Severity Of Oral Diseases Research Articles

Elevated BP180 ELISA at Diagnosis Correlates with Disease Severity and Relapse in Oral Mucous Membrane Pemphigoid: Preliminary Results from a Retrospective Monocentric Italian Study

Background: Little is known about the relevance of BP180 ELISA for the clinical management of oral mucous membrane pemphigoid (OMMP). The aim of the present study was to investigate if the levels of anti-BP180 antibodies at diagnosis could be correlated with clinical severity and relapse. Methods: The present study included 44 OMMP patients with positive direct immunofluorescence (DIF). Circulating anti-BP180 IgG was measured using the same available ELISA kit (Euroimmun cut-off 20 U/mL). Clinical severity at diagnosis was measured using the oral disease severity score (ODSS). Only patients who achieved clinical remission (CR) were included in the analysis of variables related to relapse. Relapse was calculated as the interval between the date of the best type of clinical remission achieved and the date of relapse. Results: Values of BP180 > 20 U/mL significantly correlated with higher ODSSs in both univariate (p < 0.05) and multivariate analyses (p < 0.05). Among 39/44 patients who achieved CR, 17/39 relapsed. Kaplan–Meier analysis revealed that patients with BP180 > 20 U/mL displayed worse clinical behavior in terms of relapse (p < 0.05). Conclusion: BP180 ELISA at diagnosis appears to be a useful parameter to stratify OMMP patients with more severe disease and worse clinical outcomes after clinical remission.

Clinical predictors of disease severity in oral lichen planus

Abstract Background The limited understanding of factors influencing the disease progression of oral lichen planus (OLP) poses challenges in delivering effective and personalised treatment for this condition, known to increase the risk of oral cancer and adversely impact patient quality of life. Objective This study aimed to systematically identify clinical predictors of disease severity in OLP patients. Methods This cross-sectional and single-site prospective study was conducted between December 2021 and February 2024 in the Departments of Oral Medicine and Oral & Maxillofacial Surgery, Aberdeen Royal Infirmary. Patients presenting with OLP aged 18 years or older diagnosed using Van der Meij and Van der Waal criteria were eligible to the study. Out of a total of 270 eligible OLP patients presenting consecutively to the outpatient clinics during the study period, 89 patients agreed to participate and were enrolled into the study. Participants demographic and relevant clinical data, namely medical history, smoking status, alcohol consumption, perceived stress levels, oral hygiene status and haematologic and biochemical parameters, including full blood count, haematinics, vitamin D were recorded. The outcome measure was OLP disease severity measured as the Oral Disease Severity Score (ODSS), Gingival ODSS and Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative (REU scoring system). Results A total of 89 participants were recruited into the study. The median [IQRs] age of the study population was 66 [58 to 73] years, and 65 (73%) patients were females. The median total ODSS score was 10 (range: 0-44). After adjustment for confounding factors, patients with lichen planus affecting skin or other mucosal sites had a 5.76-unit higher OLP severity score (B=5.76, 95% CI=.74-10.78, P=.025) than those without extraoral involvement as measured by ODSS. Patients with insufficient vitamin D exhibited 5.49-unit increase in disease severity (B = 5.49, 95% CI = 1.13-9.84, P= 0.014) compared to those with adequate vitamin D levels. Conclusions This study identified the importance of cutaneous and/or genital lichen planus in phenotyping OLP disease severity. We also highlight the role of vitamin D as a significant predictor of disease severity of OLP, suggesting the importance of adequate vitamin D levels in lichen planus.

Influence of different ethnicities on early childhood caries in preschool children at risk of social exclusion in Southeastern Spain.

To estimate the prevalence of early childhood caries and to study a possible influence on different ethnicities in preschool children aged 3 to 5 with social exclusion risk. Oral diseases are a major global public health problem, with negative effects at both individual and collective levels, and there is a relationship between socioeconomic characteristics such as income, occupation and educational level, with the prevalence and severity of oral diseases. A cross sectional study was conducted in a sample of 288 preschool children belonging to three schools in the Southeastern Spain among other variables dmft and ICDASS index. The ethnicity of school children at risk of social exclusion is a determining factor in the increased prevalence of cavities in primary caries.

