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Objectives: To test the hypothesis that cardiovascular diseases and risk factors are associated with ulcer relapse in after‐retirement patients with recurrent aphthous stomatitis. Subjects and Methods: This retrospective cohort study analyzed the data of 40 minor recurrent aphthous stomatitis patients aged 55–75 years, admitted to Oral Medicine Clinic at one university hospital in China between 2016 and 2018. The diagnosis of minor recurrent aphthous stomatitis was made based on the history and manifestation of oral ulcers. The ulcer relapse was evaluated after a 5‐week anti‐inflammatory treatment, and the history of systemic diseases was collected. cardiovascular disease/metabolic risk referred to the presence of any cardiovascular diseases and metabolic cardiovascular disease risks. Associations among cardiovascular diseases, risk factors, and ulcer relapse were evaluated. Results: The mean age of 40 patients with minor recurrent aphthous stomatitis was 62.4 years (SD 5.1), and 60% were women. The ulcer relapse rate was 37.5% (95% CI, 0.242–0.530). The proportion of cardiovascular disease/metabolic risk was higher in the relapse group than in the no‐relapse group after 5‐week anti‐inflammatory treatment (Fisher's exact test, p = 0.041). Conclusions: According to this single‐center experience, older patients with cardiovascular disease/metabolic risk may be more prone to oral ulcer recurrence. Nevertheless, larger prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: The present network meta‐analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?" Methods: From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta‐analysis accompanied by a random effect model and 95% credible intervals were calculated. Results: Forty‐three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta‐analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other. Conclusion: Within the limitations of the current network meta‐analysis, it seems that:A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well‐designed clinical trials with larger sample sizes are warranted.Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis. [ABSTRACT FROM AUTHOR]

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

Chronic ulcerative stomatitis (CUS) is a rare disease of the mucous membranes with characteristics similar to other autoimmune diseases. The aim of this study was to conduct a systematic review of the literature to recover all reported cases of CUS in order to summarize what are the clinical, demographic, microscopic, immunological features of CUS and its therapeutic response to different drugs. A systematic review of the literature was carried out following the statements of preferred reporting items for systematic reviews and meta‐analyses (PRISMA). The searches were performed in the electronic databases PubMed, Scopus, EMBASE, LILACS, Opengrey, and Google scholar. Inclusion criteria were articles or abstracts reporting at least one case with a final diagnosis of CUS. A total of 696 records were identified through databases, and 25 studies were selected reporting 81 cases. CUS affects more females (92%), and a greater number of cases are reported in Caucasian patients (53%). The age of patients ranged from 20 to 86 years with a mean age of 60 years (±13.86), and 15% of cases reported concomitantly skin lesions. The clinical and histopathological characteristics of CUS are very similar to those of oral lichen planus. The direct immunofluorescence (DIF) remains the gold‐standard diagnostic resource and was performed in 69 cases, revealing a dotted pattern of deposition of stratified epithelium‐specific antibodies (SES‐ANA). The serum of 38 patients was collected for the performance of the indirect immunofluorescence (IIF), and the use of epithelial substrates such as monkey and guinea pig esophagus often resulted in positive SES‐ANA IgG. Most patients were treated with antimalarials, and the treatment of choice that proved to be effective is hydroxychloroquine (HCQ). This entity must be considered in the differential diagnosis of other autoimmune diseases, as it may be underreported. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis remains the most common disease of the oral mucosa. The aim of this study was to investigate the clinical significance of serum interleukin‐6, interleukin‐17A, and tumor necrosis factor‐alpha in recurrent aphthous stomatitis. Methods: Using flow cytometry analysis, we detect the level of serum interleukin‐2, interleukin‐6, interleukin‐17A, tumor necrosis factor‐alpha, and interferon‐gamma in 127 patients with recurrent aphthous stomatitis and 20 healthy control cases; compare; and analyze the correlation of each index. Results: The levels of serum interleukin‐2, interleukin‐6, tumor necrosis factor‐alpha, and interferon‐gamma in the recurrent aphthous stomatitis group were higher than in the control group, and the differences were statistically significant (P <.05). There was no significant difference in interleukin‐17A between the two groups. Conclusion: The levels of serum interleukin‐6 and tumor necrosis factor‐alpha in recurrent aphthous stomatitis patients were significantly increased. Considering that serum TNF‐α was mostly within the normal range, its role in the pathology of RAS needed to be further explored. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this meta‐analysis was to reveal a potential association of the four functional polymorphisms in human Beta‐defensin 1 (DEFB1) gene: rs1047031(c*5G > A) at 3'UTR and rs11362 (−20 G > A), rs1800972(−44 C > G), and rs1799946 (−52 G > A) at 5'UTR with the risk of common oral cavity pathologies that included periodontitis, caries, lichen planus, and recurrent aphthous stomatitis. Methods: The relevant studies were obtained by the two researchers from PubMed, Scopus, and Web of Science up to April 29, 2020. The manual search of the reference lists was also performed. Studies on DEFB1 gene polymorphisms and oral cavity disorders, using the case‐control genetic association analysis approach, and published as full texts in English were included. To assess the association strength, odds ratios (ORs) with their 95% confidence intervals (CIs) were extracted. Results: Thirteen publications met the inclusion criteria and were incorporated in this meta‐analysis. Statistically significant values of the association tests were found only for the rs1047031 polymorphism. Allele distribution in the rs1047031 polymorphism was significantly associated with susceptibility to oral cavity pathologies (adjusted P value = 0.003). The rare variant allele carriers had a significantly higher risk for oral disasters under recessive (CC vs CT + TT), and CC vs CT models. No significant correlations between rs11362, rs1800972, and rs1799946 and the risk of oral pathologies were revealed. Conclusions: Significant association between rs1047031 polymorphism and risk of oral pathologies has been found, and therefore, we suggest to include this polymorphism in future research concerning the genetic background of the oral cavity diseases. [ABSTRACT FROM AUTHOR]

The ACE2 receptor, the binding sites for the COVID‐19, is expressed abundantly in the oral cavity, raising the question of whether the mouth is a target for the virus in addition to organs such as kidneys and lungs. Recently, a flurry of individual case reports on oral manifestation of COVID‐19 including ulceration, blistering lesions, and stomatitis were published. However, it is not clear whether the oral presentations that are not unique to the virus are indeed related to the virus and appear at a higher prevalence than in the general population. We used the i2b2 platform of hospital patient's registry to determine the odds ratio for COVID‐19 in patients that were diagnosed with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis before adjustments was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively. The odds ratio remained increased after adjustments of the comorbidities such as respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated with COVID‐19. African American race and age‐group 18‐34 were additional significant risk factors. The present study has demonstrated a significant association between COVID‐19 and RAS; however, additional longitudinal and laboratory studies are necessary to establish a cause and effect relationship between these 2 conditions. [ABSTRACT FROM AUTHOR]

