Oral Mucosal Diseases Research Articles

Rapidly analyzing of ingredients during chewing and processing of areca nut using feature-based molecular networking

As a traditional herbal medicine and food in China and many other Asian countries, the areca nut (Areca catechu L.) is not only widely used for the treatment of various diseases, but also popular as a chewing hobby. However, as a first-class carcinogen designated by IARC, clinical studies have shown that long-term chewing of areca nut is associated with oral mucosal diseases and even oral cancer. Moreover, the incidence of these diseases varies regionally, suggesting that it may be related to edible methods in different regions. In this study, UPLC-Q-TOF-MSE was combined with feature-based molecular networking to systematically characterise the chemical ingredients of areca nut. Based on these results, the ingredients of different edible parts and edible methods was rapidly compared. The compositional changes during the production process were also analysed. The obtained results provide a foundation for the scientific utilisation of areca nut.

Prevalence of oral mucosal and periodontal disease amongst patients receiving dialysis

End-stage renal disease (ESRD) requires renal replacement therapy (RRT), namely a renal transplant or renal dialysis or both. Dialysis corrects the electrolyte imbalance and reduces circulating urea and creatinine levels. ESRD patients may present with oral complications and disease due to impaired renal functions, associated comorbidities, or the pharmacological management thereof.To determine the prevalence of periodontal- and oral mucosal disease in ESRD patients undergoing dialysis. Recommendations will be made regarding dental treatment needs and dental management. Cross-sectional study. Fifty-three ESRD patients were evaluated for mucosal lesions and periodontal disease. Patient's age, race, gender, comorbidities, dialysis duration and medicationwere recorded. Treatment urgency was determined, and patients referred accordingly for appropriate dental treatment. Mean age of patients was 42,9 ±10,4 years with a median time on dialysis of 30 months. Majority of patients were hypertensive (94.34%). No oral mucosal lesions was found. PSR score of 3 was mostly found (36.58%). Sixty-two percent of patients had a moderate treatment urgency.A relationship between chronic kidney disease and periodontitis exists. ESRD patients should thus be enrolled into a periodontal screening and treatment program and all dental treatmen

Oral potentially malignant disorder awareness level among elder community in the Belawa Distric, Wajo, South Sulawesi, Indonesia

Objective: to assess awareness of senior community in the Belawa distric, Wajo, South Sulawesi, Indonesia regarding their oral soft tissue abnormality specifically regard to Oral potentially malignant disorders, and to assess community ability to descript any pain or uncomfortably origin from their oral cavity.
 Methods: A self-made questionnaire written in Indonesia language was given to the old aged-adult based on WHO criteria with age range between 45 to 75 years old, who was willing to participate in this study. The questioner consists some picture representing oral mucosal cavity with clinical feature of some ulcers, clinical feature of candida infection, and some clinical appearances of oral potentially malignant disorders.
 Results: In term of oral mucosal diseases questions, 22 (55%) participants had history of ulceration, however only 5 (45%) participants could specifically point out its previous ulcer location. However, history of pain only stated by 11 (28%) participants, 24 (60%) did not experienced any pain, and 5 (12%) did not answer the questions.
 Conclusion: knowledge and awareness regarding oral health lesion, especially the associated-potentially malignant lesion was far from ideal in the Belawa Community.

Manifestation of diseases of the mucous membrane of the oral cavity sick children with COVID-19

As we made sure, with the spread of the coronavirus infection, the number of the oral mucosa diseases caused by COVID-19 is also growing. Effective diagnosis with rational pharmacotherapy of the oral mucosa pathology caused by this new pandemic is serious problem for dentists. In this article, on the basis of clinical-laboratory methods, diagnostics and treatment of the oral mucosa diseases were carried out in 43 patients which had previously undergone COVID19. Oral examination results in patients with Coronavirus mutations show a variety of oral manifestations. The obtained research data clearly showed the necessity and advisability of including a dental examination in this category of patients after their clinical recovery. Extremely severe acute respiratory infection caused by SARS-CoV-2 coronavirus. The SARS-CoV2 virus is distinguished by its ability to infect various organs both through direct infection and through the body's immune response. This disease downstream can occur both in mild and severe form. One of the frequent complications is the development of viral pneumonia. Coronavirus can also infect the oral mucosa. The pathogenic agent enters the body due to angiotensin-converting enzyme 2, which is localized both on the surface of the alveoli and lung structures, and on the epithelial cells of the oral cavity, where it begins to actively multiply. In connection with the spread of a new coronavirus infection, the number of diseases of the mucous membrane of the oral cavity is steadily growing.