Diet and Oral Health: An Investigation Into the Impact of Pakistani Dietary Habits on Oral Disease Prevalence.

Background Dietary habits play a significant role in the rising prevalence of oral health disorders, such as dental caries and periodontal diseases, particularly in regions like Pakistan with distinct dietary customs. Objective The primary objective of this research was to investigate the impact of Asian foodon the prevalence of oral diseases, with a focus on identifying specific dietary factors that contribute to oral health issues. Methodology A cross-sectional study was carried out in Lahore between February and July 2024. The sample consisted of 384 adults aged 18 and above, selected based on specific inclusion and exclusion criteria. Data were collected through structured questionnaires assessing dietary habits and clinical examinations to diagnose oral diseases. Statistical analyses (SPSS version 26: (IBM Corp., Armonk, NY, USA), including correlation, regression, and Chi-Square, were used to evaluate the relationships between dietary patterns and oral health indicators. Results The study revealed significant correlations between dietary habits and oral disease prevalence. Among the 384 patients, 287 (74.74%) patients reported high sugar consumption, with a mean frequency of 3.26 times per week, correlating strongly with oral diseases (r=0.45, p<0.01). This group exhibited 179 patients (46.60%) with dental caries and 153 patients (39.58%) with periodontal conditions. Additionally, 262 patients (68.32%) with high carbohydrate intake, averaging 4.14 times per week, showed a moderate positive correlation with oral disease prevalence (r=0.32, p<0.05). Conversely, 193 patients (50.26%) who consumed fruits and vegetables with a mean frequency of 2.51 times per week demonstrated a significant negative correlation with oral disease prevalence (r=-0.40, p<0.01), indicating a protective effect. High sugar intake was associated with greater severity of oral diseases, with mean severity scores of 3.12 for dental caries and 3.20 for periodontal conditions. Conclusion The results show that although consuming more fruits and vegetables has a preventive effect, traditional Pakistani dietary practices, particularly excessive sugar and carbohydrate consumption, are associated with an increased incidence of oral illness.

Scoring Criteria for Autoimmune Bullous Diseases: Utility, Merits, and Demerits.

Scoring systems play a crucial role in dermatology by providing objective measurements of disease severity, treatment efficacy, and outcome comparisons. In autoimmune blistering diseases (AIBDs), standardized scoring systems are essential for accurate evaluations; however, there is currently a lack of consensus on scoring methods. This literature review explores scoring systems in AIBDs by tracing their development, addressing challenges, and highlighting their role in defining endpoints, regulatory considerations, and clinical trials. Existing scoring systems for AIBDs, such as the Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Pemphigus Oral Lesions Intensity Score, Oral Disease Severity Score, and Pemphigus Vulgaris Activity Score, are examined for their validity, reliability, and responsiveness. The Bullous Pemphigoid Disease Area Index for bullous pemphigoid is also discussed. The concept of minimal clinically important differences is explored to determine clinically significant improvements in disease severity. This review provides a comprehensive understanding of the central role of scoring systems in dermatology and their implications for research and clinical practice in AIBDs.

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

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

Pemphigus oral lesions area index (POLAI): A new scoring scale for assessing oral pemphigus vulgaris

AbstractObjectivesCurrent scales for Pemphigus vulgaris (PV) do not adequately represent the clinical variability of oral lesions. This study aimed to develop an independent scale, the Pemphigus Oral Lesions Area Index (POLAI), for assessment of oral PV exclusively, and compare POLAI, Pemphigus Disease Area Index (PDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Oral Disease Severity Score (ODSS) regarding inter‐ and intra‐observer reliability and validity.Materials and MethodsRetrospective cohort included 209 sets of digital‐photographs. Additional clinical cohort included 32 PV patients. All visits were assessed by four clinicians using the PDAI, ABSIS, ODSS and POLAI, and were rated by three specialists using the Physician's Global Assessment (PGA).ResultsThe intraclass correlation coefficient showed the inter‐observer reliability with 0.89 and 0.86 for PDAI, 0.87 for ABSIS, 0.93 for ODSS, 0.96 for POLAI, and 0.97 and 0.96 for PGA. Intra‐observer agreements showed excellent reliability for all 4 scores. Highest correlation was observed between PGA and POLAI (correlation coefficients were 0.96). The mean time taken to complete each scale was within 1.5 min.ConclusionPOLAI is valid for the assessment of oral PV with superior inter‐ and intra‐observer reliability to PDAI, ABSIS and ODSS, and is feasible in clinic.

