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The complexity of the use of antimicrobials for dental use (such as antibiotics) is directly related not only to the mode of onset of an oral infection (linked to numerous factors of local causality and comorbidity) but also to the predisposing risk for the general health of the patient with putative serious consequences related to the neck district. The abuse and misuse of antibiotics may lead to resistance to certain bacterial strains. In this regard, the evaluation of the risk/benefit of their use (especially in pregnant women) can be divided into two phases: risk analysis and subsequently risk management for the benefit of the patient for the oral pathology to be prevented or treated, respectively. This study seeks to focus on the issues and management of patients with certain antimicrobials during dental practice, placing special emphasis on new classes of antibiotics.Specific Aims:This study seeks to focus on the issues and management of patients with certain antimicrobials during dental practice, placing special emphasis on new classes of antibiotics.

Keratinized lesions have been a conceivable false-negative (FN) factor in oral exfoliative cytology (OEC); however, other factors are poorly analyzed. In this study, we aimed to identify the factors influencing the accuracy of OEC and FNs focusing on the lesion characteristics, patient background, and surgeon factors in oral potentially malignant disorders (OPMD).We retrospectively studied 44 patients who underwent both OEC and histopathological diagnosis. Sensitivity, specificity, FN rate, false-positive (FP) rate, and prevalence of both methods were compared. Similarly, accuracy indices were compared among clinical diagnosis groups (leukoplakia vs. other diagnosis). The association between patient and surgeon-related factors influencing FN OEC results were investigated using Fisher's exact test and a multiple logistic regression analysis.Overall, the sensitivity; specificity; and FN, FP, and prevalence rates of OEC were 31.8%, 82.1%, and 68.8%, 17.9%, and 36.4%, respectively. Leukoplakia was significantly more common in clinical diagnosis (P = 0.007) with sensitivity, specificity, and FN rates of 20.0%, 95.2%, and 80.0%, respectively. Contrarily, non-keratinized lesions had sensitivity, specificity, and FN of 83.3%, 85.7%, and 16.7%, respectively. In the prevalent group, leukoplakia and anucleate squamous cells were significantly associated with FN cases (P = 0.013, P = 0.050). On multivariate analysis in OEC negative patients, age ≤64 (P = 0.050) and location on the tongue (P = 0.047) was independently associated with FNs.FN of OEC was conceivable to be due to poor deep-seated cell sampling, which was associated with leukoplakia, age, and location. Therefore, these factors may be considered in the evaluation of OEC results.

Emergency department (ED) use for oral health care is a growing problem in the United States. The objective of the study was to describe spending on ED visits due to nontraumatic dental conditions (NTDCs) in the United States and to quantify changes in spending and its drivers.Spending estimates for ED visits due to NTDCs according to type of payer were analyzed for the period from 1996 through 2016 and estimates about the drivers of change were analyzed for the period from 1996 through 2013. NTDCs included caries, periodontitis, edentulism, and other oral disorders. Estimates were calculated according to age, sex, and type of payer (that is, public, private, and out of pocket), adjusted for inflation, and expressed in 2016 US dollars. The estimate of expenses was decomposed into 5 drivers for the period from 1996 through 2013 (that is, population, aging, prevalence of oral disorders, service use, and service price and intensity).The total change in spending from 1996 through 2016 amounted to $540 million, an increase of 216%. The drivers of changes in spending from 1996 through 2013 were price and intensity ($360 million), service use ($220 million), and population size ($68 million).Spending on ED visits due to NTDCs more than tripled during the study period, with price and intensity representing the main drivers. This increase was primarily in adults and paid via the public sector.Possible solutions include strengthening the oral health care safety net, especially for the most vulnerable populations.

Zdravlje zubi predstavlja okosnicu oralnog zdravlja. Suvremena stomatološka praksa utemeljena je na preventivnim postupcima, što čini kvalitetnu oralnu higijenu prvim korakom ka zdravom oralnom statusu. Multidisciplinarnim pristupom u korelaciju se dovodi oralno i sveopće zdravlje, te se usvaja teza o ljudskom tijelu kao uzajamno ovisnoj cjelini. Dobro je poznata činjenica da bolesti usne šupljine utječu na brojne organske sustave i posljedično su vezane za sistemske bolesti. Između ostalih, bolesti usne šupljine imaju utjecaj na reproduktivni sustav muškaraca. Iako se neplodnost muškaraca ubraja među javnozdravstvene probleme modernoga doba, postoji ograničen broj studija koje su se očitovale oko poveznice između zdravlja zubi i neplodnosti muškaraca. Fokusirajući se uglavnom na bolestima parodonta, u prvom redu parodontitisu kao uzroku neplodnosti u muškaraca, istraživanja nisu rezultirala jednoznačnim zaključcima, ali ustanovila su mogućnost djelomične povezanosti između oralnog zdravlja i neplodnosti kod muškaraca. Za konačno dokazivanje ili osporavanje moguće korelacije neplodnosti muškaraca i zdravlja zubi ključna su buduća longitudinalna istraživanja, čiji bi se krajnji dosezi mogli odraziti na zdravlje zajednice i proširiti spoznaje nužne za holistički pristup zdravlju. Dental health is the backbone of oral health. Modern dental practice is based on preventive procedures that make high-quality oral hygiene the first step to a healthy oral status. A multidisciplinary approach is used to correlate oral and general health as well as adopting the thesis that the human body is an interdependent entity. In fact, overall diseases of the oral cavity affect numerous organ systems and are consequently related to systemic diseases. Namely, diseases of the oral cavity have an impact on the male reproductive system. Although male infertility is included as a public health problem of the modern era, the number of studies reporting the link between dental health and male infertility is limited. Focusing mainly on periodontal diseases, primarily periodontitis as a cause of infertility in men, research did not result in unequivocal conclusions, but established the possibility of a partial connection between oral health and infertility in men. To decisively prove or dispute the possible correlation of male infertility and dental health, future longitudinal studies are essential, the conclusive results of which could be reflected on the health of the community and broaden the knowledge necessary for a holistic approach to health.

Kronična bubrežna bolest jedan je od vodećih globalnih javnozdravstvenih problema s visokom stopom mortaliteta. To je progresivna bolest koju karakterizira propadanje nefrona i smanjenje bubrežne funkcije. Sa sve većim porastom prevalencije kronične bubrežne bolesti, raste i broj bolesnika na dijalizi. Procjenjuje se da 90% oboljelih od kronične bubrežne bolesti ima promjene u usnoj šupljini. Promjene se javljaju na sluznici, žljezdanom tkivu, parodontnom ligamentu, gingivi i kosti. Oralna sluznica podložna je razvitku patoloških promjena, a najčešća promjena je bljedoća sluznice, dok je uremični stomatitis visoko specifičan za kroničnu bubrežnu bolest. Veliku važnost ima i dvosmjerna povezanost kronične bubrežne bolesti s parodontitisom. U završnom stadiju kronične bubrežne bolesti česta je pojava renalne osteodistrofije. Stomatološki zahvati kod bolesnika na dijalizi iziskuju posebnu skrb. Potrebno je saznati detaljnu anamnezu, posebice komorbiditete i lijekove koje bolesnik koristi. Vrlo je važno paziti na rizik od produljenog krvarenja te nefrotoksičnost lijekova. Potrebno je ukloniti sve potencijalne izvore upale u usnoj šupljini kako bi se spriječio nastanak sekundarne infekcije te slijediti protokol izvođenja stomatoloških zahvata specifično za bolesnike na dijalizi. Chronic kidney disease is one of the leading global public health problems with a high mortality rate. It is a progressive disease which is characterized by deterioration of nephrons and decrease in renal function. With the increase in prevalence of chronic kidney disease, the number of patients undergoing hemodialysis also increases. It is estimated that 90% of patients suffering from chronic kidney disease have oral manifestations. Oral manifestations can be found on mucosal, glandular, periodontal, gingival and bone tissue. Oral mucosa is susceptible to pathological lesions, and the most common manifestation is mucosal pallor, while the most specific one is uremic stomatitis. Chronic kidney disease and periodontitis two-way connection is of great importance as well. Renal osteodystrophy is a common occurrence in end-stage renal disease. Dental procedures in patients undergoing hemodialysis require special care. It is necessary taking detailed history, especially patients’ comorbidities and therapy. It is of importance to be aware of the risk of prolonged bleeding and drug nephrotoxicity. All potential sources of infection have to be eliminated for the purpose of preventing development of secondary infections and the protocol for performing dental procedures specific for patients undergoing hemodialysis must be followed.

