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Objective: Burning mouth syndrome (BMS) is a chronic orofacial pain disorder that is defined by a burning sensation in the oral mucosa. The aim of this study was to investigate the underlying factors, clinical characteristics and self-reported oral and general health factors associated with BMS., Material and Methods: Fifty-six women with BMS (mean age: 67.7) and their age-matched controls were included in the study. A general questionnaire, an OHRQL index and BMS-specific questionnaires were used. Each subject underwent an oral examination., Results: The mean severity of the BMS symptoms (VAS, 0-100) was 66.2 (SD 19.7). Overall, 45% of the patients reported taste disturbances. More of the patients than the controls rated their general health, oral health and life situation as 'less satisfactory'. The patients also reported more frequently on-going medications, diseases/disorders, xerostomia, allergy and skin diseases. Except for more bruxofacets among the patients, there were no significant differences regarding signs of parafunction. In a multiple logistic regression analysis, xerostomia and skin diseases showed the strongest prediction for BMS and no significant effect was found for medication, allergy or bruxofacets., Conclusions: Skin diseases and xerostomia but not parafunction were strongly associated with BMS. Our findings provide the basis for additional studies to elucidate the causal factors of BMS.

Geographic tongue (GT) is an oral mucosal lesion that affects the tongue. The association between GT and the bacterial colonization profiles of the tongue is not clear. Lingual swabs were collected from lesion sites and healthy sites of 35 patients with GT (19 males and 16 females; M age = 54.3 ± 16.1 years) and 22 controls (12 males and 10 females; M age = 56.3 ± 15.8 years). Bacterial DNA was extracted and sequenced by next-generation sequencing. At the phylum level, Fusobacteria were significantly less abundant, while Spirochaetes were significantly more abundant in GT patients compared to controls. At the operational taxonomic units level, multivariate analysis revealed distinct clusters for the three groups based on the lingual microbiota composition. Acinetobacter and Delftia were significantly associated with GT lesion and healthy sites. However, Microbacterium, Leptospira, Methylotenera, and Lactococcus were significantly associated with GT lesion sites. Additionally, Mogibacterium and Simonsiella were significantly associated with GT healthy sites and controls. The changes in the lingual microbiota profiles of patients with GT imply a shift in the lingual bacterial ecology. However, it remains unknown if this shift is a consequence of the lesions or of factors associated with the initiation and progression of the disease.

Objectives: The primary objective of this study was to investigate the association of systemic diseases, use of medications, allergies and tobacco habits with geographic tongue (GT) and fissured tongue (FT) lesions. The secondary objectives were to evaluate the clinical characteristics of tongue lesions and to compare the overall results for referred and non-referred patients., Methodology: Non-referred patients with GT (GTgp; n = 130) and FT (FTgp; n = 62) were examined by general practitioners (gp) and compared to a control group without oral mucosal lesions (C; n = 1029). Referred patients with GT (GTs; n = 166) and FT (FTs; n = 15) were examined by oral medicine specialists (s) and compared to GTgp and FTgp. Statistical analyses were performed using unpaired t-test or Fisher's exact test. A multiple logistic regression model was developed to control for age and gender as confounders., Results: Compared to the C group, GTgp patients used more anti-hypertensive medications and Swedish snus (p < 0.01). The GTgp group consisted of older males (p < 0.001) compared to C. Compared to the GTgp group, the GTs group was younger, more likely to have symptomatic lesions (p < 0.0001) and comprised of more females. Among the groups examined, FT patients had the highest mean age., Conclusion: This study identified an association between GT and anti-hypertensive medications, as well as the use of Swedish snus. It also found differences in the activities and symptoms of the lesions between referred patients and their counterparts who were seen in general dental practice; these parameters influenced the results when these conditions were taken into account.

