Oral Mucosal Disorders Research Articles

Pigmentary Disorders of Oral Mucosa

Oral mucosa under physiological condition contains a certain degree of chromic variation. Differentiating such physiological variations from pigmented lesions appears challenging without a histopathological confirmation. In several oral lesions, pigmentation is a part of the primary pathology or a secondary change to an existing entity. The pigments involved in both physiological and pathological conditions can be broadly categorised as exogenous or endogenous. Among these, melanin accounts for the majority of black to brown pigmentation including malignant melanoma. Clinically, their biological behaviour shows an ambiguity which makes it challenging to arrive at diagnosis for even the experienced practitioner. Although biopsy confirms and reassures the patient, it is impractical to biopsy all pigmented lesions. The standard diagnostic algorithm given below is to aid the clinician to diagnose and treat this diverse group of lesions.

A review on newer therapeutic modalities for immune-mediated oral mucosal disorders: A start from the dead end

The immune-mediated oral mucosal lesions pose a challenge to the oral physicians owing to their preplexing diagnosis and management. Steroids are the first line of treatment for these diseases, but they have their limitations. With improved advancements and research being done to understand the pathogenesis behind these diseases, newer modalities of treatment are being introduced as a part of the treatment protocol for long-term remission. Some of the promising ones are plasmapheresis, extracorporeal photopheresis, intravenous immunoglobulin therapy, and rituximab. Their therapeautic efficiency is yet to be established with randomized controlled trials.The purpose of this article is to focus on these novel therapies in the management of immune-mediated oral mucosal lesions and their feasibility in the Indian scenario. A PubMed search was done using the keywords plasmapheresis, extracorporeal photopheresis, immunoadsorption, rituximab, and immune-mediated oral mucosal disorders, which revealed 10,539 articles on plasmapheresis, 925 articles on extracorporeal photopheresis, 76,100 articles on immunoglobulin therapy, and 12,402 articles on rituximab. After a detailed screening, seven articles on plasmapheresis published from the year 2002 to 2012, three articles on extracorporeal photopheresis published from the year 2008 to 2011, three articles on immunoglobulin therapy published from the year 2005 to 2011, and two articles on rituximab published from the year 2006 to 2011 were identified based on their usage in immune-mediated oral mucosal disorders for inclusion in this review.

Relationship of salivary cortisol and anxiety in recurrent aphthous stomatitis.

Background and Objectives:Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal disorders. Despite extensive amount of research, the etiology of RAS remains unclear. Psychological-emotional factors were considered as one of the major predisposing factors. The aim of the study was to assess the levels of anxiety and salivary cortisol levels in patients with RAS and also to determine the association and relationship of salivary cortisol levels to variations of stress.Materials and Methods:A total of 30 patients suffering with RAS, along with the same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects at 9.00 am to avoid diurnal variations of cortisol levels. Salivary cortisol levels were measured by competitive enzyme linked immunosorbent assay. Anxiety levels of both groups were measured by using Hamilton's anxiety scale. Student's t-test was used to compare the anxiety and salivary cortisol levels between both groups.Results:The mean salivary cortisol level of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The mean anxiety scores of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The values of Pearson correlation coefficient between anxiety and salivary cortisol was 0.980 and one with a P value of 0.000 showing that there is a highly positive correlation between anxiety and salivary cortisol.Conclusion:Results suggest that anxiety may be involved in the pathogenesis of RAS. Thus besides traditional treatment of RAS patients, our findings suggest that psychological support is also needed.

Assessment of serum enzymatic antioxidant levels in patients with recurrent aphthous stomatitis: a case control study.

Background and Aim. Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae. Despite extensive research, the exact etiology of RAS remains elusive. Recently oxidant-antioxidant imbalance of the body has been implicated in the pathogenesis of recurrent aphthous stomatitis. Thus, the aim of the study was to evaluate the enzymatic antioxidant levels in patients with recurrent aphthous stomatitis. Materials and Methods. The serum levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were measured in 30 patients with recurrent aphthous stomatitis and compared to the control group, which included 30 healthy subjects. Student's t-test was performed for statistical evaluation. Results. The mean levels of superoxide dismutase (130.2 ± 15.94 U/mL) and glutathione peroxidase (3527.93 ± 488.32 U/L) were found to be significantly lower in study group as compared to control group (211.9 ± 20.93 U/mL, 8860.93 ± 1105.31 U/L, resp.) (P = 0.000) while level of catalase in study group was significantly higher when compared to control group (10981.00 ± 1018.07 U/mL versus 9764.00 ± 1621.19 U/mL) (P = 0.000). Conclusion. Enzymatic antioxidant system is impaired in recurrent aphthous stomatitis patients and seems to play a crucial role in its pathogenesis.

