Oral Mucosal Alterations Research Articles

Oral Manifestations in Diabetes Mellitus and Management Considerations: A Review

Diabetes mellitus is a chronic metabolic disorder defined as an increase in sugar levels in the bloodstream brought onby either insufficient insulin secretion, resistance to insulin's effects, or both. All age groups are affected by the chronic conditionknown as diabetes mellitus. It is among the world's major causes of mortality and morbidity. Xerostomia, dental caries,periodontal disease, gingivitis, candidiasis, other oral infections, burning mouth syndrome, taste dysfunction, oral mucosalalterations, delayed wound healing, and localized osteitis are common oral manifestations of diabetes mellitus. Majorcomplications impacting a patient's quality of life include oral complications in diabetic individuals. Long-term oral problems inthese patients’ harm blood glucose regulation, making oral complications care and prevention important. The dental professionalshould be familiar with DM's oral manifestations to identify this disease complication. This article not only discusses the oralmanifestations but also discusses management considerations in diabetic patients which will help future dental professionals indental practice. This article aims to spread knowledge and awareness about the potential oral manifestations of diabetes mellitusand treatment considerations.Keywords: , , , , ,

Comparative Assessment of Salivary Level of Cortisol, Anxiety and Depression in Patients with Oral Conditions: A Case Control Study

Introduction: Cortisol, as the main human glucocorticoid, is considered to be a biological marker of stress and anxiety. It is suggested that stress with its presumed effects on the immune system, constitutes one of the major causative agents for oral mucosal alterations. Methodology: To enable the study of gender-based differences in stress, salivary alpha-amylase levels and oral lesions, an equal gender distribution was guaranteed. The individuals were then given a clinical examination to look for oral mucosal alterations caused by stress, such as recurrent aphthous ulcers, oral lichen planus, dry mouth and burning mouth syndrome. To identify Temporomandibular Joint Disorders (TMDs), which are also linked to stress, trigger points, masticatory muscles and TMJs were examined. Results: 80 participants made up the research team, ranging in age from 24-47 years for the experimental group and 27-50 years for the control group. There was an equal number of men and women in both groups. The investigation group’s average age was 33.70 years, compared to 31.93 years for the control group (p=0.16). The study group’s female participants exhibited stress levels that ranged from 5% (N=1) for light stress to 40% (N=8) for severe stress (p=0.10). Conclusion: However, there was no connection between oral alterations and salivary alpha-amylase.

MUC5B Alters Oral Mucosa of Oral Lichen Planus Patients with Xerostomia

Oral Lichen planus（OLP）is a chronic autoimmune cell-mediated inflammatory disease. Most OLP patients complain of xerostomia/dry mouth due to changes in the oral mucosal protective barrier. Mucin 5B（MUC5B）is the predominate gel-forming mucin in the oral cavity that protects the underlying tissue from mechanical damage, chemical insult, and pathogenic microbes. This study aims to assess MUC5B in OLP subjects and correlate its role in etiopathogenesis. The study included 20 OLP subjects and 10 healthy controls. OLP subjects were divided further into 10 keratotic（reticular）and 10 non-keratotic（atrophic/erythematous）groups based on the clinical criteria. Dryness of mouth was confirmed by the subjective（Xerostomia Inventory, XI; Bother Index, BI）and clinical testing（Clinical Oral Dryness Score, CODS）method. Stimulated, unstimulated saliva and blood samples were collected from subjects. Samples were centrifuged and analysed for MUC5B level using an ELISA kit. The subjective and clinical testing methods which clinically define xerostomia are correlated with the age and sex of the OLP subjects. The stimulated and unstimulated salivary flow rate of OLP subjects was lower（p<0.05）than controls and was associated with the XI, BI, and CODS（p<0.01）. In contrast, the MUC5B level was increased in the serum of OLP subjects compared to controls（p<0.05）. OLP subjects with xerostomia, displayed lower salivary flow, decrease MUC5B in saliva and increase MUC5B in serum. Alteration of MUC5B in the saliva causes oral mucosal alterations affecting the protection of the oral cavity and increase xerostomia in OLP.

Prevalence of oral injuries and salivary changes in patients with chronic renal failure on hemodialysis: systematic review and meta-analysis

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes.