Upregulation of psoriasin/S100A7 correlates with clinical severity in patients with oral lichen planus

ObjectivesThe aim of this study was to: (1) investigate the expression patterns of antimicrobial peptides (AMPs), specifically psoriasin (S100A7) and calgranulin A and B (S100A8/A9), in patients with oral lichen planus (OLP) compared to healthy individuals; (2) evaluate the oral health-related quality of life (OHrQoL) in OLP patients versus healthy controls; (3) investigate the impact of clinical severity of OLP on OHrQoL; and (4) assess the influence of AMP expression on clinical severity and OHrQoL in OLP patients.Materials and methodsOral mucosal biopsies (n = 38) were collected from healthy individuals (n = 17) and patients with OLP (n = 21). Levels of AMPs (S100A7, S100A8, S100A9) and pro-inflammatory cytokines interleukin-8 (IL-8) and tumor necrosis factor alpha (TNFα) were assessed by RT-qPCR. AMP protein localization was identified by indirect immunofluorescence analysis. OHrQoL was assessed using the OHIP-G14 questionnaire, and clinical severity was evaluated with the Oral Disease Severity Score (ODSS). Correlations between OLP manifestation, OHrQoL, and AMP expression were evaluated.Results(1) S100A7 (p < 0.001), IL-8 (p < 0.001), and TNFα (p < 0.001) mRNA levels were significantly upregulated in OLP tissue compared to healthy tissue, while S100A8 (p < 0.001) and S100A9 (p < 0.001) mRNA levels were downregulated. Immunofluorescence staining revealed an enhanced expression of S100A7 and decreased protein expression of S100A9 in OLP tissue. (2) OLP patients (9.58 ± 8.32) reported significantly higher OHIP-G14 scores compared to healthy individuals (0.67 ± 0.87; p < 0.001), particularly in the categories “physical pain” (p < 0.001) and “psychological discomfort” (p = 0.025). (3,4) Clinical severity (25.21 ± 9.77) of OLP correlated positively with OHrQoL (ρ = 0.497) and psoriasin expression (ρ = 0.402).ConclusionsThis study demonstrated differential expression patterns of AMPs in OLP and highlighted the correlation between the clinical manifestation of OLP and OHrQoL. Further research approaches should address the role of psoriasin in the risk of malignant transformation of OLP.Clinical relevancePsoriasin is a putative biomarker to monitor disease severity including malignant transformation of OLP lesions. OHIP-G14 scores can be useful to monitor OHrQoL in OLP patients.

Oral Health Education in Patients with Diabetes: A Systematic Review.

Diabetes is known as a "silent epidemic" and is a public health problem that accounts for 9% of all deaths worldwide. The prevention of diabetes is a significant challenge, as its prevalence and incidence are both increasing rapidly. According to the World Health Organization (WHO), education is the cornerstone of diabetes treatment. Since the severity of oral diseases is significantly higher in diabetic patients, this systematic review aims to highlight the oral care of diabetic patients as a priority for glycemic control and the importance of education for diabetic patients' oral health. We evaluated 20 clinical studies and 15 meta-analyses from PubMed and Google Scholar over the last five years. Their main themes are the direct relationship between diabetes and oral health, especially periodontitis, and the necessity of education and behaviors that can lead to a better quality of life. Our analysis indicated that good oral health is a critical factor of glycemic control in diabetic patients and can be enhanced by targeted educational programs, backed by long-term medical and dental follow-up. Healthcare personnel should be encouraged to develop their knowledge of oral health in relation to the disease so that behaviors can be adopted to improve patients' quality of life. Telemedicine could also contribute to patient education and self-management of the disease.