Evaluation of Vitamin D Levels in Pediatric Patients With Recurrent Aphthous Stomatitis.

Recurrent aphthous stomatitis is one of the most common oral mucosal diseases. It is characterized by recurrent painful attacks. Its etiology is unknown. Vitamin D (vit D) is a steroid vitamin with immunomodulatory and anti-inflammatory effects. It is thought that oral cavity diseases may occur in vitamin D deficiency. This study aimed to investigate vit D levels in pediatric patients with recurrent aphthous stomatitis. In this retrospective study, 86 children with recurrent aphthous stomatitis and 71 age-matched healthy children were included in the study. The 25-hydroxyvitamin D levels examined with the enzyme immune assay were recorded for both groups. Serum vit D level was 12±4.5 ng/ml in the group with aphthous stomatitis and 31±7 ng/ml in the healthy group. A statistically significant difference was found in vit D levels between the two groups (p<0.001). Vit D levels were significantly low in children with recurrent aphthous stomatitis. Our findings suggestthat low vit D levels may be associated with recurrent aphthous stomatitis.

Serum levels of reduced glutathione, oxidized glutathione, and glutathione reductase activity in minor recurrent aphthous stomatitis patients

Background/purposeRecurrent aphthous stomatitis (RAS) is one of the most prevalent oral mucosa diseases with unknown etiology. Reduced glutathione (GSH) is a major intracellular non-protein physiological antioxidant, and it has been demonstrated that GSH deficiency may be related to cardiovascular, immune, and diabetes. The purpose of this investigation was to evaluate the potential roles of GSH, oxidized glutathione (GSSG), and glutathione reductase (GR) in the etiopathogenesis of minor recurrent aphthous stomatitis (MiRAS). Materials and methodsThe study comprised 87 patients with idiopathic MiRAS and 90 race-, age-, and gender-matched healthy individuals. The spectrophotometric method was used to determine serum GSH and GSSG concentrations as well as GR activity. The GSSG/GSH ratios were subsequently computed. For statistical evaluation, the independent sample t test, Pearson's chi-square test, Mann–Whitney U test, Kruskal–Wallis H test, and Binary logistic regression analysis were used. ResultsThe serum GSSG level, GR activity and GSSG/GSH ratio were statistically higher in MiRAS patients, whereas the concentration of serum GSH was significantly decreased. With the exception of GR, serum GSSG, GSH, and GSSG/GSH were all significantly associated with MiRAS. Serum GSSG can be regarded as a risk factor, whereas serum GSH and GSSG/GSH maybe considered as protective factors against the occurrence of MiRAS. ConclusionGSSG may be a potential danger factor to MiRAS and GSH may be a protective factor, while GR may not play an important role in the aetiopathogenesis of MiRAS.

Gene polymorphisms and serum levels of mannose-binding lectin in Czech patients with recurrent aphthous stomatitis: A case-control study.

