Oral Mucosal Diseases Research Articles

Biological therapies and management of oral mucosal disease

Biologic drugs are drugs made by living organisms and the term is usually limited to monoclonal antibodies or receptors targeting specific cytokines or cells that have been developed in recent decades. These drugs have had an enormous impact on the management of cancers, including head and neck cancers, and immune-mediated inflammatory conditions, for example, rheumatoid arthritis and inflammatory bowel disease. General dental practitioners will routinely be managing patients who are on these medications for a wide range of systemic conditions. These drugs also have a limited role in the management of immune-mediated oral mucosal disease. In this article, we will introduce the range of biological agents and their systemic indications and then elaborate on their use in oral mucosal disease and the disadvantages associated with their use.

Oral mucosal disease: dilemmas and challenges in general dental practice

Oral medicine (OM) is a recognised component of all UK undergraduate dental programmes and practising dentists are expected to safely investigate and manage patients presenting with oral mucosal disease. Delivering OM care for patients in a general dental practice setting does however come with a number of challenges and dilemmas for practitioners.General dental practitioners may be limited in their ability to arrange diagnostic tests such as biopsies or blood tests, important in reaching a definitive OM diagnosis. Lack of operator skill or lack of access to appropriate laboratory facilities to process diagnostic samples will likely contribute to this. In addition, general dental practitioners may feel underconfident to reliably interpret test results. Management of OM patients can also be time-consuming and may not generate a significant remunerative reward under current NHS payment systems.OM is a subject that overlaps with several medical specialities, and up until 2010, required dual qualification in both undergraduate dentistry and medicine. Practitioners who have not undertaken OM training beyond undergraduate dentistry may lack confidence with the subject, and fear of misjudging a lesion of concern will certainly prompt referrals from primary care into hospital-based OM clinics.

Oral medicine considerations for the older patient.

With the proportion of the world population aged over 60 years expected to nearly double to 22% by 2050, health care professionals are faced with the challenge of ensuring they are ready to address this demographic shift. As people age, they are more likely to develop comorbidities which have implications for their oral health. The effects of polypharmacy used to address these underlying health problems can also influence the oral health of older-aged patients. From a clinician's perspective, an awareness of the variety of conditions associated with old age, such as oral-mucosal disease, swellings and manifestations of underlying health conditions, are required to ensure appropriate referral, investigation and management, both in primary and secondary care settings. This article aims to provide the practitioner with an overview of orofacial and oral mucosal conditions commonly encountered with the older patient.

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.

Common oral mucosal lesions

Headlines All general dental practitioners experience common oral mucosal diseases in their practice. Once a correct diagnosis of the oral lesion is established, it is possible to acquire information about management strategies through different information sources.

Oral_voting_transfer: classification of oral microorganisms' function proteins with voting transfer model.

The oral microbial group typically represents the human body's highly complex microbial group ecosystem. Oral microorganisms take part in human diseases, including Oral cavity inflammation, mucosal disease, periodontal disease, tooth decay, and oral cancer. On the other hand, oral microbes can also cause endocrine disorders, digestive function, and nerve function disorders, such as diabetes, digestive system diseases, and Alzheimer's disease. It was noted that the proteins of oral microbes play significant roles in these serious diseases. Having a good knowledge of oral microbes can be helpful in analyzing the procession of related diseases. Moreover, the high-dimensional features and imbalanced data lead to the complexity of oral microbial issues, which can hardly be solved with traditional experimental methods. To deal with these challenges, we proposed a novel method, which is oral_voting_transfer, to deal with such classification issues in the field of oral microorganisms. Such a method employed three features to classify the five oral microorganisms, including Streptococcus mutans, Staphylococcus aureus, abiotrophy adjacent, bifidobacterial, and Capnocytophaga. Firstly, we utilized the highly effective model, which successfully classifies the organelle's proteins and transfers to deal with the oral microorganisms. And then, some classification methods can be treated as the local classifiers in this work. Finally, the results are voting from the transfer classifiers and the voting ones. The proposed method achieved the well performances in the five oral microorganisms. The oral_voting_transfer is a standalone tool, and all its source codes are publicly available at https://github.com/baowz12345/voting_transfer.