Aims: Oral and/or oropharyngeal acute mucositis during and after chemo-radiotherapy (chemo-RT) for head and neck squamous cell carcinoma (HNSCC) can be extremely painful, sometimes requiring nasogastric feeding to enable adequate nutrition. The MASCC/ISOO evidence-based guidelines recommend benzydamine mouthwash for mucositis prevention in RT (recently updated to include chemo-RT), and a Cochrane systematic review found other agents to be effective in prophylaxis. Diclofenac mouthwash is licensed for painful oral mucosal inflammatory conditions but to our knowledge has not been assessed in chemo-RT-associated oral mucositis.Method: A clinical observation and service evaluation study in 10 patients undergoing chemo-RT for HNSCC to assess the potential value of diclofenac mouthwash (0.74 mg/mL) in reducing symptoms. Patients used 20ml of mouthwash up to 4 times a day starting in week 3 (of a 6-week course of treatment), recording pain and discomfort scores using a visual analogue scale on days 0, 1,7 and 14 (until the end of week 4). As per our current clinical practice, oral mucositis was not clinically scored as an outcome. Statistical analysis was performed using a one-way ANOVA.Results: Using diclofenac mouthwash, 9/10 patients experienced pain score reduction from day 0 (mean score 6.75 ± SD 1.83) to day 2 (5.05 ± SD 1.62) and day 14 (4.09 ± SD 1.96).Conclusions: Diclofenac mouthwash may be beneficial for managing chemo-RT-induced oral mucositis. While a prospective randomised clinical trial is needed, it can be prescribed for this condition within its current licence. [ABSTRACT FROM AUTHOR]

Objectives: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross-sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS.Methods: The validity and reliability of the HADS and PSS-10 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate-to-high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS-10 and bivariate analyses, respectively.Results: A bi-factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS-10 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate-to-high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms.Conclusion: The HADS and PSS-10 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group. [ABSTRACT FROM AUTHOR]

Background: The development of recurrent aphthous stomatitis (RAS), inflammatory disease of oral mucosa, is influenced by both environmental and genetic factors. The aim of this study was to investigate polymorphisms located in seven genes coding different types of matrix metalloproteinases (MMPs)-collagenases (MMP1, MMP8, and MMP13), gelatinases (MMP2 and MMP9), stromelysin (MMP3), and membrane-type metalloproteinase (MMP16) in patients with RAS and healthy controls.Methods: Totally, 223 subjects were included in this case-control study and their detailed anamnestic, clinical, and laboratory parameters were recorded. Seventy-seven patients with RAS and 146 controls were genotyped for seventeen polymorphisms in the MMPs genes using the real-time polymerase chain reaction (PCR) or PCR with restriction analysis.Results: Allele, genotype, and haplotype frequencies of the studied polymorphisms between RAS patients and controls were similar, except for allele distributions of MMP1 rs1144393, MMP9 rs3918242, and MMP16 rs10429371, which were different between patients with RAS and healthy controls (P = .023, P = .049 and P = .025, all Pcorr  > 0.05, respectively). Moreover, the comparison of genotype frequencies (TT vs CC + CT) of the MMP16 rs10429371 variant showed a marginally significant difference between RAS patients and controls (P = .05, Pcorr  > 0.05, OR = 1.68, 95% CI = 0.95-2.98).Conclusions: No significant relationship between investigated polymorphisms in seven MMPs genes and RAS development in the Czech population was observed in this study. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of oral supplementation on the management of oral mucositis in patients with cancer undergoing chemo and/or radiation therapy.Method: This is a systematic review and meta-analysis. The search was performed at 6 databases, and in the gray literature. Methodology of included studies was evaluated by the Cochrane Collaboration Risk of Bias Tool, and evidence quality was assessed by GRADE instrument.Results: Twelve randomized clinical trials were included in this review. The oral supplementation used was an oral elemental diet with amino acids and minerals (elental), glutamine, and zinc. The majority of the studies included in this review showed benefits in delaying the occurrence of OM by using glutamine and zinc, and in reducing the severity of OM with glutamine, zinc, and elental in patients receiving chemoradiotherapy. The meta-analysis showed that the risk of oral mucositis in the zinc group was slightly lower than in the control (RR: 0.71, 95% CI: 0.53-0.96, P = 0.02, n = 982) while the glutamine group presented the same risk as the control (RR: 0.91, 95% CI: 0.78-1.05, P = 0.19, n = 314). The evidence quality suggested low confidence for zinc and glutamine studies in the estimated effect from the outcomes assessed.Conclusions: Zinc is a promising strategy in the management of oral mucositis since it delayed the occurrence and reduced its severity. Glutamine and Elental, on the other hand, had no strong evidence in the prevention and/or treatment of oral mucositis in patients with cancer. [ABSTRACT FROM AUTHOR]

Objectives: Lichenoid granulomatous reaction can be subcategorized into lichenoid granulomatous dermatitis or lichenoid granulomatous stomatitis. It is described in the literature as demonstrating a band-like lichenoid infiltration with clusters of histiocytic or granuloma formation. In this study, we presented a large case series of lichenoid granulomatous stomatitis including demographics, histological features, and subcategories and compared findings with current literature.Methods and Materials: We retrieved all cases diagnosed with lichenoid reaction with granulomatous inflammation between January 1, 2000, and August 1, 2016, from the University of Florida Oral Pathology Biopsy Service Archives.Results: A total of 47 patients with tissue from 50 biopsy sites were included. The majority of the cases were noted in females (64%) with a mean age of 59 years (range 30-88). Most patients were Caucasian, and the most common sites in descending order were: gingiva, buccal mucosa, vestibule, tongue, lip, palate, and occasional multifocal involvement. Clinical impressions by the treating clinicians included leukoplakia, dysplasia, carcinoma in situ, squamous cell carcinoma, lichen planus, vesiculobullous disease, trauma, and allergy. The histologic features of these cases ranged from lichenoid mucositis with numerous aggregates of histiocytes to well-formed granulomas, in accordance with previous classifications of similar dermatologic lesions. All cases revealed positive CD 68 in the histiocytic infiltrates and were negative for microorganisms utilizing acid-fast bacilli, Grocott methenamine-silver, and periodic acid-Schiff stains.Conclusion: Lichenoid granulomatous disease may be more common than previously reported; however, its etiology remains unknown and patients should be kept under long-term clinical follow-up. [ABSTRACT FROM AUTHOR]