Recurrent aphthous stomatitis is one of the most prevalent oral mucosal immunological diseases. A recent case-control study in the Egyptian population suggested that single nucleotide polymorphism Gly54Asp (rs1800450) of the mannose-binding lectin 2 gene might affect the mannose-binding lectin serum level and recurrent aphthous stomatitis development. The aim of this study was to determine the distribution of six functional mannose-binding lectin 2 gene polymorphisms and analyse their role in recurrent aphthous stomatitis susceptibility in the Czech population. The study included 227 subjects; 137 healthy people and 90 patients with recurrent aphthous stomatitis. Six mannose-binding lectin 2 gene polymorphisms (rs11003125, rs7096206, rs7095891, rs5030737, rs1800450, rs1800451) were analysed by the SNaPshot assay method, mannose-binding lectin serum levels were determined by enzyme-linked immunosorbent assay (ELISA) method in a subgroup of subjects (N=87). No significant differences in mean of mannose-binding lectin serum levels between healthy controls and patients with recurrent aphthous stomatitis were observed (383 ng/ml ± 249 standard deviation (SD) vs. 316 ng/ml ± 177 SD in remission phase vs. 343 ng/ml ± 254 SD in active phase; p > 0.05), also the allele and genotype frequencies of the studied mannose-binding lectin 2 polymorphisms did not differ significantly between the two groups (p > 0.05, odds ratio (OR): 0.75-1.23). Moreover, the distribution of mannose-binding lectin 2 haplotypes and haplogenotypes was similar in the healthy subjects and patients with recurrent aphthous stomatitis (p > 0.05, OR: 0.75-1.23). This study did not confirm the previously reported association of the mannose-binding lectin 2 Gly54Asp gene variant and low mannose-binding lectin serum level as the risk factors for susceptibility to recurrent aphthous stomatitis. In addition, no significant relationships between mannose-binding lectin 2 functional haplotypes or haplogenotypes and recurrent aphthous stomatitis were observed.

ФАКТОРЫ РИСКА ВОЗНИКНОВЕНИЯ ЗАБОЛЕВАНИЙ СЛИЗИСТОЙ ОБОЛОЧКИ РТА (ЛИТЕРАТУРНЫЙ ОБЗОР)

Subject. A literature review was conducted on the most complex and poorly studied section of therapeutic dentistry – diseases of the oral mucosa.&#x0D; The object – literature search and analysis of current data on the study of risk factors affecting the development and aggravation of pathological conditions on the oral mucosa.&#x0D; Methodology. Scientific publications using library databases have been studied: Elibrary, PubMed, Google Scholar. The analysis of the information was carried out on 48 sources.&#x0D; Results. The role of risk factors in the development of pathological processes on the mucous membrane of the mouth is described. The influence of socio-behavioral determinants, such as smoking and alcohol consumption, on the occurrence of pathological, in particular, precancerous conditions in the oral cavity is indicated. Particular attention is paid to the traumatic component, among which injuries with dentures come to the fore, in the development of lesions on the oral mucosa. The significance of comorbid pathology in the occurrence of oral diseases is reflected. It was noted that among the leading positions in the development of dermatoses on the mucous membrane of the mouth are occupied by neurogenic conditions. Changes on the mucous membrane of the mouth in patients with vitamin-mineral imbalances in the body are illuminated. The relationship between the appearance of lesions on the oral mucosa and the environmental characteristics of the area of residence has been demonstrated.&#x0D; Conclusions. The importance of investigating oral mucosal diseases in a particular region is emphasized in relation to the influence of certain risk factors in order to develop and improve preventive programs for the preservation of dental health.

Evaluation of Oral Dryness and the Salivary-flow Rate in Patients with Oral Lichen Planus

Background and Objectives: Oral lichen planus (OLP) is a common T-cell-mediated inflammatory oral mucosal disease. One of the complaints among OLP patients is xerostomia. However, the relationship between oral dryness and a decreased salivary-flow rate in these patients is not yet conclusive. So, we investigated oral dryness and the salivary-flow rate in OLP patients using various measurements. Material and Methods: Thirty OLP patients and 30 controls were included. The oral-dryness symptoms were collected using the Xerostomia Inventory (XI) and Bother Index (BI). The salivary-flow rate was measured using a Modified Schirmer Test (MST) and the spitting method. The clinical signs of dry mouth were determined by the clinical oral-dryness score (CODS). The Thongprasom score was used to evaluate the severity of OLP. The data were analyzed using the Mann-Whitney U test and Spearman’s rank correlation coefficient. Results: The XI score and BI score in the OLP group were significantly higher than in the control group. However, CODS, MST, the unstimulated salivary-flow rate, and the stimulated salivary-flow rate were not significantly different between the two groups. There was no correlation between oral dryness and the salivary-flow rate in OLP patients. The severity of OLP was also not correlated to oral dryness and the salivary-flow rate. Conclusion: OLP patients had more complaints about mouth dryness than the controls. However, the salivary-flow rates between the two groups were not different. Additionally, the severity of OLP was not related to dry mouth or the salivary-flow rate. The possible reasons for oral dryness among people with OLP require further investigation.