Background: Specific pathogenic bacteria have been implicated in recurrent aphthous stomatitis (RAS), a chronic inflammatory condition characterised by ulcerations in the oral mucosa. However, the aetiology behind this condition still remains unclear., Objective: The buccal microbiota of patients with RAS was compared to that of control subjects to investigate its potential role for this condition., Design: Buccal swabs were obtained from non-ulcerative areas of 60 patients, of whom 42 patients had lesions at the time of sampling, and 60 healthy age- and gender-matched controls. Bacterial DNA was extracted and analysed by Terminal-Restriction Fragment Length Polymorphism, using enzymatic digestion of the polymerase chain reaction-amplified 16S rRNA gene, yielding a series of peaks, each representing a bacterial taxon., Results: Two peaks, 60 and 489, were more prevalent in patients with RAS than controls. Conversely, peaks 58 and 490 were less common in patients than controls. When the patients were divided into subgroups, we found that the observed differences in peak-pattern were related to the presence of lesions during sampling., Conclusions: The microbiota of the non-inflamed buccal mucosa differed between patients and controls. The differences were most pronounced in patients who presented with lesions during sampling, suggesting that a disturbance in the normal buccal microbiota triggers the presence of lesions or that presence of lesions alters the microbiota.

Risk factors for poor dental health include obesity, low socio-economic status, poor dietary habits, and dental anxiety. The aim of this study was to explore the complex relation between body mass index (BMI) and number of teeth in middle-aged women taking education, dietary intake patterns, dental care utilization, and dental anxiety into account. Three groups of women (37-60 years): reference women (group I, BMI 23.8 +/- 3.1 kg/m2), obese women (group II, BMI 35.0 +/- 2.6 kg/m2), and severely obese women (group III, BMI 41.0 +/- 3.4 kg/m2) were included. Questionnaires were used to assess education, smoking, number of teeth, dental care utilization, dental anxiety, dietary intake, and meal patterns. Age, education, and smoking habits did not differ significantly between groups. However, there were significant global differences in number of teeth (27.2 +/- 3.4, 23.0 +/- 9.2, 24.7 +/- 5.9) and reported daily energy intake (9756 +/- 3363 kJ, 10344 +/- 3850 kJ, 11970 +/- 3786 kJ in groups I, II, and m, respectively). In a multiple regression model, a lower number of teeth was independently associated with higher age, higher BMI, lower education, irregular dental care, high dental anxiety, higher energy intake, and lower iron intake. These variables explained 25% of the variation in number of teeth. In conclusion, BMI is an independent predictor of number of teeth in middle-aged women when socio-economic, dietary, and psychological factors are taken into account.

The objective of this study was to evaluate the significance of preoperative dental treatment for the development of complications in the form of infections during the first postoperative weeks after heart valve surgery. In one group of patients (n = 149), oral health was examined and dental treatment performed 3-6 months prior to heart valve surgery. In a second group (n = 104), oral health was examined postoperatively and these patients did not receive any dental treatment before surgery. Infections were recorded for all patients during the first three weeks after surgery and correlated to the dental status at the time of surgery. Sepsis or endocarditis occurred in 5.4% of the first group and in 1.9% of the second group. Freedom from all infections for the two groups was 55% and 56%, respectively. The results did not reveal any significant differences between the groups regarding patients' oral health at the primary oral examination. The frequencies of postoperative complications such as focal infections, fever and increased CRP were also found to be similar for both groups. The combined scores of complications were 2.1% and 1.8%, respectively. Data from the present study do not support the suggestion that dental intervention will decrease the rate of early complications following heart valve surgery.

The efficacy of oral fluconazole versus nystatin was evaluated as a treatment modality for oral candidosis. Of the included patients (n = 60), two-thirds presented with an erythematous candidosis, and the others showed clinical signs compatible with a pseudomembranous candidosis. Predisposing factors were xerostomia (n = 18), HIV (n = 5), immunosuppression in conjunction with organ transplantation (n = 10), and wearing of dentures (n = 14). For the remaining patients no specific predisposing factors were found. One patient who was treated with nystatin was excluded owing to nausea that was related to the antifungal treatment. After 7 days of treatment with fluconazole (50 mg/day), the affected oral mucosa, assessed by the investigator, was cured or showed considerable improvement in 87% of the patients (n = 30). The corresponding figure for the nystatin group (n = 30), rinsing with 1 mL 4 times a day for 21 days, was 80%. Following treatment with fluconazole, 20 of 22 patients with symptoms at the start (91%) reported improvement. The comparable figures for the nystatin group were 10 of 12 patients (83%). Half of the patients in the nystatin group reported inconvenience from taking the medication (mean value = 25.9) compared with 23% of the patients in the fluconazole group (mean value = 6.6). Eight patients in the fluconazole group and 12 patients in the nystatin group exhibited a relapse within 6 months. These differences were not found to be statistically significant. The patients in the fluconazole group reported less inconvenience from taking the medication, a finding that may have clinical implications for compliance.