Background: The purpose of this study was to investigate the expression of nuclear EGFR (nEGFR) and the stem cell marker ABCG2 in oral leukoplakia (OL) and oral erythroplakia (OE) and to assess their significance as prognostic biomarkers for malignant transformation. Methods: In this study we included 50 patients with oral potentially malignant disorders (OPMD), 31 with OL and 19 with OE, in whom we examined the expression of nEGFR and ABCG2 by immunohistochemical methods. Results: Twenty-one (42%) of 50 patients with OL and OE developed oral squamous cell carcinoma (OSCC). The malignant transformation was increased 12, 84-fold (95% CI, 2.15-76.44, p = 0.005) in OPMD expressing both ABCG2 and nEGFR. Expression of nEGFR is a strong indicator of malignant transformation, unlike ABCG2 expression, respectively. Conclusions: Determining the co-expression of the biomarkers nEGFR and ABCG2 in OPMD may serve us to determine the risk of malignant transformation in OSCC.

The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society.We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature.The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs.To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

Introduction: Cocaine is one of the most often used psychoactive drugs worldwide, being extracted from the leaves of Erytroxylus coca plant. Its abusive use can trigger several consequences for the human body, including the oral cavity. Objective: To identify the oral disorders that are most commonly found in individuals who abuse cocaine, in addition to the main diagnostic and treatment methods. Methods: An integrative review was carried out on the databases: LILACS, BBO, LIS, MEDLINE, SciELO, Science Direct and PubMed. The following keywords were used: ‟Cocaína”, ‟Boca”, ‟Palato” and ‟Odontologia”, together with their synonyms and variations in English, obtained from DeCS andMeSH. The inclusion criteria were original articles, articles in Portuguese, English and Spanish, studies involving individuals, without restriction related to the year of publication. Animal studies, literature reviews, book chapters, theses and dissertations were excluded. Results: In total, 1373 records were identified. Of these, 22 articles were selected to comprise the review. Several oral alterations caused by cocaine abuse were found, primarily perforation of the palate, predisposition to periodontal diseases, temporomandibular disorders, bruxism, damage to oral tissues, dental caries, destructive lesions of the facial midline, xerostomia and ageusia. Among the diagnostic methods used by the professionals, anamnesis, intraoral examinations and head and neck computed tomography were the most frequently mentioned. As for treatment, in patients with palatal perforation, the reconstruction of the affected area or the use of prosthetic obturators is carried out. Conclusion: The management of these patients is not an easy task, as many of the users do not even seek professional help. The health professionals must be able to recognize these manifestations and alterations to establish timely and accurate diagnosis and treatment planning. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/). HIGHLIGHTS Integrative review aiming to detect oral changes in cocaine abusers. The main oral changes, methods of diagnosis and treatment were identified. Good anamnesis and qualified health professionals are necessary.

The aim of this multicentric study was to assess the diagnostic accuracy of a telediagnosis service for oral mucosal disorders.This study included 100 patients seen at the oral medicine outpatient clinic of 3 Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catrina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform.The sensitivity and specificity of telediagnosis were compared with those of the face-to-face approach and found to be 100% and 97.4%, respectively. The concordance between the examiners was 95%, and case management was relatively simple in approximately 60% of cases.Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.

Dentists play a major role in the diagnosis of oral potentially malignant disorders (OPMDs) that may lead to malignancy. Their knowledge on OPMDs and the risk factors associated with malignant disease needs to be sufficient. The aim of this study was to assess the level of knowledge, attitudes, and awareness of OPMDs amongst general dentists and dental specialists working in Saudi Arabia.Questionnaires were distributed to dentists working in Saudi Arabia. A total of 303 dentists participated in the study. The questionnaire included 20 questions on knowledge, attitudes, and awareness of OPMDs.The response rate was 55%. There was no significant difference between general dental practitioners and dental specialists regarding leukoplakia, which is the most common OPMD (P.05) and in identifying tobacco and alcohol as the main risk factors for malignant transformation of OPMDs into cancer (P.05). However, there was a significant difference (P.05) between specialists (75.3%) and general practitioners (52.3%) in the diagnosis of OPMDs. There was a significant difference (P.05) between specialists (63.5%) and general practitioners (28.0%) in recognising the likelihood of malignant transformation of proliferative verrucous leukoplakia. There was a significant difference between specialists (61.2%) and general practitioners (25.2%, P.05) in recognising the erosive form or atrophic type of oral lichen planus, considering that it is more likely to undergo malignant transformation.Dental specialists have better knowledge and awareness than general dentists regarding OPMDs. Improved continuous education programmes on the risk factors and diagnosis of OPMDs should be organised to train dentists.

The gingiva is a common site for neoplastic or non-neoplastic lesions. Neoplasms refer to progressive autonomous growth that can have either a benign or a malignant course. On the other hand, non-neoplastic lesions are mainly inflammatory, or occur as a reaction to some kind of irritation or lowgrade injury.Assessing the frequency distribution of gingival lesions is important to optimize oral health care services. The present study retrospectively analyzed the frequency distribution of gingival lesions on the basis of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The secondary objective was to compare this system with the 1999 International Workshop classification system.The hematoxylin and eosin (HE)-stained histopathological slides of the gingival lesions reported over the last 3 years (2018-2020) were retrieved from the archive of the Division of Oral Pathology and Microbiology at a tertiary care hospital in New Delhi, India. Correlating clinical, radiological and pathological details enabled the categorization of lesions according to the new classification system.In total, 73 gingival lesions were analyzed. Among these, reactive processes were the most frequent (39.73%), followed by inflammatory and immune conditions and lesions (26.03%), malignant tumors (21.92%), benign epithelial lesions (5.48%), and oral potentially malignant disorders (OPMDs) (5.48%). Genetic/developmental disorders were the least frequent (1.37%). However, as per the 1999 American Academy of Periodontology (AAP) system, the majority of lesions belonged to a non-specified category.The frequency distribution of biopsied gingival lesions according to the 2017 World Workshop classification in comparison with the previous classification system showed that differences between the 2 systems could be attributed to heterogeneous terminology rather than to real geographical variations.

To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID-19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case METHODS: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID-19 patients in an ICU (n = 519) RESULTS: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy CONCLUSION: COVID-19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID-19 patients, as well as to establish diagnoses and oral cavity treatments.

Oral potentially malignant disorders (OPMDs) are a heterogeneous group of oral lesions with a variable risk of malignant transformation to oral squamous cell carcinoma. The current OPMDs malignant transformation screening depends on conventional oral examination (COE) and is confirmed by biopsy and histologic examination. However, early malignant lesions with subtle mucosal changes are easily unnoticed by COE based on visual inspection and palpation. Optical techniques have been used to determine the biological structure, composition, and function of cells and tissues noninvasively by analyzing the changes in their optical properties. The oral epithelium and stroma undergo persistent structural, functional, and biochemical alterations during malignant transformation, leading to variations in optical tissue properties; optical techniques are thus powerful tools for detecting OPMDs malignant transformation. The optical imaging methods already used to detect OPMDs malignant transformation in vivo include autofluorescence imaging, narrowband imaging, confocal reflectance microscopy, and optical coherence tomography. They exhibit advantages over COE in detecting biochemical or morphologic changes at the molecular or cellular level in vivo; however, limitations also exist. This article comprehensively reviews the various real-time in vivo optical imaging methods used in the adjunctive diagnosis of OPMDs malignant transformation. We focus on the principles of these techniques, review their clinical application, and compare and summarize their advantages and disadvantages. Finally, we conclude with a discussion of current challenges and future directions of this field.