Follicular lymphoma manifests as multiple erosive and proliferative lesions of the oral mucosa: case report and brief literature review

BackgroundErosion is one of the most common and basic lesions of oral mucosal diseases. Long-term refractory oral erosions, induced by autoimmune blistering diseases, infectious diseases, malignant diseases, and some rare conditions, may substantially reduce the quality of life of patients or even constitute a life-threatening condition, resulting in a clinical dilemma regarding the accurate diagnosis and precise management of these diseases. As a special type of malignant lymphoma, most lesions of follicular lymphoma (FL) in the oral mucosa present as masses or swelling of the oral mucosa, while emerging novel presentations lead to intractable diagnoses. Hence, diagnostic algorithms for such diseases are clinically required. Case presentationA 55-year-old female patient presented to the clinic with long-lasting oral mucosal erosions and proliferative lesions. Blood tests, pathological examinations of oral lesions including haematoxylin–eosin (HE) staining, and direct immunofluorescence precluded all of the potential diagnoses described previously. Unexpectedly, positron emission tomography/computed tomography (PET/CT) and abdominal CT of the patient revealed a dense mass in the retroperitoneal area, and the final diagnosis of the retroperitoneal mass was FL. After three courses of chemotherapy conducted by the haematologist, the erosion and proliferative lesions in the patient's oral mucosa had significantly improved. HE and immunohistochemical staining results of intraoral lesions also confirmed it as oral FL. The successful diagnosis of FL in this case is of great clinical significance, as the oral and abdominal FL were treated in a timely manner to avoid unfavourable outcomes.ConclusionsTo the best of our knowledge, this is the first case of FL that exhibited widespread erosions interspersed with proliferative lesions. Clinicians should be aware of oral FL or seek systemic factors in the presence of similar refractory oral erosions when treatment is non-responsive and the diagnosis is intractable.

Quality of life in patients with oral potentially malignant disorders: oral lichen planus and oral epithelial dysplasia

The aim of this study was to evaluate and compare quality of life (QoL) parameters in patients with oral potential malignant disorders (OPMDs), namely, oral lichen planus (OLP) and oral epithelial dysplasia (OED). A cross-sectional study was completed at the oral maxillofacial surgery/oral medicine practices at University of Pennsylvania. Patients with clinical and histopathologic confirmation of OLP or OED from January to June 2021 were included in the study. The primary predictor variable was the OPMD type. The primary outcome variable was the score of 3 separate surveys: the Chronic Oral Mucosal Disease Questionnaire-26 (COMDQ-26), Oral Potential Malignant Disorder QoL Questionnaire (OPMDQoL), and Hospital Anxiety and Depression Scale. Multiple linear regression was used to determine independent predictors of increased/decreased questionnaire scores. The final study sample consisted of 100 patients:53 patients had OLP (53.0%), 39 patients had OED (39.0%), and 8 patients had OLP with OED (8.0%). Relative to OED, OLP added 15.7 points to the COMDQ-26 survey score (P < .001). Relative to OED, OLP added 8.9 points to the OPMDQoL survey score (P=.003). Oral lichen planus shows significantly poorer QoL specifically within the COMD-26 and OPMDQoL questionnaires, compared with OED. Additionally, patients with OPMDs aged 40 to 64 years were independently associated with higher COMD-26 scores compared with older patients (>65 years).