Melatonin and oral diseases: possible therapeutic roles based on cellular mechanisms.

Oral diseases, including periodontal disorders, oral cancer, periodontitis, and mucositis are the major challenges for both patients and healthcare providers. These conditions often involve inflammation, oxidative stress, and impaired cellular processes, leading to symptoms ranging from discomfort to severe debilitation. Conventional treatments for such oral diseases exhibit constraints, prompting the investigation of innovative therapeutic approaches. Considering the anti-inflammatory, anti-oxidant, and anti-cancer effects of melatonin, this study was carried out to investigate the potential protective effects of melatonin in mitigating the severity of oral diseases. Studies indicate that melatonin influences the differentiation of periodontal stem cells, inhibits oral cancer progression, reduces inflammation associated with periodontitis, and alleviates the severity of oral mucositis. Melatonin has demonstrated potential efficacy in both preclinical and clinical investigations; however, findings are frequently heterogeneous and contingent upon contextual factors. This review provides a comprehensiveoverview of current state of knowledge in this domain, elucidating the multifaceted role that melatonin may assume in combatingoral diseases. Further research should be directed toward determining the most effective dosing, timing, and administration methods for melatonin-based therapies for oral diseases.

Monocyte/High-Density Lipoprotein Ratio: An Indicator of Oxidative Stress and Disease Severity in Lichen Planus Patients

Aim: Although the etiopathogenesis of lichen planus is not clearly known, it has been noticed to be associated with various factors such as drugs, infections, autoimmune factors, genetic factors, and oxidative stress mechanisms. Oxidative stress is implicated in the pathogenesis of various diseases such as cancer and chronic inflammatory diseases. Complete blood count parameters can be utilized as oxidative stress diagnostic biomarkers for many diseases related to chronic inflammatory processes. In recent clinical studies, it has been shown that the monocyte/high-density lipoprotein (HDL) ratio (MHR) may be useful as a marker of oxidative stress in many chronic dermatoses. However, as far as we know, the relationship between oxidative stress and monocyte/HDL ratio in lichen planus cases has not been studied in the literature yet. Materials and Methods: The files of cases who were followed up with lichen planus in the dermatology clinic of a tertiary university hospital between February 2018 and July 2021 were reviewed retrospectively. There were 201 participants in the analysis, including 99 histopathologically and clinically verified LP cases and 102 age and sex-matched controls. Results: Monocyte values (p=0.16) and HDL levels (p=0.26) were not statistically different for both groups, but the MHR value (p=0.04) was detected to be statistically significantly higher in the lichen planus group than in the control group. In oral lichen planus cases, whilst the oral disease severity score and uric acid values were not correlated (p=0.11), the oral disease severity score was correlated with the CRP (p=0.03) and MHR (p=0.001) values. Conclusions: In the study, we found that MHR levels were significantly higher in lichen planus patients compared to the control group. Again, we detected that MHR had a better correlation with oral mucosa disease severity score than CRP. We suggest that MHR may be a potential index to assess disease activity in follow-up patients with lichen planus. Keywords: Lichen planus, oral mucosa, monocyte/high-density lipoprotein ratio

Oral Acitretin Plus Topical Triamcinolone vs Topical Triamcinolone Monotherapy in Patients With Symptomatic Oral Lichen Planus