Oral Mucosal Disorders in Pregnant versus Non-Pregnant Women

The effects of pregnancy on the Oral Mucosa Disorder (OMD) have been sporadically documented in some developed countries. Less known is the status of OMD during pregnancy in less developed/developing countries. Iran is no exception. This study assesses the prevalence of OMD in 200 pregnant women and compares the findings with the findings from a 200 non-pregnant woman of similar age distribution in Iran. The participants had been referred to a clinic to receive reproductive age-related services. Participants suffering from systemic chronic diseases, those on medications/drugs, smokers, needing biopsies, and those with urgent Oral Mucosal Lesion (OML) treatments were excluded from the study. Oral mucosal of all 400 participants were examined. The participants’ age ranges were from 17 to 47; with the average age of 33.14 for one group; and 30.23 for the other group. Both groups had the same level of formal education. Out of 400 examined women; 62 had lesions, including 47 pregnant (23.5%); and 15 non-pregnant (7.5%) women. This result shows that the OMD rate of occurrence was significantly higher among the pregnant women. Higher OML prevalence in pregnant women, as compared to the non-pregnant women, indicates the importance of timely oral examination of pregnant women and subsequent treatment plans for them.

Malignant transformation in 5071 southern Taiwanese patients with potentially malignant oral mucosal disorders.

BackgroundOral cancers can be preceded by clinically evident oral potentially malignant disorders (OPMDs). The current study evaluated the rate and the time of malignant transformation in the various OPMDs in a cohort of patients from southern Taiwan. Parameters possibly indicative for malignant transformation of OPMDs, such as epidemiological and etiological factors, and clinical and histopathological features were also described.MethodsWe followed-up 5071 patients with OPMDs—epithelial dysplasia with oral submucous fibrosis, epithelial dysplasia with hyperkeratosis/epithelial hyperplasia, hyperkeratosis/epithelial hyperplasia, oral submucous fibrosis, lichen planus, and verrucous hyperplasia—between 2001 and 2010 for malignant transformation.ResultsTwo hundred nineteen of these 5071 OPMD patients (202 men, 17 women; mean age: 51.25 years; range: 30–81 years) developed oral cancers (179 squamous cell carcinomas; 40 verrucous carcinomas) in the same sites as the initial lesions at least 6 months after their initial biopsies. The overall transformation rate was 4.32% (mean duration of transformation: 33.56 months; range: 6–67 months). Additionally, the mean time of malignant transformation was significantly shorter for lesions with than without epithelial dysplasia. The risk of malignant transformation was 1.89 times higher for epithelially dysplastic than non-dysplastic lesions. The anatomical site of OPMD and the presence of epithelial dysplasia were significantly associated with malignant transformation. The hazard rate ratio was 1.87 times larger for tongue lesions than for buccal lesions.ConclusionPatients with OPMDs require long-term follow up.

Oral medicine 7. Witte veranderingen van het mondslijmvlies

White lesions of the oral mucosa may be due to highly diverse disorders. Most of these disorders are benign but some may be a malignant or premalignant condition. The disease is often confined to the oral mucosa. There are also disorders which are accompanied by skin disorders or systemic diseases. Many white oral mucosa disorders have such characteristic clinical aspects that a diagnosis can be made on clinical grounds only. When the clinical diagnosis is not clear, histopathological examination is carried out. Treatment depends on the histological diagnosis. In some cases, treatment is not necessary while in other cases, treatment is not possible since an effective treatment is not available. Potentially malignant disorders are treated.

Restricted mouth opening and trismus in oral oncology.

Restricted mouth opening (RMO) and trismus are terms commonly used in oral oncology in instances where there is difficulty in mouth opening. The term trismus in oral oncology is mainly used to indicate the radiation-induced fibrosis of the muscles of mastication. The treatment given for RMO as reported in the literature is given for muscular dysfunction trismus, whereas RMO in oral oncology can occur owing to various reasons other than muscular dysfunction. RMO occurs in various conditions of the oral cavity; in posterior pharyngeal infection, where it is termed reflectory trismus; in oral submucous fibrosis; in oral mucosal disorders; in the use of certain drugs; and in minor dental procedures of the posterior oral cavity. The usage of the term trismus in all RMO cases would complicate the treatment; thus, the word should not be used in all RMO cases.