A Systematic Review and Meta-Analysis of Acupuncture Treatment for Oral Ulcer.

Oral ulcer (OU) is a common oral mucosal disease manifested with obvious pain. In some studies, the efficacy of acupuncture in OU has been confirmed, but systematic reviews and meta-analyses for them are lacking. Our aim is to evaluate the efficacy of acupuncture in the treatment of OU. We searched the literature from eight databases from their inception to December 2021. We included randomized controlled trials of acupuncture for the treatment of oral ulcer. The meta-analysis was carried out using Review Manager 5.3 and Stata 16.0. The main outcomes were the effective rate and the recurrence rate, the secondary outcomes were the visual analogue score (VAS) and the ulcer healing time. Totally, 18 studies were finally included in the meta-analysis, including 1,422 patients. In meta-analyses, we found that in comparison with Western medicine, acupuncture can improve effective rate (OR = 5.40, 95% CI: 3.40 to 8.58), reduce the ulcer recurrence rate (OR = 0.21, 95% CI: 0.13 to 0.33), and relieve the ulcer pain (MD = -2.26, 95% CI: -4.27to-0.24). In addition, compared with Western medicine, acupuncture plus Western medicine also can improve effective rate (OR = 2.95, 95% CI: 1.48 to 5.85). Compared with the Chinese medicine, the acupuncture plus Chinese medicine can improve the effective rate (OR = 8.26, 95% CI: 3.61 to 18.88) and relieve the ulcer pain (MD = -1.85, 95% CI: -2.51 to -1.19). Acupuncture may be more effective than Western medicine in terms of efficacy rate, and acupuncture combined with Western or Chinese medicine may have the potential to reduce the recurrence of ulcer and relieve the ulcer pain. However, due to limited evidence, higher quality and more rigorously designed clinical trials with larger sample sizes will be needed to further confirm our findings.

High frequencies of vitamin B12 and folic acid deficiencies and hyperhomocysteinemia in Taiwanese male patients with oral submucous fibrosis

Background/purpose: Oral submucous fibrosis (OSF) is a betel quid chewing-caused oral mucosal disease with progressive collagen deposition. This study evaluated whether Taiwanese male OSF patients had high frequencies of vitamin B12 and folic acid deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity. Materials and methodsThe blood hemoglobin (Hb), serum iron, vitamin B12, folic acid, homocysteine, and GPCA concentrations in 62 male OSF patients were measured and compared with the corresponding data in 124 age-matched male healthy control subjects. ResultsWe found that 5 (8.1%), 12 (19.4%), 32 (51.6%), 31 (50.0%), 22 (35.5%), and 6 (9.7%) of the 62 male OSF patients had Hb (<13 g/dL), iron (≤70 μg/dL), vitamin B12 (≤450 pg/mL), and folic acid (≤6 ng/mL) deficiencies, hyperhomocysteinemia (>12 μM), and serum GPCA positivity, respectively. Furthermore, OSF patients had significantly higher frequencies of Hb (P = 0.006), vitamin B12 (P < 0.001), and folic acid (P < 0.001) deficiencies, hyperhomocysteinemia (P < 0.001), and serum GPCA positivity (P = 0.030) than 124 healthy control subjects. Of the 22 OSF patients with hyperhomocysteinemia, 4 had vitamin B12 deficiency only, 7 had folic acid deficiency only, and 11 had both vitamin B12 and folic acid deficiencies. ConclusionWe conclude that Taiwanese male OSF patients have high frequencies of vitamin B12 and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity. The hyperhomocysteinemia in our OSF patients is predominantly due to deficiencies of either vitamin B12 or folic acid or both.