Symptomatic oral lichen planus (OLP) can be challenging to treat. To compare the efficacy of oral acitretin plus topical triamcinolone acetonide (TAC), 0.1%, with TAC monotherapy in patients with symptomatic OLP. This monocentric, investigator-initiated, placebo-controlled, investigator- and patient-blinded randomized clinical trial was conducted from December 2018 to June 2020 at the Postgraduate Institute of Medical Education and Research, a tertiary referral center in Chandigarh, India. Sixty-four patients 18 years or older with symptomatic OLP were recruited by consecutive sampling. Data were analyzed from July to December 2020. The patients were randomized to receive either a combination of oral acitretin (25-35 mg/d) and TAC (treatment group) or TAC in combination with placebo (placebo group) for 28 weeks, with an additional 8 weeks of treatment-free follow-up after the end of treatment (36 weeks of total study duration). The disease severity and treatment response were assessed using Oral Disease Severity Score (ODSS), Oral Health Impact Profile 14 (OHIP-14), and visual analog scale (VAS). The primary aim was to assess the number of patients achieving ODSS-75 (75% reduction in ODSS compared with baseline) in both groups at 28 weeks and at the end of 36 weeks. Among 64 patients, 31 in the treatment group and 30 in the placebo group completed the study (mean [SD] age, 50.6 [15.2] years vs 49.2 [14.4] years; male-female ratio, 13:19 vs 16:16). Baseline ODSS, visual analog scale, and Oral Health Impact Profile 14 scores were comparable in both groups. In the intention-to-treat analysis, there was a statistically significant higher number of patients achieving 75% or higher reduction in ODSS in the treatment group compared with the placebo group at the end of 28 weeks (28 [88%] vs 15 [47%], a 41 [95% CI, 20-61] percentage point difference between groups; P < .001; Cramér V = 0.47) and 36 weeks (27 [84%] vs 13 [41%], a 43 [95% CI, 23-67] percentage point difference between groups; P < .001; Cramér V = 0.47). Relapses during the posttreatment follow-up of 8 weeks were low among patients in both treatment and placebo groups (1 [3%] vs 2 [6%], a 3 [95% CI, -13 to 7] percentage point difference between groups; P > .99; Cramér V = 0.07). In this randomized clinical trial, the combination of oral acitretin and TAC was more effective than TAC monotherapy in patients with symptomatic OLP. Clinical Trial Registry of India Identifier: CTRI/2018/11/016448.

Topical applications of heterologous platelet rich plasma (PRP) for refractory gingival lesions in autoimmune blistering diseases.

Recalcitrant gingival erosions, blisters and desquamative gingivitis are common features in oral autoimmune blistering diseases (AIBD). First line treatments include high-dosage corticosteroids and other immunosuppressive drugs, with several side effects and elevated number of recurrences. Autologous platelet-rich plasma (PRP) has been recently introduced as an alternative treatment and its use seems to be promising and safe. In this study we describe the use of topical application of heterologous PRP in nine patients affected by mucous membrane pemphigoid, with gingival lesions refractory to previous treatments. Topical applications of PRP were performed once a week for 2 months and the endpoint for clinical evaluation was set 3 months after the last session. Oral disease severity score (ODSS) and VAS scores for pain measurement were recorded before and after treatment. The procedure was painless, well accepted, and free from adverse reactions. All patients (100%) reported a reduction in VAS whereas reduction in ODSS was observed in 89% of patients. Within the limits of the study, topical heterologous PRP is a safe and promising procedure to be studied in future controlled randomized trials as adjuvant treatment for refractory gingival lesions in patients with AIBDs.

STATUS OF ORAL HEALTH AMONG ATHLETES

Relevance of the problem. Rising popularity of sports activities is concentrating attention on the development of oral disorders associated with athletic performance. Poor oral health is a significant issue because it can cause pain, have a negative impact on appearance, and the qua­lity of life. The oral environment is impacted by lifestyle, individual oral hygiene and eating habits. Aim of work. The purpose of this literature is to investi­gate the status of oral health among athletes. Material and methods. The PRISMA Statement’s met­hodological principles were followed for the systematic review of scientific literature. Electronic literature re­view was performed using MEDLINE databases and the selection of the articles, published in English between 2011 and 2022 year. Data gathering protocol was created before collecting data and studying the literature. The publication search was focused on keywords and their combinations: oral health, oral diseases, sports, athletes, oral environment, performance. Results. Dental trauma was reported in three of the stu­dies that were included in the review (n=92, 5,8% of 1565 subjects). Olympic sports/ mixed sports, swimming, football, multisport games and rugby were the investiga­ted sports. The worst finding was gingivitis (BPE codes 1-2), which was present in more than three quarters of athletes. None of these studies focused on impact, but there was consensus that oral health has an influence on performance. The oral health of the athletes who were sampled is quite poor. Poor oral health was found to have a detrimental impact on athletes’ self-reported levels of training and performance. It’s possible that pain, decrea­sed well-being and increased systemic inflammation are the underlying causes of this effect. Access to preventive care may be more challenging for individuals who are required to participate in rigorous training programs. Conclusions. Findings of the review indicate that the oral health of athletes is not very good: prone to dental traumas, caries, and gingivitis. Athletes must be evalua­ted by dentists during sports activities for changes affec­ting their oral environment. Epidemiological studies are required to determine the true extent and severity of oral diseases in athletes competing in a wide variety of sports.