The present systematic review sought to evaluate the effects of Sodium Lauryl Sulfate (SLS)-free compared to SLS-containing dentifrices on (Recurrent) aphthous stomatitis (RAS) in patients with this condition. Cochrane, Medline (PubMed) and Embase databases, and some trial registries were searched through December 2017. There was no language, nor publication year restrictions. We included double-blinded randomized controlled trials that compared the effects of dentifrices with and without SLS on RAS in humans. Data extraction was compliant with PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. PROSPERO 2018:CRD42018086001. Four trials were included in this review (all crossover studies; n = 124 participants) and two contributed to the main meta-analysis based on the random-effect model. SLS-free dentifrice, when compared to SLS-containing statistically significantly, reduced the number of ulcers, duration of ulcer, number of episodes, and ulcer pain. Sensitivity analysis of the four studies as parallel-group trials shows a consistent direction of effect in favor of SLS-free dentifrice usage. In conclusion, the qualitative and quantitative synthesis of the eligible trials for this review showed that use of SLS-free consistently reduced all four parameters of ulcers measured. The available evidence suggests that patients with RAS may benefit from using SLS-free dentifrices for their daily oral care. However, future well-designed trials are still required to strengthen the current body of evidence. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis is a common ulcerative disorder of the oral mucosa, where the immune impairment may develop in genetically predisposed subjects exposed to certain environmental factors. The aim of the study was to investigate the frequency of anaemia, iron and vitamin B12 deficiency in recurrent aphthous stomatitis (RAS) and to explore its impact on the clinical presentation of RAS.Methods: A total of 141 adults including the following: 71 subjects with RAS and 70 controls were enrolled in the study. A detailed dental and haematological assessment, including full blood count, serum iron and vitamin B12 evaluation, was performed in all study participants. The results were statistically analysed with Mann-Whitney, Kruskal-Wallis, χ2 and Fisher tests with P < .05 designated as a significance level.Results: Recurrent aphthous stomatitis patients were found to suffer anaemia, iron and vitamin B12 deficiency more frequently than the controls. The mean serum iron levels were also significantly lower in RAS subjects than in controls, although still within the norm. The lowest mean serum iron levels were observed in patients with a mild course of RAS. No significant differences in mean serum iron and vitamin B12 levels were revealed as a function of stratification according to the number of lesions per single flare-up.Conclusions: The results of our study indicate an association between iron and vitamin B12 deficiency and RAS in a Polish population. However, as the haematinic deficiencies did not significantly modify the course and clinical phenotype of the disease, further studies to explore their role in RAS aetiology are required. [ABSTRACT FROM AUTHOR]

Background: The cytotoxic effect of chemotherapeutic agents to the oral mucosa, as a side effect of cancer treatment, is a major problem. Cooling the oral mucosa using ice chips in conjunction with chemotherapy is known to reduce the severity of oral mucositis. However, although the use of ice chips is of clinical value, this method of cooling has inherent problems including discomfort for the patient, non-uniformity and fluctuations in cooling temperature throughout the oral cavity. Furthermore, despite being used clinically, it is not known what reduction in temperature is required to prevent oral mucositis. The aim of this study was therefore to determine in vitro if the cytotoxic effect of 5-fluorouracil (5-FU) on the oral mucosa could be reduced by lowering the temperature during chemotherapeutic treatment.Methods: Tissue-engineered oral mucosal (TEOM) models were incubated at 20, 25, 30 or 35°C for 30 minutes followed by exposure to a clinically relevant concentration of 5-FU (162 μg/mL) for 2 hours and compared with untreated models (35°C). Cell viability and inflammatory cytokine production (IL-6 and TNF-α) were measured using PrestoBlue® and ELISA, respectively.Results: TEOM models incubated at 20°C showed an increased cell viability and had a reduced IL-6 and TNF-α production compared to models treated with 5-FU incubated at 35°C.Conclusion: This study demonstrates a reduced cytotoxic effect to the TEOM by reducing the temperature of the tissue during chemotherapy treatment and suggests that decreasing the temperature to 20°C could have clinical advantages. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis (RAS) is a multifactorial disease with unclear etiopathogenesis in which disturbance of immunological processes may be involved. The aim of our study was to investigate three single nucleotide polymorphisms (SNPs) rs3806265, rs4612666, rs10754558 in NOD-like receptor 3 (NLRP3), the gene encoding the component of inflammasome, in patients with RAS and healthy controls in the Czech population.Methods: A total of 207 subjects were included in this case-control study. Sixty-four patients with RAS and 143 healthy controls were genotyped by a method based on polymerase chain reaction using 5' nuclease TaqMan® assays. Detailed anamnestic, clinical, and laboratory data were obtained from all subjects.Results: The allele and genotype frequencies of NLRP3 polymorphisms (rs10754558 and rs3806265) between both groups were similar. However, statistically significant differences in NLRP3 rs4612666 genotypes between the patients with RAS and controls were found; carriers of the TT genotype had a higher risk of developing RAS than subjects with the CT+CC genotypes (OR = 14.69, 95%CI = 1.73-124.72, P = .004, Pcorr < .05). No associations between NLRP3 haplotypes and RAS were observed.Conclusions: Our study indicates that the NLRP3 rs4612666 polymorphism may be involved in the development of RAS in the Czech population. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral chronic ulcerative disease in which proinflammatory cytokines such as interleukin-1 (IL-1) and interleukin-6 (IL-6) are thought to play an important role. The aim of this study was to investigate the possible association between polymorphisms in the IL-1 cytokine family, IL-6 or its receptor and RAS in the Czech population.Methods: A total of 248 subjects, 184 healthy controls, and 64 patients with RAS were genotyped for IL-1A-889C>T, IL-1B-511C>T, IL-1B+3953C>T, IL-1RN86 bp variable number of tandem repeats (VNTRs) in intron 2, IL-6-597G>A, IL-6-572G>C, IL-6-174G>C, and IL-6R+48992A>C by polymerase chain reaction (PCR) methods.Results: No significant differences between investigated polymorphisms in healthy subjects and patients with RAS were detected (P>.05). In addition, complex analysis also revealed similar IL-1 or IL-6 haplotype frequencies between both groups (P>.05).Conclusions: In conclusion, IL-1 and IL-6 or its receptor gene variants cannot be used as markers for identification of Czech patients with increased risk of recurrent aphthous stomatitis. [ABSTRACT FROM AUTHOR]

Chronic ulcerative stomatitis is an immune-mediated mucocutaneous disorder characterized clinically by erosions or ulcers. Most cases are limited to the mouth. The histopathological features are non-specific or mimic those of oral lichen planus, and studies by immunofluorescent microscopy are essential for definitive diagnosis. The defining immunopathogenic mechanism is the binding of IgG to the nuclear protein deltaNp63alpha of keratinocytes in the basal and parabasal cell layers of the oral stratified epithelium. DeltaNp63alpha functions as a regulator of epithelial stem cell activity and as an antiapoptotic agent and regulates the expression of cell-to-cell and cell-to-basement membrane adhesion molecules. The autoimmune IgG-deltaNp63alpha interaction is thought to result in damage to the structural attachment of keratinocytes to one another and to the epithelial basement membrane zone and in dysregulation of the cell cycle and apoptosis of basal keratinocytes with the development of erosions or ulcers. The aims of treatment are to suppress the pathogenic immunoinflammatory responses, to prevent local infection and to promote healing. The purpose of this article is to provide a succinct review of the diagnostic, clinical and etiopathogenic features of, and treatment guidelines for chronic ulcerative stomatitis, and to argue that this disease should be regarded as a variant of oral lichen planus, rather than as a distinct entity. [ABSTRACT FROM AUTHOR]