Higher frequencies of anemia, hematinic deficiencies, and gastric parietal cell antibody positivity in vitamin B12-deficient Taiwanese male oral submucous fibrosis patients

Oral submucous fibrosis (OSF) is a progressive fibrotic oral mucosal disease associated with betel quid chewing. This study evaluated whether Taiwanese male OSF patients with vitamin B12 deficiency (the serum vitamin B12 level ≤ 450pg/mL, B12-deficient OSF patients) had high frequencies of blood hemoglobin (Hb) and serum iron and folic acid deficiencies, and serum gastric parietal cell antibody (GPCA) positivity. The blood Hb and serum iron, vitamin B12, folic acid, and GPCA concentrations in 66 Taiwanese male B12-deficient OSF patients were measured and compared with the corresponding data in 132 age-matched healthy male control subjects. We found that 6 (9.1%), 19 (28.8%), 35 (53.0%), and 9 (13.6%) of the 66 B12-deficient OSF patients had blood Hb (<13g/dL) and serum iron (≤70μg/dL), and folic acid (≤6ng/mL) deficiencies, and serum GPCA positivity, respectively. Furthermore, 66 OSF patients had significantly higher frequencies of blood Hb and serum iron and folic acid deficiencies, and serum GPCA positivity than 132 healthy control subjects (all P-values < 0.05). Of the 6 anemic B12-deficient OSF patients, one had macrocytic anemia, two normocytic anemia, and three thalassemia trait-induced anemia. Taiwanese male B12-deficient OSF patients have high frequencies of blood Hb, serum iron and folic acid deficiencies, and serum GPCA positivity. The anemia and hematinic deficiencies in B12-deficient OSF patients are likely due to OSF symptoms and signs-caused insufficient intake, poor chewing, and malabsorption of hematinic elements from ingested food stuffs rather than the GPCA positivity.

High-throughput assay for effect screening of amphotericin B and bioactive components on filamentous Candida albicans.

The aim of this study was to develop a high-throughput robotic microtiter plate-based screening assay for Candida albicans, optimizing growth conditions to replicate the filamentous biofilm growth found in vivo, and subsequently, to demonstrate the assay by evaluating the effect of nutritional drinks alone and in combination with the antifungal amphotericin B (AmB). Candida albicans cultured in a defined growth medium showed filamentous growth in microcolonies, mimicking the morphology of oral mucosal disease (oral candidiasis). Addition of nutrient drinks containing fruit juices, fish oil and whey protein to the medium resulted in changed morphology and promoted growth as free yeast cells and with weak biofilm structures. Minimum inhibitory concentration of AmB on the biofilms was 0.25 μg ml-1 , and this was eightfold reduced (0.0038 μg ml-1 ) in the presence of the nutritional drinks. The established assay demonstrated applicability for screening of antifungal and anti-biofilm effects of bioactive substances on C. albicans biofilm with clinically relevant morphology. Candida albicans is the causative agent of the majority of fungal infections globally. The filamentous morphology of C. albicans and the ability to form biofilm are traits known to increase virulence and resistance towards antifungals. This study describes the development of a plate-based in vitro screening method mimicking the filamentous morphology of C. albicans found in vivo. The assay established can thus facilitate efficient antifungal drug discovery and development.

Type-2 epithelial-mesenchymal transition in oral mucosal nonneoplastic diseases.

The oral mucosa is a membranous structure comprising epithelial and connective tissue that covers the oral cavity. The oral mucosa is the first immune barrier to protect the body against pathogens for systemic protection. It is frequently exposed to mechanical abrasion, chemical erosion, and pathogenic invasion, resulting in oral mucosal lesions, particularly inflammatory diseases. Epithelial-mesenchymal transition (EMT) is a crucial biological process in the pathogenesis of oral mucosal disorders, which are classified into three types (types 1, 2, and 3) based on their physiological consequences. Among these, type-2 EMT is crucial in wound repair, organ fibrosis, and tissue regeneration. It causes infectious and dis-infectious immunological diseases, such as oral lichen planus (OLP), oral leukoplakia, oral submucosal fibrosis, and other precancerous lesions. However, the mechanism and cognition between type-2 EMT and oral mucosal inflammatory disorders remain unknown. This review first provides a comprehensive evaluation of type-2 EMT in chronically inflammatory oral mucosal disorders. The aim is to lay a foundation for future research and suggest potential treatments.