The Link between Stroke Risk and Orodental Status-A Comprehensive Review.

One of the primary causes of disability and mortality in the adult population worldwide is stroke. A person’s general health is significantly impacted by their oral and dental health. People who have poor oral health are more susceptible to conditions such as stroke. Stroke risk has long been linked to oral and dental conditions. The risk of stroke and its cost impact on the healthcare systems appear to be significantly reduced as a result of the decline in the incidence and prevalence of oral and dental illnesses. Hypothetically, better management of oral hygiene and dental health lead to reduced stroke risk. To the authors’ best knowledge, for the first time, the potential link between dental health and stroke were cross-examined. The most typical stroke symptoms, oral and dental illnesses linked to stroke, and the role of oral healthcare professionals in stroke prevention are revealed. The potential mediating processes and subsequent long-term cognitive and functional neurological outcomes are based on the available literature. It must be noted that periodontal diseases and tooth loss are two common oral health measures. Lack of knowledge on the effects of poor oral health on systemic health together with limited access to primary medical or dental care are considered to be partially responsible for the elevated risk of stroke. Concrete evidence confirming the associations between oral inflammatory conditions and stroke in large cohort prospective studies, stratifying association between oral disease severity and stroke risk and disease effects on stroke survival will be desirable. In terms of clinical pathology, a predictive model of stroke as a function of oral health status, and biomarkers of systemic inflammation could be useful for both cardiologists and dentists.

A SCIENTIFIC SURVEY OF 3551 CASES OF STOMATOLOGICAL ALTERATIONS DIAGNOSED IN A REFERENCE CENTER IN JEQUITINHONHA VALLEY

<h3>Objectives</h3> To perform an epidemiologic and sociospatial survey of the attending a referral center of stomatology to identify the most vulnerable areas, distributions, and severity of oral diseases. <h3>Study Design</h3> This is a retrospective observational study of medical records analyzed in a reference center in Jequitinhonha Valley from 1994 to 2018. The following variables were collected: age, sex, lesion location, diagnosis, treatment, patient's address, and City Development Index (CDI). The geoprocessing and pathology proportions found by town were processed using the statistical software QGIS for Windows. <h3>Results</h3> In total, 3551 patients' medical records from 85 towns were evaluated. Most were female (62.1%), with an average age of 40.42 years. The towns with more services were Diamantina (56.86%), Gouveia (4.13%), and Presidente Kubitschek (2.78%). The pathology group with a higher proportion by town were infections/inflammations (69%) and salivary gland pathologies (20.51%). Most patients' town origins had an average CDI (0.555-0.699), considered average. <h3>Conclusions</h3> The present study showed that infections/inflammation were the most frequent oral diseases, reinforcing the need for effective strategic planning in oral health in the Jequitinhonha Valley.

ODSS vs. ABSIS and PDAI oral parts in pemphigus vulgaris: inter-rater reliability and testing times.

The existence of standard methods for diagnosis and measuring the severity of diseases leads to a more accurate severity assessment, the possibility of following up, and the possibility of comparing the results of studies. This study aimed to compare different pemphigus vulgaris (PV) assessment methods regarding inter-observer reliability and testing times-focusing on oral parts. Two dermatologists evaluated orally involved PV patients by oral parts of Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), Pemphigus Disease Area Index (PDAI), and Oral Disease Severity Score (ODSS). Seventy patients completed the study. The intraclass correlation coefficient showed the evaluators' agreements on ABSIS, PDAI, and ODSS with 0.98, 0.94, and 0.95, respectively. Reliability analyses showed near-perfect relationships between each scoring methods pairs. There was no association between lesion sites and disease severity. The PDAI scoring duration was significantly shorter, and the ABSIS scoring duration was significantly longer. ODSS is valid for evaluating oral involvement in patients with PV and relates to ABSIS and PDAI almost perfectly. Besides, it was shown that the evaluation of patients' oral involvement based on PDAI and ODSS is done in about 1 min, which seems clinically reasonable.