The negative impact of oral diseases on the function, economy, and general health of the population is well-documented. In the last decades, evidence linking increased expression of depression and oral diseases/conditions has significantly increased. The aim of this study is to assess the association between oral disease/conditions and self-reported symptoms of depression individuals.A specially designed questionnaire was distributed via social media for 1 week. It consisted of two main sections; the first section was dedicated to collect demographic variables and self-reported symptoms of oral diseases. The second section, Patient Health Questionnaire-9 (PHQ-9), was used to assess the severity of depression via nine questions using a 4-point Likert scale. Association between depression and oral disease was determined by linear regression analysis.A total of 1975 participants responded fully to the questionnaire and were included in the final analysis. The majority of participants, about 60%, showed mild to moderate symptoms of depression, while 8.9% expressed severe symptoms. Oral diseases positively associated with depression were caries, missing teeth, gingival bleeding, gingival recession, teeth mobility, and dry mouth (RResults indicated that oral diseases, particularly those adversely affecting function and esthetics, were associated with symptoms of depression in Iraqi individuals. These findings highlighted the importance of maintaining oral health as part of the general psychological wellbeing of the population.

Background: Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this systematic review is to know the last treatment approaches and their effectivity.Material and Methods: we compared the outcome of different kind of treatments in terms of the improvement of the lesions, reduction of the size of those lesions and the time needed for their healing. Inclusion criteria were: clinical trials, articles written in English or Spanish and published less than 5 years ago.Results: we used the following keywords: treatment, aphtous stomatitis, canker sores; combined with Bool-ean operators AND y OR. We selected 28 articles for reading the whole text, and after applying the eligibility criteria, we selected 17 articles for our revision. Among all the treatments, we emphasize the barrier method based in compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, with which the difference in the 3rd and 7th day was of-6,29 +/- 0,14 points in the pain score. The treatment with insulin and chitosan gel, brought a pain suppression on the third day, with no reactivation of the pain during the whole study. The application of a film composed of polyurethane and sesame oil with chitosan, brought a reduction in the size of the lesions of 4,54 +/- 2,84mm on the 6th day compared with the situation before the beginning of the treatment. The different kinds of laser, which produced a reduction in the pain score just at the beginning of the treatment up to 8,1 +/- 1,6 points, and a reduction of the size of the lesions of 4,42 +/- 1,02mm on the 7th day.Conclusions: Besides the classic treatments for RAS, we have to take into account other treatment modalities, above all the different kinds of laser.

Background: Burning mouth syndrome is an idiopathic condition characterized by burning pain in a normalappearing oral mucosa lasting at least four to six months. In the case of secondary burning mouth syndrome is associated with local or systemic factors (such as thyroid disorders) that can cause these symptoms. The aim of this review was to study the relationship between thyroid disorders and burning mouth syndrome. Material and Methods: The present study followed the PRISMA guidelines. An electronic search strategy was developed for PubMed/Medline, Scopus and Cochrane. The following combination of keywords and Boolean operators were used: Thyroid AND burning mouth; Thyroid AND burning mouth syndrome; Hypothyroidism AND burning mouth; Hypothyroidism AND burning mouth syndrome; Hyperthyroidism AND burning mouth; Hyperthyroidism AND burning mouth syndrome. The results were processed by existing free software in https:// www.graphpad.com/. To evaluate the association of the categorical variables we used the Fisher test at a level of significance of p-value ≤ 0,05. As a primary summary measure the Odds Ratio (OR) has been used. To analyze the risk of bias the guidelines of the GRADE guide were used and the grade of evidence was analyzed by the guide of Joanna Briggs Institute: Levels of Evidence and Grades of Recommendations. Results: After applying the inclusion and exclusion criteria, 5 studies were selected for review. The Chi-square was 10.92 and the Odds Ratio was 3.31 with respect to TSH values with p

The purpose of the study was to evaluate the prevalence of Oral Mucosal Lesions (OMLs) in an adult population from Santo Domingo, Dominican Republic. 751 subjects from eight communities from Santo Domingo accepted the invitation to participate in an oral screening from October 2016 to January 2017. 248 subjects were evaluated and clinically examined, age range 18-86 years. A validated instrument was designed to record demographic factors, age group, gender, anatomical location, presence or absence of OMLs, risk factors such as tobacco consumption and its frequency, and different forms of tobacco and alcohol use. A systematic oral clinical examination was conducted by a specialist. The presence or absence, and anatomic location of OMLs were recorded. The sample consisted of 44.4% males and 55.6 % females. 228 subjects had 1 or more lesions (91.9%), the median was 3 lesions per patient. In relation to risk factors, tobacco use in general was reported by 26.2 % of the subjects, with cigarette smoking reported by 75.4%, followed by other forms as "hookah" 9.2 %, marihuana 9.2%, cigars ("puros")4.6% and pipe smoking 1.5%. Among the oral lesions detected by screening, the nonpathological group was prevalent, and included physiologic melanin pigmentation as the most frequent (25.0%) followed by palatal/mandibular tori (20.2%), Fordyce granules (7.9%), and Exostosis (5.6%). Potentially malignant disorders (Oral Leukoplakia, Oral Lichen Planus and Actinic Cheilitis) corresponded to 2.2%, 0.3 %, and 0.3%, respectively. No malignancy was observed clinically. This study Authorutes to determining the prevalence of OMLs in Dominican Republic and to identifying risk factors. This is the first study reporting the prevalence of oral mucosal lesions among the Dominican adult population. This information is vital for establishing a public health program targeting the high-risk group to improve the oral health status in this population.El objetivo del presente estudio fue evaluar la prevalencia de lesiones de la mucosa oral (LMO) en una población adulta proveniente de Santo Domingo, República Dominicana. 751 individuos procedentes de ocho comunidades de la provincia de Santo Domingo, respondieron a la invitación para participar en el examen bucal, desde Octubre 2016 a Enero 2017. 248 sujetos con un rango de edad de 18-86 años, fueron evaluados y examinados clínicamente. Se diseñó y validó un instrumento para obtener datos de factores demográficos, grupos de edad, género, localización anatómica, presencia o ausencia de lesiones de la mucosa oral, factores de riesgo tales como: consumo de tabaco, frecuencia, diferentes formas de uso de tabaco y alcohol. Un especialista en el área, realizó un examen clínico bucal sistematizado en el cual se evaluó y registró la presencia o ausencia de lesiones y su localización anatómica. De acuerdo a la distribución por género, 44.4% correspondió a masculino y 55.6 % femenino. 228/248 sujetos presentaron 1 o más lesiones (91.9%), siendo la media de 3 lesiones por paciente. En relación a los factores de riesgo, el tabaco se reportó en 26.2%, siendo el fumar cigarrillos el 75.4%, seguido de otras formas como “hookah” 9.2%, marihuana 9.2%, cigarros (“puros”) 4.6% y pipa fumada 1.5 %. En cuanto a las lesiones bucales detectadas en el examen, el grupo de condiciones no patológicas fue el más frecuente e incluía a pigmentaciones fisiológicas melánicas (25.0%), seguida de torus palatino/mandibulares (20.2 %), gránulos de Fordyce (7.9%) y exostosis (5.6%),respectivamente. Las lesiones potencialmente malignas detectadas (Leucoplasia oral, Liquen plano oral y Queilitis actínica) correspondieron al 2.2%, 0.3 % y 0.3%, respectivamente. Clínicamente, no se observó malignidad. Este estudio Authoruye a determinar la prevalencia de LMO en República Dominicana e identificar factores de riesgo. Los hallazgos representan el primer estudio que muestra la prevalencia de las lesiones de mucosa oral en la población adulta dominicana. Se recomienda la creación de un programa de salud pública orientado a grupos de alto riesgo para mejorar el estatus de salud oral en esta población.