Background: Oral mucositis is a common debilitating condition in patients with cancer receiving cytotoxic therapies. This study aimed to evaluate the effects of topical administrations of the essential oil extracted from hull of Pistacia atlantica fruit (bene) on healing of oral mucositis in golden hamsters.Methods: Forty hamsters with oral mucositis induced by 5-fluorouracil administered on days 0, 5 and 10 and buccal mucosal scratching were randomly divided into four equal groups: group 1 received no additional treatment, group 2 received gel base, and groups 3 and 4 received gels containing 5% and 10% oil, respectively. From day 12, after blood sampling of all animals, a half randomly selected fraction of each group (four half groups) received once-daily topical administration of either gel type (gel base, 5% and 10%) or no treatment (control subgroup) over the buccal pouches for 3 days and the remaining halves received the same treatments for 6 days. On each final day 15 and 18, the corresponding subgroups underwent consecutively the repeated blood sampling, mucosal clinical examination and excision for histopathology.Results: Comparisons on macro- and microscopical oral mucositis scorings demonstrated dose-dependent healing promotion in the subgroups receiving active gels (P < 0.05). The blood samplings revealed the chemotherapy-related pancytopenia with no significant difference among all subgroups on either end point (P > 0.05).Conclusions: The healing effect of the bene oil could mainly be local and attributed to its antioxidants and fatty acid contents present in non-saponified and saponified fractions, respectively. [ABSTRACT FROM AUTHOR]

Background: Oral mucositis occurs in patients undergoing chemoradiation for cancer treatment. It is believed that colonization of ulcerated mucosa by bacteria, fungi, and virus results in secondary infections. The effect of chlorhexidine on the incidence and severity of oral mucositis in patients with cancer was evaluated in this review.Methods: Studies were limited to randomized placebo-controlled trials. Three databases were searched: MEDLINE (via PubMed), Web of Science, and the Cochrane Library up to May 25, 2016.Results: Ninety-eight abstracts were evaluated by three independent reviewers. Twelve studies met the criteria for inclusion. Four of these studies were assessed at unclear risk of bias and eight of them at high risk. Of the 12 studies, nine were included in two meta-analyses. Pooled results showed that chlorhexidine did not significantly reduce incidence of mucositis compared to placebo (P = 0.129), nor chlorhexidine did significantly reduce the severity of mucositis (P = 0.127), although subgroup analysis in the chemotherapy group showed a trend toward significance (P = 0.054). Side effects reported in the included studies were teeth staining and altered taste perception.Conclusions: This systematic review found that chlorhexidine is not significantly effective in reducing the severity of mucositis (moderate quality of evidence) nor in preventing the incidence of mucositis (low quality of evidence). However, more studies are needed in patients receiving chemotherapy only, as a positive trend toward significance was found (P = 0.054). [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the relation between a clinical profile and the interleukin-1β (IL-1β) genotype in a Polish cohort of patients with RAS.Methods: One hundred and four patients with RAS were enrolled in the study and all were subject to an oral examination. The severity of RAS was assessed according to the clinical type of the disease, the number of lesions per flare-up and the length of intervals between the episodes. The genotyping of two SNPs of the IL-1β gene, IL-1β c.-511 T>C (rs16944) and IL-1β c.+3954 C>T (rs1143634), was carried out by genomic DNA isolated from blood samples and by using the PCR-RFLP approach. The results were statistically analysed with chi-square and Fisher's tests and Spearman's rank correlation, with P < 0.05 assumed to be a significance level (Statistica 10; StatSoft® , Kraków, Poland).Results: No statistically significant associations or correlations were found between the presence of *2 allele and minor, major or herpetiform RAS nor after the stratification using the RAS severity score and the classification based on the number of lesions per one flare-up. A weak correlation was found between the number of lesions per one flare-up and heterozygosity promoting the A type of RAS, characterized by a low number of eruptions.Conclusions: The presence of IL-1 β *2 allele within the c.+3954 and c.-511 SNPs was found to be neither a significant risk factor for a higher incidence of any type of RAS, nor did it influence the disease severity and mode of recurrences. [ABSTRACT FROM AUTHOR]

Objective: Oral mucositis (OM) is a common complication of chemotherapy and radiotherapy. The aim of this study was to evaluate the effects of treating 5-fluorouracil-induced OM with apigenin and dexamethasone.Methods: Thirty-six male Syrian hamsters were randomly assigned to one of three groups: control (50% acetic acid + 5-FU), 50% acetic acid + 5-FU + potassium Apigenin (KA), and 50% acetic acid + 5-FU + dexamethasone. The animals from each group were sacrificed 5, 7, 10, and 14 days after inducing the mucositis, and two samples collected from each animal, accounting a total of 72 samples. Macroscopic changes were assessed by histomorphometric analysis, with ulcers being assessed by imaging analysis and the number of inflammatory cells in the ulcerated region quantified in all periods through histomorphometric analysis (H&E). Furthermore, immunohistochemical changes were evaluated by proliferating cell nuclear antigen.Results: All groups presented an increased inflammatory infiltrate after 7 days, compared to other evaluation times (P ≥ 0.05). There was significant difference between apigenin and control group in the 10-days period. Lower quantity of inflammatory cells in the apigenin-treated group in comparison with control group in the 7- and 10-days periods was observed (P < 0.05). No statistically significant difference was verified among the groups in 5- and 14-days periods. The healing process of the control group was slower than that of apigenin and dexamethasone-treated groups, with an overall significant difference between apigenin and the control group in the 10-days period.Conclusions: Apigenin treatment may enhance healing of OM induced by 5-fluorouracil, thus suggesting that more extensive research in this area may be useful to assess the role of agents of natural origin capable of preventing OM. Hence, further studies involving broader samples are need to confirm the therapeutic potential shown by this study. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis (RAS) is a common disorder with an unclear etiopathogenesis. Involvement of the immune system in the development of this condition is strongly suggested. As the variations in the inflammasome-related NLRP3 gene have been suggested to affect immune system activity, this case-control study was performed to determine whether these genetic variants are associated with RAS. Methods: We studied a group of 69 Iranian patients with RAS in comparison with 56 healthy controls. We determined four single nucleotide polymorphisms (SNPs) of NLRP3 and performed association analyses of NLRP3. Genotyping was conducted using the TaqMan method. Results: The NLRP3 rs3806265 T allele was significantly more frequent in the patients with RAS than in the healthy controls (P = 0.003). While a significant negative association was found between the C allele at the same position with RAS (P = 0.003), the TT genotype was significantly more frequent at position rs3806265 in NLRP3 in patient group than in the controls (P = 0.002). However, the frequency of CT genotype at the same position was significantly higher in healthy controls than in the case category (P = 0.002). Conclusions: Considering the high frequency of the presence of NLRP3 rs3806265 TT genotype in patients with RAS, it seems that this gene polymorphism could affect individual susceptibility to RAS. [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis (RAS) is an inflammatory disease induced by genetic and environmental factors. Toll-like receptor (TLR) and CD86 are essential components for innate immunity and cellular immune response. We aimed to determine whether inheritance of specific TLR2, TLR4and CD86 gene polymorphisms are associated with RAS.Methods: Ninety-six patients with RAS and 153 controls were studied. Eight SNPs were genotyped using PCR-RFLP technique; four in TLR2 gene: rs4696480, rs3804100, rs121917864, rs5743708; three in TLR4 gene: rs10759931, rs4986790 rs1927911; and one in CD86 gene rs17281995. Association was assessed by logistic regression analysis. Linkage disequilibrium (LD) was assessed using the Haploview program.Results: Significant increase in inheritance of A allele (OR = 1.6, P = 0.01) and AA genotype (OR = 3.89, P = 0.01) of TLR4 rs10759931 was observed in cases. TLR4rs1927911 C allele and CC genotype were also increased (OR = 1.60 and 2.78 respectively); however, this was not statistically significant (P = 0.02 and 0.03 respectively). TLR2 and CD86 did not show association with RAS.Conclusions: This is the first study to investigate the association of TLR and CD86 with RAS. We found a significant association between TLR4 rs10759931 polymorphism and RAS. Confirmatory studies in other populations and functional investigations are needed to determine the role of TLR4 in RAS. [ABSTRACT FROM AUTHOR]