Oral health in geriatrics

Aging of population due to downward trends in fertility and mortality is a major concern worldwide, particularly in developing countries. Due to prolonged life span there is a notable increase in the proportion of elderly patients who need dental care. Dental treatment should be adapted based on the age related oral mucosal changes and underlying systemic conditions. Dental professionals play a key role in diagnosing the oral manifestations of systemic diseases in older people. This paper reviews the effect of aging on oral tissues and the common oral and systemic conditions in geriatrics. The review of literature was done electronically as well as manually. For electronic search, various scientific journals and web-based search engines were used. The search terms were geriatrics, oral manifestations, systemic diseases, elderly. Cross references of relevant articles were also retrieved. The review focuses on the common oral conditions like oral mucosal disorders, oral infections, dental and periodontal diseases including salivary gland disorders. Dental treatment for patients with systemic diseases like hypertension, diabetes mellitus, cardiovascular diseases and neurological disorders are also highlighted. Oral diseases in the elderly people should be managed by regular professional and personal care and requires an understanding of the changes that occur with advancing age.

Oral proliferative verrucous leukoplakia treated with the photodynamic therapy: a case report

About 60% of the oral cancer arise on a pre-existent potentially malignant disorder of oral mucosa like the oral proliferative verrucous leukoplakia. The treatment with the photodynamic therapy of these lesions represents, in the last years, an innovative, non-invasive and effective therapeutic possibility to achieve the secondary prevention of oral cancer. In the last decade, case reports have described patients with similar treated through a photochemical reaction induced by laser light. The aim of this study is to evaluate the effectiveness of the topical 5-ALA photodynamic therapy in the treatment of a case of Oral proliferative verrucous leukoplakia. A female patient of 80 years old affected by white verrucous plaques on the right buccal mucosa was recruited for our case report. The right side lesion was treated with the photodynamic therapy with topical administered 5-aminolevulinic acid using the 635 nm laser light to activate the photosensitizer. The lesion showed complete response after 4 sessions of photodynamic therapy and no recurrence was noticed after 12 months. The photodynamic therapy can be considered an effective treatment in the management of oral verrucous proliferative leukoplakia, but more clinical trials, with prolonged follow-up controls, are necessary to evaluate its effectiveness in the mid and long time period.

Malignant transformation in 5071 patients with potentially malignant oral mucosal disorders: a follow-up study based in a Southern Taiwanese Hospital

Malignant transformation in 5071 patients with potentially malignant oral mucosal disorders: a follow-up study based in a Southern Taiwanese Hospital

Evaluation of micronuclear frequencies in both circulating lymphocytes and buccal epithelial cells of patients with oral lichen planus and oral lichenoid contact reactions

The aim of this study was to evaluate the frequency of micronuclei (MNs) in both circulating lymphocytes and buccal epithelial cells of patients with oral lichenoid contact reactions (OLCRs) or with oral lichen planus (OLP) and compare their MN scores with those of healthy controls (HCs). The study group included 21 patients (mean age 51.3±12.4; 6 males, 15 females) with OLCRs and 22 patients (mean age 47.6±14.4; 4 males, 18 females) with OLP who were clinically diagnosed and histopathologically confirmed according to WHO diagnostic criteria (WHO Collaborating Centre for Oral Precancerous Lesions, 1978). All patients with OLCR demonstrated contact allergy to tested dental materials when evaluated by skin patch testing according to International Contact Dermatitis Research Group (ICDRG), while all OLP patients tested negative to patch testing. Seventeen individuals with no oral mucosal disorders (mean age 51.7±11.3; 8 males, 9 females) were recruited to constitute the healthy control group. [Correction added on 30 May 2014, after first online publication: the term, 'mean age' has been added to the text in parenthesis throughout the Material and Methods section.] Clinical features including type of OLP, location, disease severity, presence of skin lesions, presence of systemic disease including any allergies and dental (periodontal) status were recorded. MN analyses were performed on peripheral blood lymphocytes and on smears of buccal epithelial cells of all three study groups. Most OLP and OLCR lesions were of reticular type (83%), and OLP lesions were distributed bilaterally on the buccal mucosa (90.5%). The medians of MN frequencies in buccal epithelial cells in OLP and OLCR groups were significantly higher when compared with HC group (P<0.001). [Correction added on 30 May 2014, after first online publication: in the results, 2nd sentence, the word 'lymphocytes' has been removed.] There was no significant difference between OLP group (14.5 range 3-95) and OLCR group (16.0 range 3-93) in terms of median MN frequencies in buccal epithelial cells (P=0.724) nor in peripheral lymphocytes between OLP group (2.0 range 0-7) and OLCR group (1.0 range 0-6) (P = 0.92). [Correction added on 30 May 2014, after first online publication: (P = 0.92) was wrongly placed after 'peripheral lymphocytes' and has now been shifted to the end of the last sentence.] Micronuclei scores do not distinguish OLP from OLCR when using buccal smears. OLP and OLCR both demonstrated significantly higher MN frequencies in buccal cells, compared with healthy controls. MN assessment in both buccal epithelial cells and circulating lymphocytes may serve as a potential biomarker tool for evaluating any cancer risk in OLP and OLCR. [Correction added on 30 May 2014, after first online publication: the first and second sentences in the conclusions have been slightly changed.].