PDE12 disrupts mitochondrial oxidative phosphorylation and mediates mitochondrial dysfunction to induce oral mucosal epithelial barrier damage in oral submucous fibrosis

Oral submucous fibrosis (OSF) is a chronic oral mucosal disease. The pathological changes of OSF include epithelial damage and subepithelial matrix fibrosis. This study aimed to reveal the epithelial injury mechanism of OSF. A histopathological method was used to analyze oral mucosal tissue from OSF patients and OSF rats. The expression of PDE12 in the oral epithelium was analyzed by immunohistochemistry. The epithelial–mesenchymal transition (EMT) and tight junction proteins in arecoline-treated HOKs were explored by western blotting. Epithelial leakage was assessed by transepithelial electrical resistance and lucifer yellow permeability. The expression of PDE12 and the mitochondrial morphology, mitochondrial permeability transition pore opening, mitochondrial membrane potential, and mitochondrial reactive oxygen species (mtROS) were evaluated in arecoline-induced HOKs. Oxidative phosphorylation (OXPHOS) complexes and ATP content were also explored in HOKs. The results showed significant overexpression of PDE12 in oral mucosal tissue from OSF patients and rats. PDE12 was also overexpressed and aggregated in mitochondria in arecoline-induced HOKs, resulting in dysfunction of OXPHOS and impaired mitochondrial function. An EMT, disruption of tight junctions with epithelial leakage, and extracellular matrix remodeling were also observed. PDE12 overexpression induced by PDE12 plasmid transfection enhanced the mtROS level and interfered with occludin protein localization in HOKs. Interestingly, knockdown of PDE12 clearly ameliorated arecoline-induced mitochondrial dysfunction and epithelial barrier dysfunction in HOKs. Therefore, we concluded that overexpression of PDE12 impaired mitochondrial OXPHOS and mitochondrial function and subsequently impaired epithelial barrier function, ultimately leading to OSF. We suggest that PDE12 may be a new potential target against OSF.

ХАРАКТЕРИСТИКА РАСПРОСТРАНЕННОСТИ СТОМАТОЛОГИЧЕСКОЙ ЗАБОЛЕВАЕМОСТИ У ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА, ПРОЖИВАЮЩИХ В ПОЛНЫХ И ВОССТАНОВЛЕННЫХ СЕМЬЯХ

Abstract. Introduction. Dental diseases in preschool children do not appear to tend downward. According to the literature, the prevalence of dental decay and its complications in preschool children reaches 70%, dental abnormalities more than 80%, and periodontal diseases and oral mucosa diseases up to 98%. There are some data described in literature, regarding how family types affect the overall incidence in children. At the same time, the impact of family type on the children dental health has not been studied a lot so far. Taking this into account, this paper provides data on dental morbidity in preschool children living in nuclear and reconstituted families. The aim of the study is to examine the pattern of prevalence of major dental diseases in preschool children living in nuclear or reconstituted families. Materials and Methods. Preschool children of different ages and their parents took part in this study. During the study, we identified reconstituted and nuclear families, the children from which families constituted the subject of the study. In total, the study examined 1,929 children from 1,842 nuclear families and 166 children from 146 reconstituted children. Results and Discussions. The study found that the most important dental diseases occur in children of the earliest age, before 1 year of life. With the passage of time and the child’s growth, their dental morbidity progresses and reaches its peak among preschool children aged 4.6-6 years. Children living in reconstituted families were significantly more susceptible to the onset and progression of major dental diseases than those from nuclear families. Conclusions. The impact of family type on dental morbidity in preschool children should be considered while planning the prevention and medical examination programs, which will help identify dental diseases at an early stage, prevent the development of complications, and optimize health care costs for the treatment and prevention of dental diseases in preschool children

B12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I.

The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency-related glossitis (B12-def glossitis) and gastric serum biomarkers [gastrin-17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti-Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12-def glossitis. A cross-sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests. Of 243 patients, 133 with B12-def glossitis were in the case group, and 110 with other oral mucosal diseases (non-glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow ). Univariate logistic regression showed that G17hi PGIlow was a high-risk factor for B12-def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti-H. pylori antibodies compared to the non-G17hi PGIlow group. Gastric serum biomarkers in patients with B12-def glossitis generally showed G17hi PGIlow , suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non-G17hi PGIlow groups may represent different etiologies of B12 deficiency.

Консультация терапевтом стоматологического пациента с поражением слизистой оболочки полости рта. Когда, зачем, о чем?

Oral mucosal pathology is a significant problem in stomatology due to the complexity of a differential diagnosis and often requires the systemic therapy of it. Therefore, it is not uncommon for patients with diseases of the oral mucosa to be referred to a therapeutic physician to find the etiological factor of oral mucosa disease and to choose the systemic therapy. However, the purpose of the consultation and the capacity of the therapist’s physician in such situations may be interpreted differently by stomatologists and therapists. There is an example of the patient with lichen planus. The main tasks of the therapist consultation in this case are: to provide a general clinical examination of the possible somatic manifestations of the lichen planus autoimmune process, to evaluate the therapy to exclude possible influence some of the medication to the lesion of oral mucosal or progression lichen planus, to assess the general condition of the patient in order to select the treatment regimens using systemic corticosteroids and risk factors for the development of side effects of this therapy.

