aspects of the disease, is essential. The oral medicine specialist and endodontist must know how to diagnose radiopaque periapical lesions. Knowing how to differentiate between inflammatory, non-inflammatory, neoplastic and metabolic lesions expedites diagnosis and ensures the selection of the appropriate treatment.

Oral pathology and oral medicine in Latin American countries: current stage.

Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.

Assessing Tele-Oral Medicine in Saudi Arabia: A Cross-Sectional Study on Specialists’ Experiences and Effectiveness in Oral Healthcare

Introduction: Teledentistry is an emerging tool to exchange medical information and clinical images to facilitate the diagnosis, prevention, and treatment of oral diseases and patient assurance and education. Considering the shortage of oral medicine specialists in Saudi Arabia, this study aims to assess the experiences of dental specialists with tele-oral medicine and its potential applicability in addressing this shortage. Materials and methods: This was a pilot, cross-sectional study conducted among specialists in the field of oral medicine from January 2020 to March 2020. A total of 16 preselected cases with oral lesions, including clinical history and images, were developed, validated, and shared via email with study participants. Each case included questions on differential diagnosis, provisional diagnosis, and management. The responses were recorded, analyzed, and presented as means and percentages. Results: A total of 49 subjects participated in this study and more than half were under 40 years of age and two-thirds were women. A total of 23 participants had prior experience with tele-oral medicine, mainly via WhatsApp (95.7%), and these cases were received from patients, their families, friends, or other dentists. For all study cases, the correct diagnosis score ranged between 73.50 and 100%, and correct management ranged between 51 and 98%. Conclusions: Tele-oral medicine is an effective tool that may play an important role in patient management in rural regions with a shortage of oral medicine services. Further studies with larger sample sizes and in collaboration with international centers are warranted to confirm these findings.

Medication-Related Osteonecrosis of the Jaw: A Cross-Sectional Study on the Prevalence of Cutaneous Manifestations and the Primary Care Physician's Role in its Early Diagnosis

BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is a side effect in patients undergoing treatment with bone-modifying agents (BMA) for cancer or osteoporosis. Although most cases are treated by oral medicine specialists, some cases may present extraorally as a fistula in the skin or erythematous swelling localized to the jaw area, causing these patients to consult a primary care physician. This study examined the prevalence and clinical characteristics of extraoral manifestations of MRONJ in a large cohort to raise awareness among primary care physicians of this entity, enabling prompt diagnosis and treatment. MethodsMedical records were retrieved of patients diagnosed with MRONJ between 2003 and June 2020 in the Oral Medicine Unit of The Sheba Medical Center, Israel. Data relating to demographics, medical background, type of BMA, and clinical presentation were collected. ResultsIn total, 515 patients (378 women [73%] and 137 men [27%]; mean age: 65 years, range: 32-94 years) met the inclusion criteria, among whom 84 (16.5%) presented with extraoral manifestations of MRONJ. Of these 84 patients, 21 (24.7%) presented with extraoral fistulas. Extraoral manifestations were strongly correlated with MRONJ of the mandible (n = 67; P = .0006). ConclusionsMRONJ is a significant side effect of BMA therapy. Although MRONJ mostly presents intraorally, some patients may initially present with extraoral manifestations of erythematous swelling or fistulas localized to the jaw area. Primary care physicians should consider MRONJ as a differential diagnosis in such patients.

Validity of a Mobile Application to Diagnose Temporomandibular Disorders.

This study aimed to assess the diagnostic accuracy of a mobile application by comparing its diagnoses to those of Orofacial Pain and Oral Medicine specialists and further imaging results (CBCT and MRI) in 500 patients with temporomandibular disorder (TMD). The research focused on three diagnostic categories: the initial specialist diagnoses, the final diagnoses after imaging, and the mobile app's diagnoses. The concordance rates, sensitivities, specificities, and positive predictive values of the diagnoses were examined, with further imaging serving as the gold standard. The mobile app demonstrated a high concordance rate compared to both the final (0.93) and the initial specialists' diagnoses (0.86). The sensitivities, specificities, and positive predictive values also indicated strong reliability, affirming the app's diagnostic validity. Although the concordance rate was slightly lower when comparing the app's diagnoses to the imaging results (CBCT and MRI), the specialists' diagnoses yielded similar results. The study suggests that user-friendly diagnostic mobile applications, based on the diagnostic criteria for TMD, could enhance the clinical management of TMD. Given the reliability of mobile applications for diagnostic purposes, their wider implementation could facilitate the provision of appropriate and timely treatments for patients with TMD.

Prevalence of Tongue Normal Variant Lesions in Geriatric Patients with Hypertension in Surabaya: A Multicenter Observational Study

Abstract Introduction The risk of degenerative diseases in the elderly is higher due to aging and decreased body function. This process affects both systemic conditions and locally in the oral cavity. Aside from aging, degenerative disease itself can trigger the incidence of soft tissue abnormalities. Aging can cause structural and functional changes in the systemic vasculature, resulting in a degenerative disease such as hypertension. Elderly who suffers from hypertension can develop oral mucosa abnormalities and most of them are found on the tongue. This study was aimed to identify the prevalence of normal variant lesions on the tongue in the elderly with hypertension. Methods This was an observational descriptive study with a cross-sectional design done in January–March 2020. Samples were elderly obtained from several public health centers in Surabaya that matched the inclusion criteria. Subjective and clinical examinations were performed by oral medicine residents and specialists. Results A total of 401 elderly were screened and 147 elderly (36.65%) met the inclusion criteria which are having hypertension and willing to participate in this study. Those who met the criteria, mainly were female from the 60 to 74 years old age group. Normal variants of tongue obtained from the examination were fissured tongue (90.48%), coated tongue (63.95%), crenated tongue (33.33%), lingual varices (12.24%), and benign migratory glossitis (4.08%). Conclusion From this study, we figured out that fissured tongue was the most common normal variant lesion of the tongue in the elderly with hypertension. Coexistence between hypertension and tongue lesions can be developed from pathological changes of disease or as side effects of medication taken such as antihypertensive drugs.