OP143: Leonardo da Vinci Partnership – A lifelong learning programme to raise awareness of dental and medical professionals within Europe for the early detection of oral cancer – Phase 2

Objective To create cooperation among institutions at an European level in order to raise awareness on oral cancer among dental and medical professionals. To develop educational material for purposes of screening and for the early detection of oral cancer and potentially malignant disorders. Methods In order to understand gaps in knowledge and performance, during Phase I of this project we undertook: 1. A review of literature on dentist’s awareness, opinions and behaviors in published studies regarding early detection and prevention or oral cancer in Europe. 2. A Delphi survey among opinion leaders on issues pertaining to defining ways of improving early diagnosis of oral cancer. 3. A review of literature on oral cancer screening programs in Europe. 4. Catalogued and reviewed all available teaching resources (including e-learning) on screening for oral cancer. We set out to develop e-learning materials on the topic of early detection. Results Dentists encounter oral cancer patients infrequently during their life time performance. The diagnostic dilemma is complicated by oral mucosal disorders that may be mistaken for cancer. The reviews of literature confirm fundamental gaps in knowledge and understanding of early signs and symptoms. There are inequalities in screening performances within as well as between European countries largely based on available resources of training. During Phase 1 of the Leonardo Partnership, the group produced a comprehensive e learning package ( www.oralcancerldv.org ) in three languages for Europe wide use. Conclusions The Leonardo da Vinci Partnership will address the failures to implement screening for oral cancer by recommending strategies on involvement of medical and dental professionals. The partnership has a resolute drive to develop further e-learning material to improve skills in early detection and tobacco cessation that could be translated to other European languages. Relevance A three to five year agenda within Europe which will lead to key educational improvements to support dentists’ and doctors’ performance in the early detection of oral cancer and giving advice on tobacco cessation.

PP027: Primary Hodgkin’s lymphoma: A rare manifestation in the hard palate

Purpose To report the rare involvement of the hard palate as the only manifestation of Classical Hodgkin Lymphoma and the differential diagnosis with other infections and lymphoproliferative disorders of oral mucosa. Material and methods A 43-year-old white female complained of a 6 month history of sore throat. The physical examination revealed an ulcer measuring 2.0 cm on the hard palate that presented communication with nasal cavity. The initial diagnostic hypotheses were leishmaniosis, tuberculosis or infectious cutaneous mucosal diseases. Results Analytical results of infectious agents were negative. An incisional biopsy showed lymphoplasmocitary infiltrate, with presence of Hodgkin and Reed-Sternberg cells, that exhibited immunoreactivity to CD30 and Fascina and nonreactivity to CD15, CD45, CD56, CD20, CD3 and TIA1, supporting a diagnosis of classical Hodgkin lymphoma, Ann Arbor clinical stage I-A. The patient was submitted to three cycles of chemotherapy (ABVD) and there was no evidence of disease at 15 months of follow-up. Conclusions The primary extranodal Hodgkin’s lymphoma of the oral cavity suggests a new diagnostic and epidemiological perspective, that it may be associated with a new disease. So, it should be included in the differential diagnosis of ulcerative lesions of the palate.

Copper/zinc and copper/selenium ratios, and oxidative stress as biochemical markers in recurrent aphthous stomatitis

ProjectRecurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The aim of this study is to scrutinize the relationship between oxidative stress and serum trace elements (copper, Cu; zinc, Zn; selenium, Se), and to evaluate the ratios of Cu/Zn and Cu/Se in this disorder. ProcedurePatients with RAS (n=33) and age- and sex-matched healthy control subjects (n=30) were enrolled in this study. Malondialdehyde (MDA) concentrations in plasma and the activities of superoxide dismutase (SOD1; CuZnSOD), glutathione peroxidase (GPx) and catalase (CAT) in erythrocyte were determined as spectrophotometric. Also, the levels of Se, Zn and Cu in serum were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction. Results and conclusionsOxidative stress was confirmed by the significant elevation in plasma MDA, and by the significant decrease in CAT, SOD1, and GPx (p<0.05). When compared to controls, Zn and Se levels were significantly lower in patients, whereas Cu levels was higher in RAS patients than those in controls (p<0.05). In addition, the correlation results of this study were firstly shown that there were significant and positive correlations between Se–CAT, Se–GPx, and Cu–MDA parameters, but negative correlations between Se–Cu, Se–MDA, Cu–CAT, Cu–SOD1 and Cu–GPx parameters in RAS patients. Furthermore, the ratios of Cu/Zn and Cu/Se were significantly higher in the patients than the control subjects (p<0.05). Our results indicated that lipid peroxidation associated with the imbalance of the trace elements seems to play a crucial role in the pathogenesis of RAS. Furthermore, the serum Cu/Zn and Cu/Se ratios may be used as biochemical markers in these patients.

Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap - a randomised prospective trial

BackgroundOral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.MethodsThis study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.ResultsAverage increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value > 0.05.ConclusionBased on this study radial forearm free flap is a superior method compared to transposition of nasolabial flap to cover the surgical wound of oral submucous fibrosis.

A Study to evaluate the Frequency and Association of Various Mucosal Conditions among Geriatric Patients

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. To evaluate the oral mucosal status in the elderly population of different age group and fnd out the association of age, gender and denture with oral mucosal disorders. The study sample consisted of 570 geriatric persons concentrating mainly on the oral mucosal changes or lesions occurring in the geriatric population. Individuals those are aged above 60 years were selected, and all the examined geriatric persons were categorized into 3 age groups to fnd out the association of oral mucosal lesions in each group. Group I-60 to 65 years, Group II-66 to 70 years, Group III-71 and above years. The sample of 570 elderly patients included 279 (48.95%) men and 291 (51.05%) women in three age groups: 61 to 65 years (40.35%), 66 to 70 years (31.05%), and 71 years and older (28.60%). The sample included 254 (44.56%) dentate patients, 205 (35.96%) denture wearers (partial and complete denture wearers) and 111 (19.47%) edentulous persons who lacked dentures in both the jaws. Almost half of the patients examined (48%) had one or more oral mucosal lesions. The 48% of the patients who presented with oral mucosal lesions, twenty fve different oral mucosal conditions were identifed and the three most common fndings were lingual varices (13.68%), denture induced infammatory fbrous hyperplasia (4.21%), squamous cell carcinoma (4.21%). There was some differences in the distribution of oral mucosal condition among the sexes. Leukoplakia and dysplasia were signifcantly associated with men (p < 0.001) whereas the association of fbroma and lichen planus with women were signifcant (p < 0.001). In our study it was found that patients in groups II and III had more prevalence of oral mucosal disorders. Lingual varices, oral squamous cell carcinoma, fbroma and denture induced infammatory fbrous hyperplasia were more commonly associated with the geriatric patients. The oral lesions (fbroma and lichen planus) were strongly associated with women while leukoplakia was strongly associated with men. Ageing is an important factor that can infuence the occurrence of mucosal lesions and with age the oral mucosa becomes more permeable to noxious substances and more vulnerable to external carcinogens.

Honey for Oral Mucosal Disorders

Honey for Oral Mucosal Disorders

Oral Mucosal Disorders Associated with Hepatitis C Virus Infection: Oral Lichen Planus

Oral Mucosal Disorders Associated with Hepatitis C Virus Infection: Oral Lichen Planus

Le alterazioni del cavo orale negli utenti in carico ai servizi di assistenza domiciliare: un’indagine di prevalenza

ObjectiveThe purpose of this study is to estimate the prevalence of oral mucosal disorders and mouth hygienic conditions of the users in charge of home care services to a Tuscan Health Company. Materials and methodsFour hundred eight users were included, their mouth has been observed and an oral interview has been performed. Patients were observed by home care nurses, because there is no dental hygienist in home care services. Home care nurses were trained by a dentist, who thought them how to reveal signs of oral mucosal disorders. They were equipped with a LEAD torch, which facilitated the observation. ResultsTwenty-one percent of the patients had inflammatory lesions localized to the oral mucosa and 3.3% had lesions of uncertain nature. 17.6% presented alterations related to teeth. Almost half of the patients had low levels of oral hygiene. ConclusionsThe data of prevalence of oral alterations suggest the need to increase the awareness of health professions about oral care and the need of specific services in mouth hygiene in home care.