In it together: Candida-bacterial oral biofilms and therapeutic strategies.

Under natural environmental settings or in the human body, the majority of microorganisms exist in complex polymicrobial biofilms adhered to abiotic and biotic surfaces. These microorganisms exhibit symbiotic, mutualistic, synergistic, or antagonistic relationships with other species during biofilm colonization and development. These polymicrobial interactions are heterogeneous, complex and hard to control, thereby often yielding worse outcomes than monospecies infections. Concerning fungi, Candida spp., in particular, Candida albicans is often detected with various bacterial species in oral biofilms. These Candida-bacterial interactions may induce the transition of C. albicans from commensal to pathobiont or dysbiotic organism. Consequently, Candida-bacterial interactions are largely associated with various oral diseases, including dental caries, denture stomatitis, periodontitis, peri-implantitis, and oral cancer. Given the severity of oral diseases caused by cross-kingdom consortia that develop hard-to-remove and highly drug-resistant biofilms, fundamental research is warranted to strategically develop cost-effective and safe therapies to prevent and treat cross-kingdom interactions and subsequent biofilm development. While studies have shed some light, targeting fungal-involved polymicrobial biofilms has been limited. This mini-review outlines the key features of Candida-bacterial interactions and their impact on various oral diseases. In addition, current knowledge on therapeutic strategies to target Candida-bacterial polymicrobial biofilms is discussed.

Insights into the activation of oral keratinocyte cell death by Candida albicans and Staphylococcus aureus biofilms

Polymicrobial biofilms comprising Candida albicans and Staphylococcus aureus can increase the frequency and severity of oral diseases. This study assessed oral keratinocyte cell death, apoptosis and/or necrosis, promoted by soluble factors from single and dual biofilms of S. aureus and C. albicans. The soluble factors were obtained from the 16-h biofilm growth media. Cell viability was assessed by MTT and cell membrane damage by LDH. SEM was used for morphology changes. Assessment of apoptosis and necrosis was performed using annexin V and propidium iodide and caspases -2, -3, -6, -8 and -9. Statistical analysis was conducted with ANOVA and Tukey tests (α = 5%). Dual biofilms promoted the greatest harmful effect on oral cells, with a viability rate of 31.76%, damage to cell membranes and LDH released. Dual biofilms also induced higher percentages of necrotic cells (24.95%). Apoptosis was associated with caspases -2, -3, -6 and -8 activation.

A proof of concept pilot trial of probiotics in symptomatic oral lichen planus (CABRIO).

To preliminary evaluate the clinical effects of probiotics in individuals with symptomatic oral lichen planus and the possible mechanisms of action. A group of 30 individuals with symptomatic oral lichen planus were recruited in a randomised double-blind parallel group controlled (1:1) proof-of-concept pilot trial of probiotic VSL#3 vs placebo. Efficacy outcomes included changes in pain numeric rating scale, oral disease severity score and the chronic oral mucosal disease questionnaire. Adverse effects, home diary and withdrawals were assessed as feasibility outcomes. Mechanistic outcomes included changes in salivary and serum levels of CXCL10 and IFN-γ and in oral microbial composition. The probiotic VSL#3 was safe and well tolerated. We observed no statistically significant change in pain, disease activity, quality of life, serum/salivary CXCL10 or oral microbial composition with respect to placebo. Salivary IFN-γ levels demonstrate a trend for a reduced level in the active group (p=0.082) after 30days of probiotic consumption. The present proof-of-concept study provides some weak not convincing indication of biological and clinical effects of probiotic VSL#3 in individuals with painful oral lichen planus. Further research in this field is needed, with the current study providing useful information to the design of future clinical trials.