MANAGEMENT OF ULCERATIVE ORAL LICHEN PLANUS PREDISPOSED BY PSYCHOLOGICAL STRESS

Background: Oral lichen planus (OLP) is a chronic inflammatory autoimmune oral mucosa disease. The ulcerative type of OLP presents as erythematous ulceration with mucosal erosions surrounding whitish striae. The aetiology of OLP is unknown, but can be predisposed by psychological factors. Purpose: Reporting ulcerative oral lichen planus predisposed by psychological stress. Case: A 36 years old woman complained very painful ulcer in the right buccal mucosa and a grey-purple lower lip lesion for a year. It had been treated with topical corticosteroids, antibiotics, tretinoin, and vitamins but did not heal. Extraoral examination on the lower vermillion showed bluish-purple macules, diffuse and irregular borders, rough and painful. Intraoral examination in the right buccal mucosa showed an irregular yellowish-white ulcer with an erythematous area and white striae. Case Management: Screening for psychological stress by DASS 42 showed moderate stress and severe anxiety. Autofluorescence examination showed no malignant transformation sign. A complete blood count test showed low neutrophil and lymphocyte count. ANA test was normal. Systemic Methyl Prednisolone 8 mg was prescribed 2 tabs twice a day and tapered off after the lesion resolved within 1 week. Supportive treatments include Benzydamine HCl and multivitamins. Discussion: Stress, anxiety, and depression were possible factors of OLP mediated by the Hypothalamic-pituitary-adrenal (HPA) axis system and the Sympathetic-adrenal-medullary (SAM) system. Specific mechanisms are mediated by Antigen-specific CD8+ (CTLs) that are activated with the help of CD4+ T-cells. Non-specific mechanism mediated by MMP-9 activation. They led to the apoptosis of keratinocytes. Systemic corticosteroids are an important treatment for oral lichen planus that do not responded to topical steroids. Conclusion: Oral Lichen Planus is a chronic inflammatory disease that affects the oral mucosa and can be predisposed by psychological stress. Corticosteroid is very effective to treat oral lichen planus, especially the erosive-ulcerative type. Keywords: Oral Lichen Planus, Psychological Stress, Ulcerative

Knowledge and Awareness of Oral Mucosal Diseases Among Saudi Dentists

Background: Oral mucocutaneous lesions have a significant impact on patient care. Late diagnosis of oral lesions may affect patients' quality of life and prognosis. Dentists are usually the first to encounter such lesions, and many studies have explored the knowledge and management related to oral cancer. However, not many studies have examined a more comprehensive understanding and management of oral lesions, including infectious and autoimmune/immune-mediated diseases. Aims: This study aimed at evaluating dentists’ knowledge and referral patterns regarding oral mucocutaneous diseases. Methods: A questionnaire-based cross-sectional study was conducted to evaluate dentists’ knowledge about oral mucocutaneous diseases and referral patterns among Saudi dentists. A total of 301 participants were included in the study. It was voluntary and written informed consent was obtained from the participants. A Chi-square test was used to compare the categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: A total of 301 participants responded. Significant differences were observed between genders when asked about being comfortable with treating oral mucosal lesions in their practice (p-value: .019), and males were more convenient than females. A significant difference (p-value: .011) was observed between different educational levels when the participants were asked about the management of patients with oral mucosal lesions. Overall, the majority of participants rarely or never managed oral lesions. When comparing the different groups of participants, postgraduate residents responded more accurately (p-value: 007). Approximately 60% of all participants did not or rarely managed oral lesions in their practice. Conclusion: It was found that there was a lack of knowledge among dentists regarding the detection and treatment of oral mucosal lesions. This lack of knowledge can lead to unfavorable patient care and prognosis outcomes.

Machine Learning-Based Genome-Wide Salivary DNA Methylation Analysis for Identification of Noninvasive Biomarkers in Oral Cancer Diagnosis.