Salivary protein candidates for biomarkers of oral disorders in people with a crack cocaine use disorder

The use of cocaine and its main derivative, crack, can cause some systemic effects that may lead to the development of some oral disorders. To assess the oral health of people with a crack cocaine use disorder and identify salivary protein candidates for biomarkers of oral disorders. A total of 40 volunteers hospitalized for rehabilitation for crack cocaine addiction were enrolled; nine were randomly selected for proteomic analysis. Intraoral examination, report of DMFT, gingival and plaque index, xerostomia, and non-stimulated saliva collection were performed. A list of proteins identified was generated from the UniProt database and manually revised. The mean age (n=40) was 32 (±8.88; 18-51) years; the mean DMFT index was 16±7.70; the mean plaque and gingival index were 2.07±0.65 and 2.12±0.64, respectively; and 20 (50%) volunteers reported xerostomia. We identified 305 salivary proteins (n=9), of which 23 were classified as candidate for biomarkers associated with 14 oral disorders. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n=7) and nasopharyngeal carcinoma (n=7), followed by periodontitis (n=6). People with a crack cocaine use disorder had an increased risk of dental caries and gingival inflammation; less than half had oral mucosal alterations, and half experienced xerostomia. As possible biomarkers for 14 oral disorders, 23 salivary proteins were identified. Oral cancer and periodontal disease were the most often associated disorders with biomarkers.

Prevalence of Oral Mucosal Alterations in A Sample of Egyptian Cardiovascular Patients Secondary To Cardiovascular Drugs: A Hospital Based Cross-Sectional Study

Prevalence of Oral Mucosal Alterations in A Sample of Egyptian Cardiovascular Patients Secondary To Cardiovascular Drugs: A Hospital Based Cross-Sectional Study

FREQUENCY OF ORAL LESIONS AMONG DIABETIC PATIENTS, MUCOSAL ALTERATIONS AND RISK FACTORS

Objectives: To estimate the frequency of Oral lesions among diabetic patients in the Department of Oral Medicine.Methods and materials: Study design was cross sectional and was brought in the Department of Oral Medicine Dental Section Bolan Medical College Sandman Provincial Hospital Quetta, from June 2021 to May 2022. A total of 50, 35 male and 15 female with known history of diabetic were reported in the Department of Oral Medicine Dental Section Sandeman Provincial Hospital Quetta (SPH) for their routine Dental problems were included in this survey.Results: 72% reported patients were male and 28% were female. The mean age of the patients were 40.25 years. Majority of the diabetic patients age were between 52 to 62 ( n=23, (46%) years, and second majority cases were having age ranged between 41-51(n=17, 34%) years and third majority cases were having age ranged from 30-40(n=7, 14%) years. Dental caries was the most common fi ndings in this study 36%, followed by Xerostomia 28%, gingivitis 24%, abnormal taste 22%, Burning mouth 14%, Angular chelitis and Depapillated Tongue 12% each, Candidiasis 16%, oral ulcerations 10% and periodontitis 8% respectively. In this study Xerostomia and dental carries were statistically signifi cant between oral lesions and diabetic patients.Conclusion: IDiabetic patients had higher incidence of oral lesions and mucosal alterations than non-diabetic patients. Higher incidence of oral lesions brings out the requisite of the regular oral examination to make sure the initial diagnosis and handling Oral mucosal lesions in diabetic patients.

COMPOUND ODONTOMA: REPORT OF TWO CASES FROM DIAGNOSIS TO ORTHODONTIC APPROACH

The current report presents 2 cases of young patients with compound odontomas. Case 1 refers to a 15-year-old boy who was referred complaining of dental misalignment after delayed eruption without alteration of oral mucosa. Case 2 refers to a 12-year-old girl presenting a swelling in the lower alveolar mucosa of the right canine region. Radiographically, in both patients there was a mixed lesion very suggestive of compound odontoma associated with unerupted left superior canine and right inferior canine, respectively. Both patients underwent curettage that microscopically confirmed the diagnosis of compound odontomas. The patients underwent orthodontic treatment and were accompanied for 5 years. Eruption delay of permanent tooth is the most common clinical feature of odontoma. Proper diagnosis, adequate treatment, and orthodontic intervention, when indicated, are important for a successful outcome.