Screening as a stage in the prevention of oral mucosal diseases in patients undergoing chemotherapy for malignant growths

Relevance. The incidence of malignant growths in the maxillofacial area has consistently increased over the years. Chemotherapy stands out as one of the most effective treatments for cancerous tumors. Chemotherapeutic drugs possess the capability to either inhibit the proliferation of malignant cells or cause damage to them. However, while acting on abnormal cells, cytostatic drugs also impact actively dividing cells in normal tissues, including the mucous membranes in the oral cavity. As a result, various complications are observed in every patient undergoing treatment for malignant neoplasms (MN), particularly chemotherapy (CT). The nature and severity of side effects undergo changes based on the specific drugs and cytostatic treatment regimen employed. Adverse reactions and side effects inherent to each drug category manifest at different points throughout a chemotherapy course and its aftermath. Oral mucosal (OM) complications, such as oral mucositis, may ensue as a consequence of CT side effects.Materials and methods. In order to assess the effectiveness of screening for OM disorders arising as side effects of chemotherapy, a study involving 37 patients undergoing chemotherapy for an underlying condition was conducted. The screening study comprised two stages: Stage I involved a quality-of-life assessment utilizing questionnaires developed by the authors, while Stage II entailed a clinical examination of the oral mucosa. The obtained data were subjected to statistical analysis methods. Variation statistics were employed to assess the likelihood of data errors.Results. Comprehensive OM diagnostics in patients undergoing chemotherapy for an underlying oncology condition enable the early identification of oral mucosal diseases and the prevention of complications. It is recommended to conduct a thorough clinical examination and employ toluidine blue staining during each follow-up visit. Any observed clinical or stained tissue changes, the emergence of new erythematous lesions, erosions, or ulcers may serve as indicators of malignant transformation.Conclusion. It is advisable to incorporate screening diagnostics into each patient's dental visit to proactively prevent the onset of various pathological conditions.

Orofacial complications from immune checkpoint inhibitors: A retrospective analysis from two academic medical centers.

Immune checkpoint inhibitors (ICIs) are FDA-approved for various cancers, yet their orofacial immune-related adverse events (irAEs) remain poorly understood. Our two-center retrospective study aims to better understand the prevalence and nature of these orofacial irAEs. We retrospectively collected demographics, ICI details, and onset of orofacial irAEs in ICI-treated patients at University of California San Francisco and City of Hope (2013-2021). Orofacial irAEs were identified by ICD-10 codes and data categorized as dry mouth/xerostomia, oral mucosal lesions, and orofacial neuropathies. Patients with pre-existing orofacial conditions resembling the reported irAEs were excluded. Among 3768 ICI-treated patients, 408 (10.8%) developed 467 orofacial irAEs: oral mucosal diseases (41.4%), dry mouth/xerostomia (41.0%), and orofacial neuropathies (17.6%). Notably, head and neck cancers had the highest incidence of orofacial irAEs. Orofacial irAEs are relatively common in patients receiving ICIs, necessitating careful monitoring and management of these complications during and after the treatment.

Cytological Features of Oral Cytobrush Smears in Type II Diabetes Mellitus Patients

Oral cytology is a renewed field that aids in diagnosis and observation of possible epithelial changes associated with oral mucosal diseases. Aim; to study the main cytomorphological alteration in gingival and buccal smears from type II diabetics in relation to their hyperglycemic status. The study includes 40 type II diabetic patients (20 new-diagnosed and 20 treated diabetics patients) and 20 healthy persons of both sex. Papanicolaou stained smear were prepared from their cheek and gingiva. The morphological features of 100 unfolded epithelial cells were evaluated under light microscope. Results of this study show that diabetics’ oral mucosa cells characterized by large nuclei with frequent evidence of binucleation, granular chromatin, prominent nucleoli. However, there was frequent small blue cytoplasm and buccal smears showed altered keratinization. As conclusion oral cytology from type II diabetics is associated with detectable cytomorphological changes that is site specific and indicate epithelial cell regeneration and degeneration with altered keratinization especially in buccal mucosa.