Introduction: Oral mucositis (OM) has been described as the oral complication most frequently associated with antineoplastic therapy. However, the influence on the quality of life of affected patients is still unclear.Objective: To evaluate the impact of OM on the oral-health-related quality of life (OHRQoL) of patients diagnosed with cancer, who developed chemotherapy- and/or radiotherapy-induced OM.Methods: This is a cross-sectional evaluation of QoL using oral health impact profile-14 (OHIP-14). The study group comprised a sample of 60 patients diagnosed with cancer, who developed OM during the treatment. The instrument (OHIP-14) composed of seven dimensions was used: functional limitation, physical pain, psychological discomfort, physical deficiency, psychological deficiency, social incapacity, and deficiency.Results: The internal consistency of OHIP-14 measured by the Cronbach's α coefficient was of 0.76. Physical pain attained the highest score (worst quality of life) among the studied dimensions 60.8% (292/480), followed by physical limitation 52.7% (253/480), and psychological discomfort 50.8% (244/480). The dimension 'social limitation' obtained the lowest score 27.2% (131/480). There was statistically significant difference as regards gender (P = 0.021) for physical pain, with greater impact among patients of the male gender.Conclusion: Oral-health-related quality of life is significantly affected by OM in individuals diagnosed with cancer. [ABSTRACT FROM AUTHOR]

Background A portion of patients with recurrent aphthous stomatitis ( RAS) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high blood homocysteine level with RAS. Methods The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations in 273 RAS patients were measured and compared with the corresponding levels in 273 age- and sex-matched healthy control subjects. Results We found that 57 (20.9%), 55 (20.1%), 13 (4.8%), and 7 (2.6%) RAS patients had deficiencies of hemoglobin (Men < 13 g/dl, Women < 12 g/dl), iron (<60 μg/dl), vitamin B12 (<200 pg/ml), and folic acid (<4 ng/ml), respectively. Moreover, 21 (7.7%) RAS patients had abnormally high blood homocysteine level. RAS patients had a significantly higher frequency of hemoglobin, iron, vitamin B12, or folic acid deficiency and of abnormally elevated blood homocysteine level than healthy control subjects (all P-values = 0.000 except for folic acid P = 0.022). If 273 RAS patients were further divided into 32 patients with major-typed RAS (Mj RAS) and 241 patients with minor-typed RAS (Mi RAS), we found that male Mj RAS patients had a significantly lower mean hemoglobin concentration than Mi RAS patients ( P = 0.021), but Mj RAS patients had a significantly higher mean homocysteine level than Mi RAS patients ( P = 0.000). Conclusion We conclude that there is a significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and abnormally high blood homocysteine level with RAS. [ABSTRACT FROM AUTHOR]

Background RAS may affect quality of life and impacts oral health and daily activities; consequently, psychological factors, dental needs and patients' perceptions. Professionals should understand this relation to adequately manage oral ulcers. This study aimed at investigating the relationship between oral health impacts, oral health-related quality of life and psychological profiles in patients with recurrent aphthous stomatitis ( RAS). Methods Fifty-three patients (30 men and 23 women, mean age: 31.1 ± 10.1 years) with RAS participated in this study. During ulcer episodes, participants completed Hospital Anxiety and Depression Scale ( HAD), Neuroticism-Extraversion-Openness Five Factor Inventory ( NEO- FFI), Oral Health Impact Profile ( OHIP-14) and United Kingdom Oral Health-Related Quality of Life measure ( OHQoL- UK) proformas. Patients completed OHIP-14 and OHQoL- UK again when they were ulcer-free. The statistically significance levels were set at P ≤ 0.05. Results During ulcer episodes, patients reported worse oral health impacts and an inferior quality of life in comparison with ulcer-free times ( P < 0.0001). Higher OHIP scores were significantly associated with higher HAD depression ( P = 0.036) and anxiety ( P = 0.012) scores. NEO- FFI scores had no significant relations with OHIP and OHQoL- UK scores ( P > 0.05). During ulcer-free periods, no relationships were detected between OHIP, OHQoL- UK, HAD and NEO- FFI scores ( P > 0.05), except between OHQoL- UK and conscientiousness scores ( P = 0.05). Conclusions RAS increased the negative oral health impacts on patients and consequently lowered their quality of life. Stressful situations and conditions (including anxiety and depression), rather than inherent personality profiles and stable psychological traits, were related to oral health impacts and quality of life in patients with RAS. [ABSTRACT FROM AUTHOR]

Background All aspects of aetiopathogenesis of recurrent aphthous stomatitis (RAS) have not been elucidated. RAS and Behçet's disease (BD) have clinical and immunological characteristics in common. Although T17 cytokines and alpha-enolase have been shown to play effective roles in BD and many other autoinflammatory diseases recently, their roles in RAS have not been studied extensively. In the present study, we investigated levels of several Th1, Th2 and Th17 pathways related cytokines and alpha-enolase to elucidate pathogenesis of RAS and to obtain data about possible treatment alternatives for the condition. Methods Serum interleukin-1, interleukin-13, interleukin-17, interleukin-18, interferon gamma and alpha-enolase levels in 24 patients with RAS, 30 patients with BD and 20 healthy controls were measured. Results Serum interleukin-1, interleukin-13, interleukin-17, interleukin-18, interferon gamma and alpha-enolase levels were higher in patients with RAS and patients with BD than in healthy controls ( P < 0.005). Conclusion Like Th1 and Th2 cells, Th17 cells were found to be effective in pathogenesis of RAS. In addition, alpha-enolase, the levels of which were high, may play an important role in etio-pathogenesis of RAS. Further studies to be designed in the light of these findings are required to shed light on pathogenesis and treatment of the condition. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy, and safety of newly customized natural oral mucoadhesive gels, containing either aloe vera or myrrh as active ingredients, in the management of minor recurrent aphthous stomatitis ( Mi RAS). Subjects and Methods Ninety subjects with Mi RAS were recruited from Oral Medicine Clinic, at Faculty of Dentistry, King Abdulaziz University, Saudi Arabia, for this randomized, double-blind, placebo-controlled study. Two new natural gels, containing aloe vera and myrrh, were prepared in a concentration of (0.5% w/w), in addition to a plain mucoadhesive gel used as a placebo. Patients with fresh ulcers (<48-h duration) were instructed to apply either one of the three gels four times a day for a period of 5 days. Clinical efficacy was investigated in the form of changes in ulcer size, pain intensity, erythema, and exudation at days 4 and 6 of study entry. Participants were interviewed for the emergence of any side effects. Results 76.6% of patients using aloe gel showed complete ulcer healing, 86.7%, and 80% of them revealed subsidence of erythema and exudation, respectively, especially at day 6 visit, whereas 76.7% of myrrh-treated patients revealed almost absence of pain at day 6. No side effects were encountered with the use of any of the three gels. Conclusion The new formulated aloe- and myrrh-based gels proved to be effective in topical management of Mi RAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction. [ABSTRACT FROM AUTHOR]