To improve diagnostic procedures and facilitate clinical decision-making, computer-assisted image analysis was performed on color slides from 30 patients with histopathologically verified oral lichenoid reactions. Areas from white hyperkeratotic and adjacent red inflamed areas of the lesions were selected and subjected to image analysis. The digitization of the color slides was done by means of an image scanner, and the digital information was transmitted to a personal computer for subsequent feature extraction and analysis. The different oral lesions were characterized as the difference in mean values between white hyperkeratotic and red inflamed areas, respectively, compared with clinically normal tissue. Statistical analyses were made on three different color systems: Red-Green-Blue (RGB), normalized red-green-blue (rgb), and Intensity-Hue-Saturation (IHS). The results showed statistically significant differences in all color systems for both the hyperkeratotic areas and adjacent inflammatory reactions. A linear correlation was obtained when the results of the image analysis of color variations were compared with a clinical score system for hyperkeratosis and inflammation evaluated by two investigators independently.

This prospective study evaluated the significance of microbial analysis and antimicrobial treatment for the cure of angular cheilitis. Furthermore, various etiologic factors were investigated for their relative effect on the healing process. The study included 1) an open trial with 50 patients infected by Candida albicans and/or Staphylococcus aureus, and 2) an intraindividual comparison of eight patients with bilateral lesions infected by Candida albicans as the only detected pathogen. After a base-line examination the patients received ointments containing nystatin and/or fusidic acid, on the basis of the outcome of an initial microbial analysis. The patients were evaluated clinically, photographed, and examined for microorganisms at different time intervals. Ninety-six per cent of the patients who participated in the open trial had no sign of infection after 42 days of treatment. Lesions in the double-blind study, treated with nystatin, were healed after 28 days, whereas lesions that received placebo persisted throughout the treatment period. Increasing age, dry skin, and extended skinfolds at the corner of the mouth were factors closely related to the length of the healing process.

HLA antigens were examined in patients with erosive oral lichen planus (OLPe), cutaneous lichen planus (CLP), or lichenoid reactions (LR) adjacent to amalgam fillings. The control group had amalgam restorations in contact with the oral mucosa but without any reactions. A strong association was found between HLA-DR3 and OLPe, with an RR value of 21.0 (p less than 0.05). The corresponding values for CLP and LR were 2.3 and 1.5, respectively (NS). The haplotype A1-B8-DR3 was more frequently found in OLPe (p less than 0.05) and CLP (p less than 0.05) than in LR and controls (NS). The data indicate that OLPe, CLP, and LR, which present with virtually the same histopathologic features, are different in their association with HLA-DR3. Moreover, the increased frequency of HLA-DR3 in OLPe suggests an autoimmune component in the pathogenesis of this disorder.

The present morphological study was designed to evaluate the significance of Langerhans cells in the pathogenesis of cholesteatoma. Biopsies of middle ear cholesteatomas were examined for Langerhans' cells expressing HLA-DR and anti-Leu 6 antigens by immunohistochemistry using monoclonal antibodies. No apparent difference in number of cells was observed when epithelium of cholesteatoma was compared with epithelium of healthy ear canals. Expression of HLA-DR antigens was detected on keratinocytes in Aspergillus flavus infected epidermis, used as a control tissue. This finding indicated an increased immunosurveillance of this tissue. However, no such expression of HLA-DR antigens was detected on epidermal cells of cholesteatomas. The results of the present study did not support the hypothesis of Langerhans' cells as having a primary role in the development of cholesteatoma.