ORAL ALTERATIONS ASSESSMENT IN PATIENTS AT A HOSPITAL IN SOUTHERN BRAZIL

Objectives The objective of this study was to evaluate and describe the prevalence of the most common causes for oral examination needs during hospitalization or outpatient care. Study Design This cross-sectional study analyzed the main oral examination needs and procedures in oral medicine performed from January 2018 to July 2020. Results A total of 470 patients were included in this study, including hospitalized patients (n = 325) and outpatients (n = 145). In both groups, more than 50% of the patients were female and married. The main cause for the medical or interdisciplinary team to request oral mucosa evaluation was dysphagia (64.46%), dry mouth (44.77%), mucositis (27.2%), fungal infection (20.2%), dry lips (11.06%), and traumatic ulcer (10.6%). Other conditions and/or procedures, including tooth extractions, odontogenic infections, and prosthesis adjustments, corresponded to 61.27%. Between-group analysis showed that hospitalized patients were 9.5 times more likely to present these oral mucosa alterations (48.3%). Conclusions This study provides information on the most frequent oral alterations among outpatients and hospitalized patients. The knowledge of this scenario in different complexities may improve the quality of health care, especially preventive measures. This knowledge may also reduce health care costs with more efficient approaches. The objective of this study was to evaluate and describe the prevalence of the most common causes for oral examination needs during hospitalization or outpatient care. This cross-sectional study analyzed the main oral examination needs and procedures in oral medicine performed from January 2018 to July 2020. A total of 470 patients were included in this study, including hospitalized patients (n = 325) and outpatients (n = 145). In both groups, more than 50% of the patients were female and married. The main cause for the medical or interdisciplinary team to request oral mucosa evaluation was dysphagia (64.46%), dry mouth (44.77%), mucositis (27.2%), fungal infection (20.2%), dry lips (11.06%), and traumatic ulcer (10.6%). Other conditions and/or procedures, including tooth extractions, odontogenic infections, and prosthesis adjustments, corresponded to 61.27%. Between-group analysis showed that hospitalized patients were 9.5 times more likely to present these oral mucosa alterations (48.3%). This study provides information on the most frequent oral alterations among outpatients and hospitalized patients. The knowledge of this scenario in different complexities may improve the quality of health care, especially preventive measures. This knowledge may also reduce health care costs with more efficient approaches.

Occurrence of oral mucosal lesions in type 2 diabetes mellitus patients

Introduction: Diabetes Mellitus is a syndrome characterized by chronic hyperglycemia which leads to many complications including those in the oral cavity. Oral mucosal lesions are one of them. The study was conducted to investigate the various oral mucosal alterations in Type 2 diabetes mellitus patients and to compare them with control subjects. Material and methods: An observational case–control study was carried out at Dental outpatient department of MGM Medical College &amp; Hospital, Jamshedpur. It involved 74 diabetic mellitus type 2 patients and 74 non- diabetic control subjects. Complete case history was recorded with thorough clinical examination using specially designed case history format. Extraoral and intraoral examinations were performed using a mouth mirror, probe, tweezers and gauze. Result: With respect to specific oral mucosal lesions, Coated tongue and Xerostomia were the most prevalent among the Diabetes mellitus type 2 patients. A highly significant differences found for Coated tongue (p = 0.000) and Xerostomia (p = 0.001) among the cases and controls. Fissured tongue, lingual varicosity, melanin pigmentation and frictional keratosis found to be more in Diabetes mellitus type 2 patients than control subjects but the differences were not significant.

Reply to Takeshita, W.M.; Ribeiro, D.A. Comment on "Pop et al. Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students. Int. J. Environ. Res. Public Health 2021, 18, 13246".

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Comment on Pop et al. Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students. Int. J. Environ. Res. Public Health 2021, 18, 13246.

We read the manuscript recently published in International Journal of Environmental Research and Public Health titled "Early diagnosis of oral mucosal alterations in smokers and e-cigarette users based on micronuclei count: a cross-sectional study among dental students" by Pop et al. [...].

Cancer causing chewing habits and related oral lesions - A comparative study among females of socio-culturally different areas of West Bengal.

Smokeless tobacco, as well as areca-nut both, causes cancerous and precancerous lesions of the oral cavity. The traditional value of India, as well as West Bengal do not allow females for smoking, but there is no such disapproval for using smokeless tobacco or areca nut. Geographically and socio-culturally, the Northern part of West Bengal differs from its Southern part. This study aimed to assess the prevalence of different chewing habits, habit products, and habit-related different oral lesions among females in two socio-culturally different areas of West Bengal. A total of 222 women from areas of North Bengal and 173 women from areas of South Bengal aged 15 years and above were selected. A face-to-face interview was conducted using a structured questionnaire. An oral cavity examination was done to rule out any oral mucosal alterations caused by cancer-causing habits. Chi-square test or Fischer's exact tests were used to compare unpaired proportions as appropriate. In areas of the northern part of Bengal, 42.34% of females were chewers, and in areas of the southern part of Bengal 18.50% of females were chewers. Younger female chewers were more from areas of the northern part of Bengal. Women, residing in different areas of the northern part of Bengal had more habit-related oral lesions, compared to the southern part of Bengal. Special attention should be given to increasing awareness regarding chewing habit-related health hazards among females, especially in areas of North Bengal.

Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students.

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and e-cigarette users compared to nonsmokers. We obtained smears from the buccal mucosa of 68 participants divided in 3 groups (smokers, e-cigarette users and nonsmokers), which were further processed with Papanicolaou stain. The frequencies of micronuclei and micronucleated cells were recorded and statistically analyzed at a level of significance of p < 0.05. The mean micronuclei values per 1000 cells were 3.6 ± 1.08 for smokers, 3.21 ± 1.12 for e-cigarette users and 1.95 ± 1.05 for nonsmokers. The mean values of micronucleated cells per 1000 cells were 2.48 ± 0.91 for smokers, 2.39 ± 1.07 for e-cigarette users and 1.4 ± 0.68 for nonsmokers. Smokers and e-cigarette users had significantly higher values of micronuclei and micronucleated cells compared to nonsmokers, but there were no significant differences between smokers and e-cigarette users. We concluded that the micronuclei count can be used as an early indicator for alterations of oral mucosa and exfoliative cytology represents an accessible tool which could be applied for mass screening.

Oral condition of patients submitted to bariatric surgery

INTRODUCTION: Obesity is a chronic disease that impairs health or exacerbates others comorbidities. Among the treatment options, bariatric surgery has shown effective and lasting results. However, patients may experience adverse effects, like gastric reflux, nausea, vomiting, dehydration, vitamin and mineral deficit, and thereby potentiate negative effects of oral manifestation, including dental erosion, caries, periodontal disease, alterations of saliva and oral mucosa. OBJECTIVES: Evaluate oral condition of Unified Health System (SUS) patients at the bariatric surgery service of Hospital Evangélico de Vila Velha (Brazil), analyzing DMFT index, PSR (Periodontal Screening and Recording), salivary pH and the self-perception of oral health. METHODS: An prospective, observational descriptive case series study, conducted in the dental clinic located at Universidade Vila Velha (Brazil), evaluated 24 patients subjected to bariatric surgery. Patients were included in the study after explanation, reading and signing of the Informed Consent Form. The data were collected by means of questionnaires on oral health perception, clinical examination and salivary collection. RESULTS: All evaluated patients had periodontal disease, besides a considerable amount of decayed teeth (7.86%), despite the alkaline pH registered in 83.3% of the sample. Furthermore, 83.3% of the patients stated they did not receive oral hygiene orientation before the gastroplasty. CONCLUSION: The oral health of the participants was unsatisfactory due to the high rates of periodontitis and decayed teeth, even with alkaline salivary pH. Self-perception of oral health does not correspond to the results obtained in the clinical examination. Thus, the inclusion of dentistry in the multidisciplinary team can contribute to health and care of bariatric surgery patients.

Поражение слизистой полости рта при заболеваниях системы крови

Signs of many diseases of body organs and systems are manifested in the oral cavity. Patients with blood disorders are characterized by prominent oral mucosal alterations. One of the most common symptoms includes increased mucosal bleeding, as well as vulnerability and impaired epithelialization of the oral mucosa. The clinical manifestations spectrum depends on the underlying disease severity. Secondary (fungal, herpes virus) infections complicate the diagnosis. Such patients require comprehensive physical and laboratory examination. Blood tests, as well as laboratory tests on other bodily fluids allow dentists to clarify the systemic disease diagnosis, and to provide proper topical treatment.

Gene expression analysis of autofluorescence margins in leukoplakia and oral carcinoma: A pilot study.