Background This study investigated the association between xerostomia and health risk behaviours, general and oral health and quality of life. Methods A cross-sectional study involving 800 adults over 65 years of age residing in Spain using a computer-assisted telephone questionnaire. The severity of xerostomia was assessed through the Xerostomia Inventory (XI). Both univariate and adjusted multinomial logistic regression were used to determine the risk (OR) of xerostomia. Results The sample comprised of 492 females (61.5%) and 308 males, with a mean age of 73.7 ± 5.8 years. Some, 30.7% had xerostomia: 25.6% mild, 4.8% moderate and 0.3% severe, the majority being female (34.8% vs 24%; p = 0.003). The mean XI was 24.6 ± 6.3 (95% CI 19.2–24.8) for those with poor health, whereas it was 17.4 ± 6.3 (95%CI 16.1–18.6) in those reporting very good health (p p = 0.002). Logistic regression showed that the highest OR for xerostomia was observed among adults with poor general health (2.81; 95%CI 1.8–4.3; p p = 0.001). Those who needed help with household chores had 2.16 higher OR (95%CI 1.4–3.4; p = 0.001) and 1.69 (95%CI 1.1–2.7; p = 0.03) in the adjusted model. Females had a higher risk of suffering from xerostomia than males. Conclusion The strong association between xerostomia and the general and oral health status of older adults justifies the need for early assessment and regular follow-up.

A 28-year-old woman was referred by her dentist to an oral and maxillofacial surgeon for white lesions of the lower lip and lateral tongue borders on both sides. The diagnoss morsicatio labiorum and linguarum was made. Cheek, tongue, and lip biting occurs with some regularity and often patients are unaware of this habit. The diagnosis of morsicatio is based on clinical appearance and additional diagnostics are unnecessary. The condition belongs to a subcategory of obsessive-compulsive disorders. Treatment is not always necessary, but may consist of making the patient aware of the cause, possibly combined with symptomatic and/or causal therapy, for instance with an occlusal splint or cognitive behavioral therapy.Een 28-jarige vrouw werd door haar tandarts verwezen naar een mka-chirurg vanwege witte afwijkingen van het lippenrood van de onderlip en de tongranden beiderzijds. De mka-chirurg stelde de diagnose morsicatio labiorum en linguarum. Wang-, tong- en lipbijten komt met enige regelmaat voor en een patiënt is zich vaak niet bewust van deze gewoonte. De diagnose morsicatio wordt gesteld op basis van het klinische aspect en aanvullende diagnostiek is niet nodig. De aandoening valt onder een subcategorie van obsessieve-compulsieve stoornissen. Behandeling is niet altijd noodzakelijk maar kan bestaan uit het bewust worden van de oorzaak en eventueel een symptomatische en/of causale therapie met bijvoorbeeld een opbeetplaat of vormen van cognitieve gedragstherapie.

Introduction: Oral clinical manifestations in HBV HCV and HIV patients indicate a deterioration in general health status. The aim of the study was to assess pathomorphologic features of oral mucosa observed in patients with these diseases. Methodology: The study was conducted in N1 Dental Clinic of YSMU after M. Heratsi. The total number of patients taking part in the research was 120, including HBV (n = 40), HCV (n = 40) and HIV (n = 40). After biopsy and subsequent histological examination of the oral mucosa, statistical analysis was carried out using Excel 2013 and R software. Results: Pathomorphological examination revealed inflammatory infiltrations in all samples collected from HBV, HCV and HIV patients. These changes included microcirculatory disorders in 98.3% of samples: fibrinous-like deposits lining the surface of erosions and ulcers on the oral mucosa (1.67%), fibrosis of the mucous membrane (70%), dystrophy of squamous epithelium (93.3%) and bone sequestration (3.3%). Comparative analysis of pathomorphological characteristics revealed distinct content of infiltrates: lymphoplasmacytic infiltration in patients with HBV and HCV, while HIV patients showed neutrophils infiltration and lack of plasmocytes. Conclusions: There are common abnormal morphological changes in the oral mucosa typical of all patients with HBV, HCV and HIV, as well as liver diseases specific to each of them. Inflammation in the patients with HIV indicated impairment of the humoral immune system. Understanding the distinct characteristic of inflammation in the oral cavity could be useful for early differential diagnosis and management of patients with HIV, HBV and HCV.

Oral inflammatory diseases (OIDs) are a group of dental diseases with multiple clinical manifestations that impact the majority of the world's population. Many studies have investigated the associations between individual OID traits and genomic variants, but whether pleiotropic loci are shared by oral inflammatory traits remains poorly understood. Here, we conducted multitrait joint analyses based on the summary statistics of genome-wide association studies (GWASs) of five dental traits from the UK Biobank. Among these genome-wide significant loci, two were novel for both painful gums and toothache. We identified causal variants at each novel locus, and functional annotation based on multiomics data suggested IL10 and IL12A/TRIM59 as potential candidate genes at the novel pleiotropic loci. Subsequent analyses of pathway enrichment and protein-protein interaction networks suggested the involvement of the candidate genes in immune regulation. In conclusion, our results uncover novel pleiotropic loci for OID traits and highlight the importance of immune regulation in the pathogenesis of OIDs. These findings will enhance our understanding of the pathogenesis of OIDs and be beneficial for risk screening, prevention, and the development of novel drugs targeting the immune regulation of OIDs.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a recently identified virus responsible for life-threatening coronavirus disease 19 (COVID-19). The SARS-CoV-2 infected subjects can be asymptomatic or symptomatic; the later may present a wide spectrum of clinical manifestations. However, the impact of SARS-CoV-2 on oral diseases remain poorly studied. Detection of SARS-CoV-2 in saliva indicates existence of virus in the oral cavity. Recent studies demonstrating the expression of ACE-2, a SARS-CoV-2 entry receptor, in oral tissues further strengthens this observation. Cytokine storm in severe COVID-19 patients and copious secretion of pro-inflammatory cytokines (IL-6, IL-1β and TNF-α) in multiple symptomatic oral pathologies including periodontitis and periapical periodontitis suggests that inflammatory microenvironment is a hallmark of both COVID-19 and oral diseases. Hyperinflammation may provide conducive microenvironment for the growth of local oral pathogens or opportunistic microbes and exert detrimental impact on the oral tissue integrity. Multiple case reports have indicated uncharacterized oral lesions, symptomatic irreversible pulpitis, higher plaque index, necrotizing/desquamative gingivitis in COVID-19 patients suggesting that SARS-CoV-2 may worsen the manifestations of oral infections. However, the underlying factors and pathways remain elusive. Here we summarize current literature and suggest mechanisms for viral pathogenesis of oral dental pathology derived from oral microbiome and oral mucosa-dental tissue interactions. Longitudinal studies will reveal how the virus impairs disease progression and resolution post-therapy. Some relationships we suggest provide the basis for novel monitoring and treatment of oral viral disease in the era of SARS-CoV-2 pandemic, promoting evidence-based dentistry guidelines to diagnose virus-infected patients to improve oral health.

The incidence of human papillomavirus (HPV)-associated cancers, especially those from the head and neck region, has increased. The relatively early age of presentation of HPV-positive head and neck cancer (HNC) indicates that viral infection might be acquired early in life. Persistent HPV infection has been recognized as the main risk factor for cancer development, but most studies have focused on evaluating HPV persistence in the genital region. Thus, in this work, we aimed to evaluate the prevalence of HPV in oral cavity and oropharynx in a young population, as well as the possible persistence of the infection after 12 months. Our results indicate that almost half (46.8%) of the analyzed population harbors an HPV infection either in the oral cavity or in the oropharynx. Furthermore, after 1 year of initial identification, half of them eliminated the infection, and only one person (5.26%) exhibited persistence. Interestingly, 50% of the individuals who successfully eliminated the infection acquired a new viral type, indicating that even when the primary infection is effectively eliminated by the immune system, there is a dynamic circulation of HR-HPV types that produce reinfection. This dynamic HPV infection among young individuals could influence the future establishment of cancer in some proportion of the cases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42770-021-00602-3.