A bibliometric study on research trends and hotspots of recurrent aphthous stomatitis

Background/purposeRecurrent aphthous stomatitis (RAS) is a common oral mucosal disease. Despite a variety of scientific articles have been available till date, merely a few scientometric analyses have been systematically carried out in this field. The objective of this study was to recognize the hotspots and research trends related to RAS via bibliometric approach. Materials and methodsThe Elsevier's Scopus database was searched to retrieve qualified literature through an advanced search strategy on 9 Feb 2023. The basic information was collected as following: article type, publication year, journals, impact factor, the count of citations, citation density, keywords, authors, contributing institutions and country. ResultsA list of 986 publications were identified from 1933 to 2022, and the number of citations for each paper varied from 0 to 283. A steady increasing trend in the number of documents could be observed each decade with the summit in 2010s. Controlled study (n = 334) and major clinical study (n = 192) were the most common types of study design. Scully C (n = 26) was identified as the most productive author. United States (n = 166) and Turkey (n = 101) top the list of dedicating countries. ConclusionThis report would offer profound insight into the current status of RAS research and serve as a reference source for anyone planning to enhance the quality of future work.

Thalidomide for management of refractory oral mucosal diseases

Thalidomide has anti-inflammatory properties and has been used off-label for multiple mucocutaneous disorders, but its application in managing refractory oral mucosal diseases is unclear. This study aimed to review the efficacy and safety of thalidomide in treating various oral mucosal disorders refractory to conventional therapies. The medical records of patients who were prescribed thalidomide from 2002 through 2021 for oral mucosal disorders were reviewed. Data collected included demographic characteristics, oral mucosal disease diagnosis, treatment courses, and thalidomide dose, duration, response, and side effects. Thalidomide was prescribed for 28 patients with diagnoses of recurrent aphthous stomatitis (n = 14), inflammatory oral lichenoid lesions (n = 6), traumatic ulcerative granuloma with stroma eosinophilia (n = 5), chronic radiation-induced mucositis (n = 2), and orofacial granulomatosis (n = 1). Patients were treated for a median duration of 84 days (range 2-1,582). Clinical improvement was observed in 19 of 22 patients who completed at least 1 cycle of thalidomide (86.4%), with complete resolution in 12 patients (54.5%). Adverse events occurred in 75% of patients (n = 21), with 8 requiring thalidomide discontinuation. The most common adverse events included peripheral neuropathy (42.9%), drowsiness (28.6%), and constipation (21.4%). Thalidomide may be considered for the management of refractory oral mucosal disorders. Drug side effects are common and need monitoring closely during use.

Optical coherence tomography: Promising imaging technique for the diagnosis of oral mucosal diseases.

This review aims to summarize the latest application of optical coherence tomography (OCT) in oral mucosal diseases, promoting an accurate and earlier diagnosis of such disorders, which are difficult to be differentiated. References on the application of OCT in oral mucosal diseases were mainly obtained from PubMed, Embase, Web of Science and Scopus databases, using the keywords: "optical coherence tomography and 'oral mucosa/oral cancers/oral potentially malignant diseases/oral lichen planus/oral leukoplakia/oral erythroplakia/discoid lupus erythematosus/oral autoimmune bullous diseases/oral ulcers/erythema multiforme/oral mucositis'". It is found that OCT is showing a promising application potential in the early detection, diagnosis, differential diagnosis, monitoring of oral cancer and oral dysplastic lesions, as well as the delineation of tumor margins. OCT is also playing an increasingly important role in the diagnosis of oral potentially malignant disorders, oral mucosal bullous diseases, oral ulcerative diseases, erythema multiforme, and the early detection of oral mucositis. Optical coherence tomography, as a novel optical technique featured by real-time, noninvasive, dynamic and high-resolution imaging, is of great use to serve as an adjunct tool for the diagnosis, differential diagnosis, monitoring and therapy evaluation of oral mucosal diseases.

The Correlation Between the Recurrent Aphthous Stomatitis Lesion and Quality of Life Among Productive-Age Patients

Background: Recurrent Aphthous Stomatitis (RAS) is an ulcerative disease in oral mucosa. These lesions are usually located on the non-keratinized oral mucosa with the characteristics of recurrent ulcerated lesions and the presence of pain. Some people affected by RAS will have various impacts on speech, swallowing, and chewing functions. Patients with RAS usually experience pain, and this impact greatly affects their quality of life. Objective: This study examined the relationship between RAS and patients' quality of life. Materials and Methods: This study is a cross-sectional observational study. The method of taking the subjects was done using consecutive sampling with 32 subjects. Data collection was carried out with objective and subjective data. Results: A significant relationship exists between RAS and patient quality of life p = 0.044 (Fisher's Exact Test,p0.05). There is a significant correlation between RAS and patient quality of life Spearman's correlation test, significance p0.05) with a value of p = 0.018 with a strength level of a correlation coefficient of 0.415, which means that it has a moderate level and a direction of the correlation is positive. Conclusion: Aspects of social functioning limitation and bodily pain are most influenced by the emergence of RAS lesions. There is a positive correlation between RAS and patients' quality of life.