Background In spite of all the efforts, recurrent aphthous stomatitis ( RAS) and oral lichen planus ( OLP) still have unexplained etiology. The role of anxiety, depression, and psychological stress in occurrence and intensity of symptoms in RAS and OLP patients has been investigated in this study. Methods A total of 110 patients with RAS in the acute phase and 112 patients with OLP also in acute phase participated in this study. All patients filled out questionnaires related to the primary disease ( RAS/ OLP) after which they took the following psychological tests: Beck Depression Inventory ( BDI), The State-Trait Anxiety Inventory ( STAI), and Ways of Coping Questionnaire ( WCQ). Results According to multiple regression analysis, in patients with RAS, the highest correlation was found between results of the pain intensity and STAI test (β= 0.66; p < 0.000). In the patients with OLP, the highest correlation was found between the level of hyperkeratosis and WCQ test (β = 0.53; P < 0.000), inflammation and results of BDI test (β = 0.33; P < 0.002), and results of dynia test and STAI test (β = 0.31; P < 0.004). Conclusions In this study, a high correlation between anxiety, depression, and psychological stress with symptoms of RAS and OLP has been observed. [ABSTRACT FROM AUTHOR]

Introduction Acute lymphoid leukemia ( ALL) is the hematologic neoplasia most commonly diagnosed in children. Among the secondary side effects of chemotherapy, mucositis is the most frequent complication. The aim of this study was to evaluate the seroprevalence of herpes viruses HSV-1, EBV, and CMV and the presence and severity of oral mucositis in children and adolescents diagnosed with ALL. Methodology Ninety-two patients diagnosed with ALL were evaluated. Serum samples were collected before chemotherapy and tested by ELISA method. Presence of mucositis was observed on the first day before antineoplastic therapy (D0) and on 7th day post-therapy (D7). Classification of mucositis intensity was performed according to toxicity criteria established by the National Cancer Institute. Results 70.7% of the patients presented mucositis on the D7, and of these, 60% were classified as Grade I and 40% as Grade II; of the 92 individuals tested, 59 (64.1%) presented antibodies for HSV-1, 57 (62%) for EBV, 75 (81.5%) for CMV_IgG, and 21 (22.8%) for CMV_IgM. Using a logistic regression model, the presence of HSV-1 was observed to be 4.10 times greater in Grade II mucositis severity than in Grade I ( P = 0.03). Conclusion Based on the findings of this study, it was possible to conclude that infection by the herpes viruses HSV-1, EBV, and CMV is ubiquitous in the studied population and that HSV-1 may be a risk factor for aggravating the severity of mucositis. [ABSTRACT FROM AUTHOR]

Context Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease. However, the available therapies for RAS only relieve symptoms and do not provide a cure. Aims This study assessed the response to treatment with levamisole and low-dose prednisolone drug combination in patients with RAS. Methods and Material Fifty RAS subjects were enrolled in the single-blind randomized placebo-controlled trial. Study medications were administered thrice daily for 3 consecutive days/week for 3 consecutive weeks. Patients in Group 1 received placebo, Group 2 received levamisole (50 mg) and Group 3 received levamisole (50 mg) and low-dose prednisolone (5 mg). Patients were followed up for 60 days after treatment. Response to treatment was assessed using the following clinical parameters: pain due to ulcers, number of ulcers/episode, size of ulcers, duration of ulcers, and frequency of ulcers (episodes/month). Statistical analysis used: Mann-Whitney U-test. Results A statistically significant improvement was noted in all parameters except for the size of ulcers in patients treated with levamisole alone and with combination of levamisole and low-dose prednisolone. There was no statistically significant improvement in the placebo group. Both active groups had significantly better improvement when compared to placebo group, while there was no significant difference between the two active groups. Conclusions Levamisole alone and combination of levamisole and low-dose prednisolone are effective modes of therapy for RAS. [ABSTRACT FROM AUTHOR]

Noma (cancrum oris) is a destructive necrotising disease affecting orofacial tissues predominantly of malnourished young children. It is characterised by a rapid acute onset which usually starts in the mouth, spreads intra-orally destroying soft tissue and bone and progresses to perforate the facial skin, causing disfigurement. Polybacterial anaerobic infection is critical too, but is not alone sufficient for the initiation of noma. Cofactors, first and foremost malnutrition, but also systemic viral and bacterial infections are crucial to the development of noma. A patient with necrotising stomatitis or noma must be admitted to hospital for antibiotic treatment, fluid and electrolytes as well as nutritional supplementation and general supportive treatment. The epidemiology of noma in the South African population is unknown, and the clinicopathological features are poorly characterised. Although worldwide there is no evidence that HIV infection is a strong risk factor for noma, HIV infection may play a substantial role in the pathogenesis of noma in South Africa. [ABSTRACT FROM AUTHOR]

Background Recurrent aphthous stomatitis ( RAS) is a common oral ulcerative condition. At ulcer sites vascular adhesion molecule-1 ( VCAM-1), E-selectin and intercellular adhesion molecule-1 ( ICAM-1) are strongly expressed on blood vessels, and ICAM-1 is expressed on keratinocytes. Expression of these molecules would promote leukocyte accumulation and invasion of the epithelium. Thus, polymorphisms in these candidate genes might contribute to RAS susceptibility. We investigated whether the inheritance of specific selectin, ICAM and VCAM gene polymorphisms is associated with RAS susceptibility. Methods Ninety-six RAS cases and 153 controls were recruited from a Jordanian population. Blood was collected for hematological investigations and genotyping. Six SNPs were genotyped: E-selectin rs5361 and rs1805193, L-selectin, rs2205849, ICAM-1 rs5498, ICAM-5 rs885743 and VCAM-1 rs1800821. Association was determined using chi-square and binary logistic regression analysis after correcting for confounding factors. Linkage disequilibrium was determined using the EH program, and the Phase 2.1 program was used to construct and compare haplotypes between cases and controls. Results There was a significant association of the A allele ( Pcorr = 0.027), AA and AC genotypes ( OR = 10.9 and 9.0, respectively) of the E-selectin rs5361 gene polymorphism and TAA haplotype (rs2205849, rs5361, and rs1805193, respectively; P = 0.03) with RAS. None of the other SNPs showed a significant association. Conclusions This is the first report to link inheritance of the A allele, AA and AC genotypes of the E-selectin rs5361 polymorphism with increased risk of RAS. Further studies in different patient cohorts are needed to confirm the association, and functional analyses might clarify the biological significance of the association. [ABSTRACT FROM AUTHOR]