Autofluorescence is considered a useful technique in the early detection of oral mucosal alterations. However, its efficacy to discriminate tumor margins is still under debate. The purpose of this pilot study was to confirm the existence of molecular divergence from the center of a lesion compared to white light and autofluorescence (VELscopeTM ) visualized margins in leukoplakia and oral carcinoma. Molecular divergence from the center of the lesion to white light and VELscopeTM defined margins was compared in patients with leukoplakia (n=3) and oral carcinoma (n=4). Expression profiling of 45 selected genes was performed through custom-made TaqMan arrays. Gene Ontology was used for biological pathway analysis. Irrespective of pathology, the greatest molecular divergence existed between the center of the lesion and both white light and VELscopeTM margins. VELscopeTM and white light margins were also molecularly distinct in oral carcinoma samples. Indeed, the white light margin retained molecular abnormalities observed in the center of the lesion thus suggesting the existence of a "partially transformed" cell population. Despite the limited low number of patients, our data confirm the benefit of combining autofluorescence with conventional oral examination in identifying surgical margins during biopsy procedures for leukoplakia and oral carcinoma.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody positivity in 884 patients with burning mouth syndrome

Burning mouth syndrome (BMS) is characterized by burning sensation of the oral mucosa in the absence of clinically apparent oral mucosal alterations. This study evaluated the anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity in 884 BMS patients. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 884 BMS patients were measured and compared with the corresponding levels in 442 age- and sex-matched healthy control subjects. We found that 175 (19.8%), 143 (16.2%), 42 (4.8%), 20 (2.3%), 170 (19.2%), and 109 (12.3%) BMS patients had blood Hb, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 884 BMS patients had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 442 healthy control subjects (all P-values<0.005). Of 175 anemic BMS patients, 95 had normocytic anemia, 27 had thalassemia trait-induced anemia, 21 had iron deficiency anemia, 15 had pernicious anemia, 15 had macrocytic anemia other than pernicious anemia, and 2 had microcytic anemia other than iron deficiency anemia and thalassemia trait-induced anemia. Burning sensation of oral mucosa (100.0%), dry mouth (48.1%), numbness of oral mucosa (30.7%), and dysfunction of taste (16.7%) were the four common symptoms in 884 BMS patients. BMS patients have significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects.

IRON DEFICIENCY PREDISPOSES TO ORAL MUCOSA ALTERATIONS AND CANDIDA INFECTION

Objectives Iron deficiency (ID) is the most common nutritional deficiency, but its diagnosis is not always easy. We investigate patients with oral mucosa alternations as the initial manifestation of iron deficiency (ID) or iron deficiency anemia (IDA). Materials and methods Sixty-four patients (50 IDA and 14 ID) with a wide range of sore mouth were diagnosed and treated. The iron studies and anemia classification based on the mean and heterogeneity of red cell size were assessed. Results ID predisposed 64 patients to a high incidence of Candidainfection (81%) and showeda variety of oral manifestations including angular cheilitis (63%), atrophic glossitis (59%), pseudomembranous candidosis (44%), erythematous candidosis (41%), median rhomboid glossitis (5%), chronic mucocutaneous candidosis (5%), papillary hyperplastic candidosis (3%) and cheilocandidosis (3%). Others included pale oral mucosa (31%), burning mouth (28%) and recurrent oral ulcers (6%). The values of hemoglobin in 64 ID patients varied from normal to life-threatening levels but none had developed advanced systemic symptoms except fatigue. All had low serum iron and ferritin; however, 14 (22%) patients were nonanemic and 19 (30%) patients remained normocytic. All oral changes can be successfully meliorated by iron therapy plus antifungals when candidosis existed. A colorectal cancer in two patients was diagnosed and treated. Conclusions Our findings demonstrate that oral mucosa alterations accompanying oral candidosis are a sensitive indicator of ID. ID is the prime promoting factor in the development of oral mucosa alternations; anemia is merely a late manifestation of ID. It is essential to investigate the origin of ID, because it can be the initial sign of a serious disease, particularly malignancy.

Consistent Technique Limits Suspension Laryngoscopy Complications.

Introduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL. Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL. Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutive minutes. The incidence of postoperative complications was calculated and analyzed with respect to gender, smoking status, dentition, laryngoscope type, and suspension system. Results A total of 213 consecutive SL cases were reviewed, including 174 patients (94 male, 80 female). The overall postoperative complication rate was of 3.8%. Four patients experienced tongue-related complications, two experienced oral mucosal alterations, one had a dental injury, and one experienced a minor facial burn. The complication incidence was greater with the Zeitels system (12.5%) compared with the Lewy suspension system (3.3%), although it was not significant ( p = 0.4). Likewise, the association of complications with other patient factors was not statistically significant. Conclusion Only 8 out of 213 cases in the present series experienced complications, which is significantly less than the complication rates observed in other reports. Consistent and conscientious protection of the dentition and of the oral mucosa and limiting suspension times to 30 minutes are factors unique to our series that appear to reduce complications in endolaryngeal surgery.