Simple SummaryBecause tissue biopsy is the gold standard for diagnosing oral cancer, it is often performed to confirm disease during screening, management, and monitoring. However, many reports are negative. Salivary biomarkers can provide the preliminary stratification of suspicious lesions to encourage patient selection in clinical practice. However, the discovery and implementation of salivary biomarkers still need to be refined. Therefore, in this study, we successfully utilized machine learning techniques to select optimal methylome biomarkers that may be applied for oral cancer diagnoses.This study aims to examine the feasibility of ML-assisted salivary-liquid-biopsy platforms using genome-wide methylation analysis at the base-pair and regional resolution for delineating oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs). A nested cohort of patients with OSCC and OPMDs was randomly selected from among patients with oral mucosal diseases. Saliva samples were collected, and DNA extracted from cell pellets was processed for reduced-representation bisulfite sequencing. Reads with a minimum of 10× coverage were used to identify differentially methylated CpG sites (DMCs) and 100 bp regions (DMRs). The performance of eight ML models and three feature-selection methods (ANOVA, MRMR, and LASSO) were then compared to determine the optimal biomarker models based on DMCs and DMRs. A total of 1745 DMCs and 105 DMRs were identified for detecting OSCC. The proportion of hypomethylated and hypermethylated DMCs was similar (51% vs. 49%), while most DMRs were hypermethylated (62.9%). Furthermore, more DMRs than DMCs were annotated to promoter regions (36% vs. 16%) and more DMCs than DMRs were annotated to intergenic regions (50% vs. 36%). Of all the ML models compared, the linear SVM model based on 11 optimal DMRs selected by LASSO had a perfect AUC, recall, specificity, and calibration (1.00) for OSCC detection. Overall, genome-wide DNA methylation techniques can be applied directly to saliva samples for biomarker discovery and ML-based platforms may be useful in stratifying OSCC during disease screening and monitoring.

Electrospun patch delivery of anti-TNFα F(ab) for the treatment of inflammatory oral mucosal disease.

Chronic ulcerative oral mucosal inflammatory diseases, including oral lichen planus and recurrent aphthous stomatitis, are painful and highly prevalent, yet lack effective clinical management. In recent years, systemic biologic therapies, including monoclonal antibodies that block the activity of cytokines, have been increasingly used to treat a range of immune-mediated inflammatory conditions such as rheumatoid arthritis and psoriasis. The ability to deliver similar therapeutic agents locally to the oral epithelium could radically alter treatment options for oral mucosal inflammatory diseases, where pro-inflammatory cytokines, in particular tumour-necrosis factor-α (TNFα), are major drivers of pathogenesis. To address this, an electrospun dual-layer mucoadhesive patch comprising medical-grade polymers was investigated for the delivery of F(ab) biologics to the oral mucosa. A fluorescent-labelled F(ab) was incorporated into mucoadhesive membranes using electrospinning with 97% v/v ethanol as a solvent. The F(ab) was detected within the fibres in aggregates when visualised by confocal microscopy. Biotinylated F(ab) was rapidly eluted from the patch (97±5% released within 3h) without loss of antigen-binding activity. Patches applied to oral epithelium models successfully delivered the F(ab), with fluorescent F(ab) observed within the tissue and 5.1±1.5% cumulative transepithelial permeation reached after 9h. Neutralising anti-TNFα F(ab) fragments were generated from whole IgG by papain cleavage, as confirmed by SDS-PAGE, then incorporated into patches. F(ab)-containing patches had TNFα neutralising activity, as shown by the suppression of TNFα-mediated CXCL8 release from oral keratinocytes cultured as monolayers. Patches were applied to lipopolysaccharide-stimulated immune-competent oral mucosal ulcer equivalents that contained primary macrophages. Anti-TNFα patch treatment led to reduced levels of active TNFα along with a reduction in the levels of disease-implicated T-cell chemokines (CCL3, CCL5, and CXCL10) to baseline concentrations. This is the first report of an effective device for the delivery of antibody-based biologics to the oral mucosa, enabling the future development of new therapeutic strategies to treat painful conditions.