Objectives To determine (i) effects of lawsone methyl ether ( LME) mouthwash on antifungal drug resistance of oral Candida, (ii) effects of LME mouthwash on changes in genotype of oral Candida, and (iii) allergy and subjects' satisfaction on LME mouthwash in comparison with chlorhexidine ( CHX). Materials and methods A randomized clinical trial was conducted in HIV-infected subjects and denture wearers receiving either LME or CHX mouthwash. Candidal culture by oral rinse technique was performed as baseline and after using the mouthwash for 2 weeks. Antifungal drug resistance and changes in genotype of oral Candida were assessed by microdilution assay, inverted repeat polymerase chain reaction and restriction fragment length polymorphism assays, respectively. Allergy and subjects' satisfaction on the mouthwashes were recorded. Statistical analysis was performed using Chi-squared and Fisher's exact tests. Results Twenty-nine HIV-infected subjects (age range, 26-54 years; mean age, 41 years) and 38 denture wearers (age range, 27-76 years; mean age, 55 years) were enrolled. C. albicans was the most common specie found in both groups followed by C. tropicalis, C. parapsilosis, and C. glabrata. Neither antifungal drug resistance nor significant changes in genotyping of Candida were noted among those receiving LME mouthwash. Subjects' satisfaction on taste and smell of LME mouthwash was comparable to that of CHX. Conclusions Use of LME mouthwash for 2 weeks neither led to antifungal drug resistance nor significant changes in genotype of oral Candida. Thus, LME may be an alternative mouthwash in prophylaxis of oral candidiasis among those at risk of developing the disease. [ABSTRACT FROM AUTHOR]

Background Recurrent aphthous stomatitis ( RAS) is one of the most common oral mucosal diseases in many parts of the world. However, there is very limited published clinical evidence for the therapies used in this condition. This could be partly due to the difficulty in evaluating the efficacy of oral ulcer treatment objectively. In this paper, we present a method for assessing and monitoring the severity of oral ulcers before and after treatment. Methods Six ulcer characteristics, number, size, duration, ulcer-free period, site and pain, were used to generate an ulcer severity score (USS). The scores for 223 RAS patients were determined, and 79 were scored again after 3-month therapy with topical betamethasone. Results The scores for the minor RAS group were between 18 and 43 (mean 29.2 ± 5.3). The mean score in the major ulcers group (range: 28-60, mean 39.9 ± 6.1) was significantly greater than in the minor group ( P < 0.001). The herpetiform recurrent ulcers score range was wide (range: 18-57, mean 36.6 ± 8.4). The mean severity score decreased significantly after treatment ( P < 0.001). Conclusions The USS was indicative of the disease activity in recurrent oral ulceration. It helped in assessing the efficacy of therapy, as the change in the numerical score reflected the change in ulcer severity in response to treatment. This tool may well prove to be of value in clinical management, research and in clinical trials. [ABSTRACT FROM AUTHOR]

Herpes simplex virus type 1 is one of the most frequent causes of oral infection in humans, especially during early childhood. Several experimental models have been developed to study the pathogenesis of this virus but all of them employed adult animals. In this work, we developed an experimental model that uses mice younger than 4 days old, to more closely resemble human infection. Mice were infected subcutaneously with the prototype strain Mc Intyre of Herpes simplex-1, and the progression of infection was studied by immunoperoxidase. All animals died within 24-72 h post-infection, while viral antigens were found in the oral epithelium, nerves and brain. The most striking result was the finding of viral antigens in the nucleus and cytoplasm of cells belonging to striated muscles. Organotypic cultures of striated muscles were performed, and viral replication was observed in them by immunocytochemistry, electron microscopy and viral isolation. We conclude that the infection of striated muscles is present from the onset of oral infection and, eventually, could explain some clinical observations in humans. [ABSTRACT FROM AUTHOR]