BackgroundHand-foot-mouth disease (HFMD) is a global public health issues, especially in China. It has threat the health of children under 5 years old. The early recognition of high-risk districts and understanding of epidemic characteristics can facilitate health sectors to prevent the occurrence of HFMD effectively.MethodsDescriptive analysis was used to summarize epidemic characteristics, and the spatial autocorrelation analysis and space-time scan analysis were utilized to explore distribution pattern of HFMD and identify hot spots with statistical significance. The result was presented in ArcMap.ResultsA total of 52,095 HFMD cases were collected in Zibo city from 1 Jan 2010 to 31 Dec 2019. The annual average incidence was 129.72/100,000. The distribution of HFMD was a unimodal trend, with peak from April to September. The most susceptible age group was children under 5 years old (92.46%), and the male-to-female ratio is 1.60: 1. The main clusters were identified in Zhangdian District from 12 April 2010 to 18 September 2012. Spatial autocorrelation analysis showed that the global spatial correlation in Zibo were no statistical significance, except in 2012, 2014, 2015, 2016 and 2018. Cold spots were gathered in Boshan county and Linzi district, while hot spots only in Zhangdian District in 2018, but other years were no significance.ConclusionHot spots mainly concentrated in the central and surrounding city of Zibo city. We suggest that imminent public health planning and resource allocation should be focused within those areas.

Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs.

Background Erosion 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 presentation A 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. Conclusions To 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.

The consumption of smokeless tobacco (TSF) causes several damages to health, mainly in the oral cavity, being a predisposing factor to cancer and resulting in many lesions, this makes it necessary to know how to identify which are the main soft tissue lesions caused by TSF. The aim of this study is to analyze the main oral soft tissue injuries associated with the consumption of TSF. The research was based on an integrative literature review, the bibliographic survey was carried out with the help of the Health Sciences Descriptors (DeCS): Smokeless Tobacco, Tobacco, Diseases of the mouth and Oral Mucosa. The following databases were used: SciELO, LILACS, VHL and PubMed. As inclusion criteria, only complete studies, in Portuguese and English, free of charge and within the time frame from 2015 to 2022. The exclusion criteria were repeated studies, simple or expanded abstracts, opinion articles or reviews, and finally, studies that were not within the theme and objective of this research. The research resulted in 27 articles analyzed, among these, 6 articles were selected to compose this study. As a result, it was shown that irritation and direct contact for long periods of oral soft tissues with tobacco, generates inflammation and epithelial stress, which makes it a predisposing factor to various oral lesions. It is concluded that the main soft tissue lesions associated with the consumption of TSF are, commonly, white lesions such as, for example, oral candidiasis, TSF keratosis, Leukoplakia, Smoker's Melanosis and Erythroleukoplakia. El consumo de tabaco sin humo (TSF) provoca diversos daños a la salud, principalmente en la cavidad bucal, siendo un factor predisponente al cáncer y dando lugar a numerosas lesiones, esto hace necesario saber identificar cuáles son las principales lesiones de tejidos blandos provocadas por TSF. El objetivo de este estudio es analizar las principales lesiones de los tejidos blandos bucales asociadas al consumo de TSF. La investigación se basó en una revisión integrativa de la literatura, el levantamiento bibliográfico se realizó con la ayuda de los Descriptores de Ciencias de la Salud (DeCS): Tabaco sin humo, Tabaco, Enfermedades de la boca y Mucosa Oral. Se utilizaron las siguientes bases de datos: SciELO, LILACS, BVS y PubMed. Como criterios de inclusión, solo estudios completos, en portugués e inglés, gratuitos y en el período de 2015 a 2022. Los criterios de exclusión fueron estudios repetidos, resúmenes simples o ampliados, artículos de opinión o revisiones y, finalmente, estudios que no fueron dentro del tema y objetivo de esta investigación. La investigación resultó en 27 artículos analizados, entre estos, 6 artículos fueron seleccionados para componer este estudio. Como resultado se demostró que la irritación y el contacto directo por largos periodos de los tejidos blandos orales con el tabaco, genera inflamación y estrés epitelial, lo que lo convierte en un factor predisponente a diversas lesiones orales. Se concluye que las principales lesiones de tejidos blandos asociadas al consumo de TSF son, comúnmente, lesiones blancas como, por ejemplo, candidiasis oral, queratosis TSF, leucoplasia, melanosis del fumador y eritroleucoplasia. O consumo de tabaco sem fumaça (TSF) causa diversos prejuízos a saúde, principalmente em cavidade oral, sendo um fator predisponente ao câncer e resultando em muitas lesões, isso torna necessário saber identificar quais são as principais lesões em tecidos moles causadas pelo TSF. O objetivo desse estudo é analisar as principais lesões em tecidos moles orais associados pelo consumo do TSF. A pesquisa foi feita a partir de uma revisão integrativa de literatura, o levantamento bibliográfico foi feito com auxílio dos Descritores de Ciências da Saúde (DeCS): Tabaco sem fumaça, Tabaco, Doenças da boca e Mucosa Oral. As seguintes bases de dados foram utilizadas: SciELO, LILACS, BVS e PubMed. Como critério de inclusão, apenas estudos completos, em português e inglês, gratuitos e dentro do recorte temporal de 2015 a 2022. Os critérios de exclusão foram estudos repetidos, resumos simples ou expandidos, artigos de opinião ou resenhas, e por fim, estudos que não estavam dentro da temática e objetivo dessa pesquisa. A pesquisa resultou em 27 artigos analisados, dentre esses, 6 artigos foram selecionados para compor esse estudo. Como resultado, evidenciou-se que a irritação e contato direto por longos períodos dos tecidos moles orais com o tabaco, gera inflamações e estresses epiteliais, o que o torna um fator predisponente a várias lesões orais. Conclui-se que, as principais lesões em tecidos moles associadas ao consumo de TSF são, comumente, lesões brancas como, por exemplo, Candidíase oral, Ceratose do TSF, Leucoplasia, Melanose do tabagista e Eritroleucoplasia.

Introduction Traditional meta-analyses on the diagnostic accuracy of oral lesions have been conducted, but they were inherently limited to direct pairwise comparisons between a single method and a single alternative, while multiple diagnostic options and the ranking thereof were methodologically not possible. Objective To evaluate the diagnostic values of various methods in patients with oral potential malignant disease by performing a network meta-analysis. Methods Two authors independently searched the databases (MEDLINE, SCOPUS, the Cochrane Register of Controlled Trials, and Google scholar) up to June 2020 for studies comparing the diagnostic accuracy of various tools (autofluorescence, chemiluminescence, cytology, narrow band imaging, and toluidine blue) with visual examination or other tools. The outcomes of interest for this analysis were sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results Treatment networks consisting of six interventions were defined for the network meta-analysis. The results of traditional meta-analysis showed that, among six methods, narrow band imaging showed higher sensitivity, specificity, negative predictive value, positive predictive value, and accuracy compared to visual examination. The results of network meta-analysis showed that autofluorescence, chemiluminescence, and narrow band imaging had higher sensitivity compared with visual examination, and that chemiluminescence and narrow band imaging had higher negative predictive value compared with visual examination. However, autofluorescence and chemiluminescence had lower specificity compared with visual examination. There were no significant differences in positive predictive value and accuracy among the six interventions. Conclusion This study demonstrated that narrow banding imaging has superiority in terms of sensitivity and negative predictive value compared with the other five tested agents.

Oral infections with high-risk (hr)HPV genotypes are associated with a subset of head and neck squamous cell carcinomas. Oral hrHPV infections may result from having oral sex, but also from horizontal infection from mouth to mouth. In such cases, saliva can serve as a vehicle for HPV transmission. Still, the prevalence and dynamics of salivary HPV antibodies in healthy non-vaccinated individuals are poorly known and the role of the salivary antibodies in protection from oral HPV infection is unclear. We used an ELISA assay to evaluate the dynamics and correlation of oral HPV16 infection and HPV16L1 and E7 specific antibody levels in saliva and serum samples among 39 women, 13 of which had persistent oral HPV16 infection. The women were mothers-to-be, sampled before delivery and followed up for 36 months postpartum. HPV16L1 IgG and sIgA antibodies were regularly detected in saliva. Antibody levels in serum remained stable during the 36-month follow-up, while antibody levels in saliva fluctuated. There was considerable individual variation in salivary HPV16L1 antibody levels, and some women had persistent oral HPV16 infection but no salivary antibodies. No differences in salivary HPV16L1 levels were found between the women with persistent or transient oral HPV16 infection.