Salivary microbiota and metabolic phenotype of patients with recurrent aphthous ulcers.

Recurrent aphthous ulcer (RAU) is a prevalent oral mucosal disease, affecting around 20% of the global population. It can greatly impair the quality of life for affected individuals. However, the exact etiology of RAU remains unknown. 16S rRNA sequencing (16S rRNA-seq) and non-targeted liquid chromatography-mass spectrometry (LC-MS) were employed to investigate the salivary microbiota and metabolic phenotype between RAU patients (N = 61) and healthy controls (HCs) (N = 105). Findings from 16S rRNA -seq indicated reduced oral microbial diversity in RAU patients compared to HCs, but increased interactions. Clinical variables did not show any significant association with the overall diversity of oral microbiota in RAU patients. However, significant correlations were observed between specific microorganisms and clinical variables. LC-MS results revealed dysregulation of amino acid, lipid, nucleotide, and caffeine metabolism in RAU patients. Furthermore, correlation analysis of 16S rRNA-seq and LC-MS data revealed a significant association between salivary microbiota and metabolites in RAU patients. Our study revealed notable differences in salivary microbiota and metabolic profiles between RAU patients and HCs, indicating a strong link between oral microbiota dysbiosis, metabolic disturbances, and the onset and progression of RAU.

Nanochemistry of gold: from surface engineering to dental healthcare applications.

Advancements in nanochemistry have led to the development of engineered gold nanostructures (GNSs) with remarkable potential for a variety of dental healthcare applications. These innovative nanomaterials offer unique properties and functionalities that can significantly improve dental diagnostics, treatment, and overall oral healthcare applications. This review provides an overview of the latest advancements in the design, synthesis, and application of GNSs for dental healthcare applications. Engineered GNSs have emerged as versatile tools, demonstrating immense potential across different aspects of dentistry, including enhanced imaging and diagnosis, prevention, bioactive coatings, and targeted treatment of oral diseases. Key highlights encompass the precise control over GNSs' size, crystal structure, shape, and surface functionalization, enabling their integration into sensing, imaging diagnostics, drug delivery systems, and regenerative therapies. GNSs, with their exceptional biocompatibility and antimicrobial properties, have demonstrated efficacy in combating dental caries, periodontitis, peri-implantitis, and oral mucosal diseases. Additionally, they show great promise in the development of advanced sensing techniques for early diagnosis, such as nanobiosensor technology, while their role in targeted drug delivery, photothermal therapy, and immunomodulatory approaches has opened new avenues for oral cancer therapy. Challenges including long-term toxicity, biosafety, immune recognition, and personalized treatment are under rigorous investigation. As research at the intersection of nanotechnology and dentistry continues to thrive, this review highlights the transformative potential of engineered GNSs in revolutionizing dental healthcare, offering accurate, personalized, and minimally invasive solutions to address the oral health challenges of the modern era.

Comparison of tunnel and VISTA techniques for multiple gingival recession treatment: A systematic literature review.

Gingival recession (GR) has become one of the most common concerns in oral mucosal diseases. It causes discomfort such as root hypersensitivity, root caries, and aesthetic problems, leading to the development of various surgical techniques to address GRs. This study compared the non-advanced tunnel and m-VISTA techniques in treating multiple GRs. A literature search related to the efficiency of non-advanced tunnel and m-VISTA techniques was conducted in MEDLINE (PubMed), EMBASE (ScienceDirect), Cochrane Central Register of Controlled Trials (Cochrane Library), Springer Link, and Google Scholar. Randomized controlled trials (RCTs) reporting periodontal parameters published in the recent four years (2019-2023) were included and assessed for the risk of bias. All in vitro, animal, pilot studies, case reports, and case series were excluded. Five RCTs were included with 195 cases of GRs. Comparing the two techniques revealed a significant increase in keratinized tissue width (KTW) from baseline to 6 months (-1.4 mm), in clinical attachment level (CAL) (-2.65 mm), and in recession depth (-2.7 mm) for the tunnel technique. On the other hand, a significant increase in GR width (-2.26 mm) was found in the m-VISTA group. Finally, there were no significant differences in probing depths. Both techniques were effective in root coverage and may be valuable for treating multiple GRs.