Background Recurrent aphthous stomatitis is one of the most common lesions of oral mucosa. Helicobacter pylori is suggested as one of the etiological agents of recurrent aphthous stomatitis. Here, we conduct a study for evaluating the impact of H. pylori eradication on clinical course of recurrent aphthous stomatitis. Methods Forty-six patients with minor aphthous lesions were enrolled. The number of RAS lesions at last 6 months and vitamin B12 levels were recorded. All patients were detected for H. pylori with endoscopic biopsy. H. pylori was positive in 30 patients and negative in 16 patients. H. pylori-positive 30 patients received eradication therapy. Three months after therapy, patients were re-evaluated with urea breath test; 18 patients were negative (eradicated), and the remainders (12 patients) were positive (non-eradicated) for H. pylori. 6 months after eradication, vitamin B12 levels and number of aphthous lesions at 6 months were recorded. Results Vitamin B12 levels were significantly increased in H. pylori-eradicated group ( P = 0.001), whereas no significant change was found in non-eradicated group ( P = 0.638). Mean number of aphthous lesions (per 6 months) of H. pylori-eradicated group was significantly decreased after eradication ( P = 0.0001); in the non-eradicated group, no significant change was found ( P = 0.677). In Hp-positive group, number of RAS lesions and vitamin B12 levels were negatively correlated when evaluated both before and after eradication. Conclusions This study provides evidence to support the beneficial effect of H. pylori eradication in patients with recurrent aphthous stomatitis. The underlying mechanism might be the increase in vitamin B12 levels after eradication. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2012) 41: 568-576 Background: Oral microbial flora and a damaged oral mucosa may increase the risk of bacteriemia, fungemia and complications in immunocompromised patients. Aim of the Study: Assessment of presence: bacteria and Candida spp. in different oral lesions, and the incidence of bacteremia in the case of a damaged mucosa in transplant recipients and patients receiving anti-tumour chemotherapy. Material and Method: Forty-five patients - 18 months to 18 years of life, were included (20 - organ recipients, 14- anti-tumour chemotherapy, 11 - control group). Clinical, oral mucosa examination focused on the type, severity and site of lesions, and microbiology assessed the presence of bacteria and fungi in the material from lesions. Blood cultures were performed in ten immunocompromised patients with manifestations of systemic infection. The control material consisted of blood cultures made prior to the onset of oral lesions and after 4-6 weeks following their remission in a diagnosed bacteremia. The statistical analysis was performed. Results: In the subjects with secondary immunodeficiency, among other coagulase-negative Staphylococcus (CoNS), Candidia spp. were more frequent. In cancer patients, mucositis was associated with Candida spp., Streptococcus spp. Organ recipients with stomatitis exhibited the presence of CoNS, Streptococcus viridians and other. Oral lesions in the control group contained Haemophilus parainfluenzae, Neisseria spp. and Staphylococcus aureus. In 30% of immunocompromised patients, oral lesions were accompanied by bacteremia. Conclusions: A correlation has been found between oral lesions and the presence of S. aureus in patients without secondary immunodeficiency, and of CoNS, Enterococcus spp., Candida spp. in immunocompromised patients. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2012) 41: 90-95 Background: Oral lichen planus (OLP), which is a chronic inflammatory disease of the oral mucosa with unknown etiology, affects about 2% of the population. MicroRNAs are small non-coding RNAs involved in normal processes such as development and differentiation as well as progression of human diseases. The aim of this study was to investigate the expression of miR-21, miR-125b, and miR-203 and to compare RNA levels of their potential targets, the tumor suppressor p53 and its relative p63, both known to be deregulated in OLP. Methods: In biopsies from 20 patients with OLP and 20 age- and sex-matched healthy controls, epithelium was laser dissected and analyzed for the expression of miR-21, miR-125b, miR-203, p53, and p63 using qRT/PCR. Results: Increased expression of miR-21 and miR-203, decreased expression of miR-125, and down-regulation of p53 and ΔNp63 RNA were seen in OLP compared to normal oral mucosa. When comparing microRNA expression to levels of p53 and p63 RNA, a significant negative correlation was seen between ΔNp63 and miR-203 and between miR-21 and p53, respectively. Conclusion: Results indicate a role for the studied microRNAs in changes seen in OLP. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2011) 40: 721-725 Background: Sjögren's syndrome (SS) occurs associated with parotid neoplasm, non-Hodgkin's B-cell lymphoma, which could impair the condition or be life-threatening for patients. The aim of this work was to analyze cell proliferation and apoptosis modifications in acinar, ductal and inflammatory infiltrate in salivary glands (SG) in patients with Sjögren Syndrome, keratoconjunctivitis, or stomatitis sicca or in healthy subjects, to establish parameters that indicate the likelihood of malignancy of the disease in populations at risk. Methods: A study was performed with n = 58 histological samples of lower lip SG from patients diagnosed with SS, keratoconjunctivitis, or stomatitis sicca (SICCA) and from healthy subjects (C). Ki67 and caspase-3 immunolabeling were performed. Results: The most important result was significant differences between the three study groups in Ki67 and caspase-3 markers ( P < 0.0001) in infiltrated lymphocytes. Conclusion: The results of this work are indicative of a high degree of proliferation (85%) in infiltrated lymphocytes (IL) associated with SS which, according the literature, could be considered a risk. Furthermore, the markers used in this work are widely known and represent a lower cost than others and can be used to determine risk groups within the population of SS patients, enabling their follow-up. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2011) 40: 715-720 Background: Recurrent aphthous stomatitis is a common ulcerative disease of the oral mucosa. Recurrent oral aphthous ulceration is also a feature of the more serious and systemic Behçet's disease. Nitric oxide is a free radical synthesized by one of a family of nitric oxide synthase (NOS) enzymes and is an important regulator of inflammation and immunity. Association of NOS3 gene polymorphisms encoding endothelial nitric oxide synthase has been reported in Behçet's disease but not recurrent aphthous stomatitis. The aim of this study was to investigate any association between NOS2 gene polymorphisms that encode inducible nitric oxide synthase and recurrent aphthous stomatitis. Methods: This is a case control association study. Eighty-three Jordanian recurrent aphthous stomatitis patients and 83 age, gender and ethnically matched controls were genotyped for three NOS2 single-nucleotide polymorphisms, rs10459953, rs1060822 and rs2297518. Chi-squared analysis was used to compare the allele frequencies and genotypes. Results: There was a significant association between recurrent aphthous stomatitis and inheritance of single-nucleotide polymorphism rs2297518 ( P = 0.006). Although no direct association was demonstrated between rs10459953 or rs1060822 and recurrent aphthous stomatitis, a strong linkage disequilibrium was identified between rs1060822 and rs2297518. Conclusion: Inheritence of a NOS2 single-nucleotide polymorphism rs2297518 is associated with increased risk of recurrent aphthous stomatitis in a Jordanian population. Confirmatory studies in other populations and investigation of other NOS2 gene polymorphisms will enhance our understanding of the functional basis of this association and help elucidate the role of inducible nitric oxide synthase in recurrent aphthous stomatitis. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2011) 40: 604-609 Introduction: The aims of this study were to test the validity and reliability of a newly developed discipline-specific questionnaire, the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), to measure quality of life in patients with chronic oral mucosal conditions. Materials and methods: Two patient samples were recruited for the purposes of this study. First, a random sample of 160 patients attending the Oral Medicine Unit of Cork University Dental School and Hospital with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis. Second, the COMDQ was randomly distributed to a sample of 100 patients without a chronic oral mucosal condition. Convergent and discriminative validity and internal consistency of the newly developed questionnaire were assessed. Results: This study has demonstrated that the newly developed questionnaire has good convergent validity with Pearson correlation coefficient of 0.819 with Oral Health Impact Profile-14 and 0.883 with Visual Analogue Scale for pain scores. The discriminative validity was also good with statistically significant differences between patients with chronic oral mucosal conditions and without chronic oral mucosal conditions. The new instrument has also demonstrated excellent reliability with Cronbach's alpha of 0.929. Conclusions: In conclusion, this study has demonstrated that the COMDQ is a valid and reliable measure to assess quality of life in patients with chronic oral mucosal diseases and therefore will be a valuable instrument in the management of these conditions. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2010) 39: 420–423 Background: Recurrent aphthous stomatitis (RAS), commonly referred to as canker sores, is a very common and painful oral mucosal disease. Although the etiology of RAS is not well understood, a number of factors may play a role, including nutritional deficiencies. The objective of this study was to compare dietary vitamin intake in RAS patients to that of a control group. Methods: One hundred subjects, who had suffered at least three episodes of minor RAS in the previous 12 months, completed a detailed Diet History Questionnaire designed and validated by the US National Institutes of Health. DietCalc software was used to calculate daily dietary intakes of nine different vitamins in the study subjects. Daily intakes were energy-adjusted and compared to age- and gender-matched nutrient intake data on 9033 subjects from the US National Health and Nutrition Examination Survey. Results:  The study subjects had significantly lower daily intake of vitamin B12 ( P < 0.0002) and folate ( P < 0.0001) as compared to the controls. Conclusions: Our results demonstrate that patients with recurrent aphthous stomatitis are more likely to have lower dietary intakes of vitamin B12 and folate than a control group. These results support and extend previous studies indicating a link between the etiology of RAS and hematological deficiencies of vitamin B12 and folate. These findings suggest that consuming sufficient amounts of these vitamins may be a useful strategy to reduce the number and/or duration of RAS episodes. [ABSTRACT FROM AUTHOR]