Early diagnosis of oral potentially malignant disorders (OPMDs) may be hindered by similar clinical presentations shared between benign oral lesions and OPMDs. The goal of this retrospective pilot study was to assess the use of machine learning (ML) as an adjunctive evaluation in conjunction with conventional comprehensive oral examination of OMPDs. Digital images of 80 deidentified intraoral lesions (40 benign intraoral lesions and 40 OPMDs) were collected. The images, which were previously identified independently by experienced oral pathologists, were used to create 3 datasets: raw images, grayscale images, and enhanced color images. The datasets were subsequently divided into training (n = 60), test (n = 10), and validation (n = 10) groups so that class labels (benign lesion or OMPD) were distributed equally in each group. A cross-validated grid search was used to optimize the hyperparameters of the Extreme Gradient Boosting (XGBoost) classifications model. Predictions were made on the test group and used to optimize the prediction threshold. The final results were validated by predictions based on the validation group. The XGBoost classification model was able to differentiate between benign intraoral lesions and OPMDs with a mean classification accuracy of 70%, sensitivity of 80%, and specificity of 60% when grayscale and enhanced color intraoral images were used. A mean classification accuracy of 50%, sensitivity of 40%, and specificity of 60% were observed when raw intraoral images were used. The results demonstrated that ML may be a promising tool for the diagnosis of OPMDs when used as an adjunct to conventional comprehensive oral examination.

Instagram has proven to be an important resource for complementing learning in various areas of knowledge, including Dentistry. The aim of this study was to characterize the content of Instagram pages about stomatology and oral pathology and identify the level of scientific evidence present in the posts. The last 5 posts of 110 public Instagram pages, focused on oral lesions or changes in normality located from the hashtags, #stomatology, #oral pathology, #oral pathology, #oral medicine, #oral pathology and #oral health were evaluated. A script developed by the researchers through Google Forms was used as a research instrument, which provided descriptive statistics. The GRADE and Oxford University guides were used to analyze the scientific evidence. It was shown that the scientific quality of publications focused on stomatology and oral pathology in this social network is precarious, since most (62.7%) do not present any reference that corroborates the statements made. As a result, 98.2% of the posts fall within level 5 (lowest) of the Oxford list and 100% of the publications fall within the very low level of the GRADE system. It is evident that the degree of reliability of the publications found by this research is low, which demands more training in the search for information through social networks. Further studies on this topic are necessary, given the widespread use of social networks by dental academics. Instagram se ha mostrado como un importante recurso para complementar el aprendizaje en varias áreas de conocimiento, entre ellas la Odontología. El objetivo de este estudio fue caracterizar el contenido de las páginas de Instagram sobre Estomatología y Patología Oral e identificar el nivel de evidencia científica presente en los posts. Se evaluaron las últimas 5 publicaciones de 110 páginas públicas de Instagram, centradas en lesiones orales o alteraciones de la normalidad localizadas a partir de los hashtags, #estomatología, #patologíaoral, #medicinaoral, #patologíaoral y #saludoral. Como instrumento de investigación, se utilizó un guión preparado por los investigadores a través de Google Forms, que proporcionó estadísticas descriptivas. Para el análisis de la evidencia científica se utilizaron las guías GRADE y de la Universidad de Oxford. Se demostró que la calidad científica de las publicaciones centradas en la estomatología y la patología oral en esta red social es precaria, ya que la mayoría (62,7%) no presenta ninguna referencia que corrobore las afirmaciones realizadas. Como resultado, el 98,2% de los puestos encajan en el nivel 5 (el más bajo) de la lista de Oxford y el 100% de las publicaciones encajan en el nivel muy bajo del sistema GRADE. Es evidente que el grado de fiabilidad de las publicaciones encontradas por esta investigación es bajo, lo que exige una mayor formación en la búsqueda de información a través de las redes sociales. Son necesarios más estudios sobre este tema, dado el amplio uso de las redes sociales por parte de los estudiantes de odontología. O Instagram tem se mostrado como um recurso importante para complementação da aprendizagem em diversas áreas de conhecimento, inclusive na Odontologia. O objetivo deste trabalho foi caracterizar os conteúdos das páginas do Instagram sobre Estomatologia e Patologia Oral e identificar o nível de evidência científica presente nas postagens. Foram avaliadas as últimas 5 publicações de 110 páginas públicas do Instagram, focadas em lesões bucais ou alterações de normalidade localizadas a partir das hashtags, #estomatologia, #patologia bucal, #patologia oral, #oral medicine, #oral pathology e #oral health. Como instrumento de pesquisa foi utilizado um roteiro elaborado pelos pesquisadores através do Google Forms, o qual forneceu a estatística descritiva. Para análise da evidência científica foram utilizados os guias GRADE e da Universidade de Oxford. Foi demonstrado que a qualidade científica das publicações voltadas à Estomatologia e Patologia Oral nessa rede social é precária, uma vez que a maioria (62,7%) não apresenta nenhuma referência que corrobore com as afirmações feitas. Em decorrência disso, 98,2% das postagens se enquadram no nível 5 (mais baixo) da listagem de Oxford e 100% das publicações se encaixam no nível muito baixo do sistema GRADE. Fica evidente que o grau de confiabilidade das publicações encontradas por esta pesquisa é baixo, o que demanda maior treinamento na busca por informações através de redes sociais. Mais estudos sobre este tema são necessários, haja vista a ampla utilização das redes sociais por acadêmicos de Odontologia.

Pemfigus i pemfigoid su potencijalno smrtonosne autoimune bulozne bolesti koje mogu zahvatiti sluznice i kožu. Dijagnoza se postavlja na temelju laboratorijskih i histoloških pretraga, kliničkog pregleda te anamneze. Patohistološki je pemfigus obilježen akantolizom tj. pucanjem međustaničnih veza (dezmosoma) koje se nalaze u trnastom sloju epitela zbog stvaranja antitijela usmjerenih prema tim spojevima. Posljedica toga je nastanak intraepitelnog mjehura. Kod pemfigoida su protutijela usmjerena protiv hemidezmosoma, multiproteinskih kompleksa koji se nalaze duž bazalne membrane i spajaju epitel s vezivom, te je prisutan nalaz subepitelnog mjehura. Nakon pucanja mjehura nastaju erozije, lezije koje se mogu inficirati ukoliko nije ordinirana lokalna i/ili sustavna terapija koja smanjuje upalu i imunološku reakciju, ublažava simptome i potiče epitelizaciju sluznice. Zlatni standard za detekciju bolesti je direktna imunofluorescencija koja se provodi uzimanjem uzorka iz nepromijenjenog perilezijskog tkiva. Kako bi se potvrdila dijagnoza ovih autoimunih bolesti tkivo ne smije biti razoreno te mora sadržavati u sebi depozite imunoglobulina G i/ili C3 komponentu komplementa na odgovarajućoj lokalizaciji, ovisno o tome koji je ciljni antigen. Uz patohistološku analizu i direktnu imunofluorescenciju tkiva moguće je koristiti indirektnu imunofluorescenciju za praćenje tijeka bolesti te ELISA-u (engl. enzyme-linked immunosorbent assay), visoko osjetljivi i specifični imunoenzimski test. Pravodobna dijagnostika te odgovarajuća terapija uvelike utječe na prognozu i krajnji ishod bolesti. Primarno liječenje pemfigusa su sistemski kortikosteroidi u kombinaciji s adjuvantnim imunosupresivima ili rituksimab (anti-CD20 monoklonalno antitijelo) dok se u teškim slučajevima mogu primijeniti i intravenski imunoglobulini i plazmafereza. Liječenje pemfigoida obično uključuje topikalnu primjenu sredstva za ublažavanje bolova s protuupalnim djelovanjem, a za tu svrhu odlični su lokalni kortikosteroidi. Mogu se propisati i pomoćni imunosupresivni lijekovi. Novije metode liječenja i jasnije razumijevanje patogeneze bolesti poboljšali su prognozu pemfigusa/pemfigoida te smanjili mortalitet. Pemphigus and pemphigoid are potentially fatal autoimmune diseases with blisters that affect mucocutaneous surfaces and skin. The diagnosis is made on the basis of laboratory and histopathological tests, clinical examination and medical history. Histopathologically, pemphigus is characterized by acantholysis i.e. the breaking of intercellular connections (desmosomes) located in the spinous layer of the epithelium due to the formation of antibodies directed towards these connections. The consequence of these events is the formation of an intraepithelial blister. In pemphigoid the antibodies are directed against hemidesmosomes, multiprotein complexes that are located along the basement membrane and connect the epithelium with the connective tissue. There is a finding of a subepithelial blister. After the bursting of the blisters, erosions occur, lesions that can become infected if supportive antiseptic therapy with agents that stimulate epithelialization of the mucous membrane has not been conducted. The gold standard for the detection of the disease is direct immunofluorescence, which is performed by taking a sample from the unchanged perilesional tissue. In order to confirm the diagnosis of these autoimmune diseases, the tissue must not be necrotic and must contain deposits of immunoglobulin G and/or the C3 component of complement in the appropriate localization, depending on which antigen is affected. In addition to pathohistological analysis and direct immunofluorescence of the tissue, it is possible to use indirect immunofluorescence to monitor the course of the disease and ELISA, enzyme-linked immunosorbent assay, a highly sensitive and specific immunoenzymatic test. Timely diagnosis and appropriate therapy greatly influence the prognosis and the final outcome of the disease. The primary treatment of pemphigus are systemic corticosteroids in combination with adjuvant immunosuppressants or rituximab (anti-CD20 monoclonal antibody), while in severe cases intravenous immunoglobulins and plasmapheresis can also be used. Treatment of pemphigoid usually involves the topical application of a pain reliever with an anti-inflammatory effect, and topical corticosteroids are excellent for this purpose. Auxiliary immunosuppressive drugs may also be prescribed. Newer treatment methods and a clearer understanding of the pathogenesis of the disease have improved the prognosis of pemphigus/pemphigoid and reduced mortality.

BackgroundIt is difficult to distinguish the clinical and histopathological aspects of oral lichen planus lesions from those of oral lichenoid reaction. Some criteria were proposed to distinguish them, mainly because they have different biological behaviors. The aim of the present study was to compare the lymphocyte population and the expression of E-selectin between these lesions.MethodsParticipants with a clinical diagnosis of oral lichen planus (GOLP) and oral lichenoid reaction (GOLR) who needed to perform a biopsy were selected. The tissue was frozen and immunostaining was performed for CD3/CD4, CD3/CD8, CD4/CLA, CD8/CLA, and CD62E. The analysis of each immunostaining was accomplished using the ImageJ program.ResultsIn total, 25 participants with oral lichen planus and 11 with oral lichenoid reaction were seen. In the evaluation of CD3 + CD4+/CD3 + and CD3 + CD8+/CD3 + proportions, there was a higher percentage of these cells in the oral lichen planus group when compared with the oral lichenoid reaction group (p = 0.027 and p = 0.038 respectively). The average number of CLA + lymphocytes for CD4+/CLA + and CD8+/CLA + in both groups was not statistically significant (p = 0.840; d = 0.363). In GOLP, the number of CD4 + CLA+/E-selectin and CD8 + CLA+/E-selectin was not statistically significant (p = 0.951 and p = 0.454 respectively); neither in GOLR (p = 0.454 and p = 0.989 respectively).ConclusionOur results indicate that CD3 + CD4+, CD3 + CD8+, CD4 + CLA+, CD8 + CLA + lymphocytes and E-selectin are present in both lesions. However, the proportion of CD3 + CD4+/CD3 + and CD3 + CD8/CD3 + cells is higher in the oral lichen planus group when compared with the oral lichenoid reaction group, suggesting that these cells may be important for the etiopathogenic mechanism of these lesions.

This procedural report details the case of a 10-year-old boy with oral Crohn's disease successfully treated with intralesional corticosteroid injections. The intervention used topical anesthesia with a eutectic mixture of lidocaine 2.5%/prilocaine 2.5% cream followed by intralesional triamcinolone acetonide. This approach safely and effectively reduced patient discomfort while allowing for an acceptable and durable clinical outcome.

A systematic review of case reports and series of oral syphilis found that the most affected anatomical site was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). Supplemental digital content is available in the text., Rapid emergence of syphilis and oral sexual behaviors has focused attention on oral syphilis, and published reports of cases with oral syphilis have increased in the recent decades. We performed a systematic literature review by searching articles from PubMed, EMBSE, and Google Scholar, looking for case reports or series that would potentially have the clinical characteristics and outcomes for each individual case with oral syphilis. A total of 145 cases with the infection, from 95 studies, were identified to include in our review. Two main clinical phenotypes (ulcerative lesions and mucous patches) appeared to be of particular relevance to oral manifestations. A solitary ulcer was mostly manifested as the lesion of primary syphilis (91.7%) preferentially located on the upper lip, tongue, palate, and buccal mucosa. The most affected anatomical site in the patients with single location involved was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). It is concluded that oral syphilis has its predominant clinical phenotypes although it can manifest in diverse manners.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.

Oral human papillomavirus (HPV) is associated with increasing rates of HPV-associated oropharyngeal cancer (OPC) in men. Sequential infection from one site to another has been demonstrated at the cervix and anus. Thus, risk of an oral HPV infection following a genital infection of the same type in the HPV Infection in Men study was investigated. Samples from 3,140 men enrolled in a longitudinal cohort were assessed for sequential genital to oral infection with one of nine HPV types (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58); and then also sequential, same-type oral to genital infection. Incidence rate ratios (IRRs) compared rates of oral HPV among men with and without prior genital infection of the same type. Risk of sequential HPV infections were assessed using Cox proportional hazards model. Incidence of an oral HPV infection was significantly higher among men with a prior genital infection of the same type for any of the 9 HPV types (IRR: 2.3; 95% CI: 1.7–3.0). Hazard ratio of a sequential genital to oral HPV infection was 2.3 (95% CI: 1.7–3.1) and 3.5 (95% CI: 1.9–6.4) for oral to genital infection. Both changed minimally after adjustment for age, country, circumcision, alcohol use, lifetime sexual partners and recent oral sex partners. HPV infections at one site could elevate risk of a subsequent genital or oral HPV infection of the same type in men, emphasizing the importance of vaccination to prevent all HPV infections.

While the small intestine is the main site of disease, many other organs are affected by celiac disease (CeD). Dental enamel defects (DED) are common in patients with CeD, and these are one of the indicators of CeD, even when no other symptom of CeD is present. Data on dental and oral cavity manifestations in Asian patients with CeD are scanty. The purpose of the current study was to evaluate dental and oral manifestations in Asian patients with CeD. We recruited 118 patients with biopsy-confirmed CeD (36 treatment naive and 82 on follow-up for at least 1 year on gluten-free diet [GFD]) and 40 controls. Diagnosis was made as per the standard criteria. Oral and dental manifestations were evaluated by a dental surgeon. The DED were evaluated according to Aine’s criteria. Overall higher number of patients with CeD (66.9%), both treatment naive (69.4%) and those on GFD (65.8%) had DED in comparison to controls (20%) (odds ratio, 8.1, 95% confidence interval [CI] 3.4–19.2; p

Demographic and clinical findings of patients with mucocutaneous morphea have not been well characterized, to our knowledge.To determine the demographic and clinical characteristics of morphea patients with mucocutaneous lesions who were enrolled in the Morphea in Adults and Children cohort.Cross-sectional study of 735 patients in the Morphea in Adults and Children cohort from 2007 to 2018.A total of 4.6% of linear morphea patients had oral involvement versus 2.4% among the entire cohort, whereas 10.3% of generalized morphea patients had genital involvement versus 3.7% among the entire cohort. Patients with genital lesions were older at disease onset than those with oral morphea (57 versus 11.5 years; P .001) and had more frequent extragenital lichen sclerosus et atrophicus (59.2% versus 5.6%; P = .004).Selection bias and limited number of affected subjects.Oral morphea lesions predominate in younger patients with facial linear morphea, whereas genital lesions predominate in postmenopausal women with overlying extragenital lichen sclerosus et atrophicus.

Objectives A new oral care nursing plan format for improved communication among dentists, nursing staff, and caregivers has been developed in Germany. We aimed to (1) describe this plan, (2) investigate the prevalence of oral health problems among elderly patients with care needs documented by the plan, and outline the recommendations in the plans, and (3) investigate whether the accommodation costs or care needs of patients influenced oral care quality or the need for oral hygiene support documented within the plan. Methods In this cross-sectional trial, oral care nursing plans were collected from outpatient and inpatient care clinics. Items on the oral care nursing plan were divided into three areas (oral health, oral hygiene needs, coordination needs and dental therapy), and were correlated with care level and accommodation costs. Results Oral care nursing plans were collected from seven dentists (N = 747; 94.5% from inpatient, 5.5% from outpatient care). The plans enabled documentation of well-known oral health and hygiene problems among elderly patients. In their current form, the plans provided recommendations for obvious oral hygiene tasks such as toothbrushing or fluoridating, rather than specialized tasks such as nutritional advice or dry mouth asymptomatic therapeutic approaches. While accommodation costs were associated with the need for oral hygiene support (not with oral care condition), the care level influenced both measures. Conclusions The oral care nursing plan can facilitate documentation of oral health and hygiene among elderly individuals with care needs. Further clarification of the plan would help promote careful documentation by dentists.

Objective Dental insurance may be a protective factor in reducing unnecessary emergency department (ED) use for nontraumatic dental pain. The purpose of this study was to 1) characterize patient demographics and identify risk factors associated with ED utilization for dental problems among individuals dually enrolled in medical and dental insurance and 2) investigate antibiotic and opioid prescription patterns among these patients following discharge. Further study of this unique population may provide insight into other causes of unmet dental need beyond lack of dental insurance. Methods Claims data from a large national managed health care plan from 2015 to 2018 were used to evaluate ED use for dental problems in patients with synchronous medical and dental insurance. National counts for ED visits, total visit costs, primary diagnoses, and outpatient treatments for antibiotics and opioids were assessed. Multivariable regression was used to assess any associated demographic and health-related variables. Results 1492 unique patients were admitted to the ED for dental pain and 429,376 unique patients presented for other symptoms. Utilization rates for nontraumatic dental pain were estimated to be 0.4% of all ED visits, with an average cost of $1487 per visit. Within three days following discharge from the ED, 58% of patients filled an opioid prescription and 38% filled an antibiotic prescription. Patients who presented for dental ED pain were more likely to be younger, live in a ZIP code with a lower median household income, have more medical comorbidities, and receive fewer preventive dental procedures within the prior year. Conclusion Our findings demonstrate a low rate of ED utilization for nontraumatic dental pain among dentally insured patients and highlight the protective value of prior dental visits for reducing ED use. Given high rates of antibiotic and opioid prescription fill following discharge, comprehensive ED guidelines regarding appropriate antibiotic and opioid treatment pathways may be helpful to provide more definitive care to patients with dental insurance.

Oral diseases are a significant global health problem across all countries and populations. With about 3.5 billion cases (2017), more people are affected than by any other disease group. The main oral diseases comprise tooth decay of permanent and deciduous teeth, severe periodontal disease, and oral and lip cancer. With a largely unchanged high global prevalence, but significantly growing population sizes, the pressure on health systems is increasing, particularly in low- and middle-income countries.Nonetheless, in many countries oral health has insufficient priority as a key health topic, including the global health policy discourse of German and international stakeholders. One of the fundamental challenges is ensuring universal and equitable access to basic oral healthcare services for all and without financial hardship (Universal Health Coverage).This paper provides an introductory overview of the global trends for the main oral diseases, which are generally characterized by stark inequalities. Opportunities for improving the situation through population-wide risk reduction and preventive approaches, access to oral healthcare, and policy options are highlighted. In addition, a range of relevant global (oral) health topics with potential for tangible change are discussed. Lastly, the reform areas of the Lancet Series on Oral Health from 2019 are presented and recommendations for the German and international global health policy discourse are provided.Orale Erkrankungen sind ein signifikantes globales Gesundheitsproblem über alle Länder und Bevölkerungsgruppen hinweg. Mit fast 3,5 Mrd. Erkrankungsfällen (2017) sind so viele Menschen betroffen wie von keiner anderen Krankheitsgruppe. Die Haupterkrankungen sind unbehandelte Karies der bleibenden oder der Milchzähne, fortgeschrittene Parodontopathien, Zahnlosigkeit sowie Karzinome der Mundhöhle und Lippen. Bei weitgehend unverändert hoher globaler Prävalenz erhöhen durch Bevölkerungswachstum bedingte stark steigende Fallzahlen den Druck auf schwache oder überlastete Gesundheitssysteme, insbesondere in Ländern der unteren und mittleren Einkommensgruppen.Dennoch wird der Mundgesundheit in vielen Ländern nur unzureichende Priorität eingeräumt und sie erhält als wichtiges Thema im gesundheitspolitischen Diskurs der deutschen und globalen Akteure nach wie vor wenig Aufmerksamkeit. Eine der fundamentalen Herausforderungen ist dabei die Gewährleistung eines allgemeinen und fairen Zugangs zu adäquater universeller Basisgesundheitsversorgung für alle Menschen ohne Verursachung von finanziellen Härten (Universal Health Coverage).Dieser Beitrag gibt einen einführenden Überblick über die globalen Trends der weltweiten Krankheitslast der oralen Haupterkrankungen, die von starken Ungleichheiten geprägt sind. Verbesserungsansätze aus der bevölkerungsweiten Risikoreduktion und Prävention, der Versorgungsplanung sowie gesundheitspolitische Lösungen werden kurz vorgestellt. Dabei werden die im internationalen Diskurs wichtigen Themen angesprochen und die im Rahmen einer Lancet-Artikelserie zur globalen Mundgesundheit aus dem Jahr 2019 entwickelten Reformbereiche besprochen. Schließlich werden neue Initiativen diskutiert sowie Empfehlungen für die deutsche und internationale gesundheitliche Entwicklungspolitik gegeben, die in den kommenden Jahren die Situation der globalen Mundgesundheit entscheidend verbessern könnten.

Objectives: Clarify the association between income group and oral health-related quality of life. Methods: Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values. Results: Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen’s d = −0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen’s d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen’s d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (β = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (β = −0.28, p < 0.10). Conclusions: The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.

An 18-year-old woman had a 14-year history of recurrent skin, nail, and oral mucosal abnormalities, treated with 3- to 6-month courses of itraconazole; the abnormalities typically recurred within 6 to 12 months of discontinuing itraconazole. Skin scrapings from the lower extremities demonstrated fungal elements; fungal culture of the skin scrapings grew Candida albicans. What is the diagnosis and what would you do next?

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.

Structured examination and treatment are essential in medicine. For dental students, a structured approach to the assessment of oral mucosal lesions is missing thus far. To validate an approach, a structured questionnaire was compared with the habitually used free description of oral lesions (white lesions, ulcers, hyperplasia). Thirty-three dental students were divided into two groups (Group 1 (n = 17) used the free description; Group 2 (n = 16) used a guided questionnaire) to characterize mucosal lesions in patients and make a tentative diagnosis. Although no difference was found between the groups regarding the suspected diagnosis or the histopathological findings, there was a significant advantage of the structured questionnaire in all aspects of the description compared to the free description (p = 0.000018). Thus, a structured description is an important aspect in the evaluation of oral mucosal changes, and a guided questionnaire should be implemented in the study of dentistry.