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Self-inflicted or factitious injuries of the oral mucosa are not rare and may appear in various forms often mimicking other oral lesions. Detailed medical history and clinical examination will usually reveal the underlying cause of the injury. However, if the patient is not aware of the bad habit, it will take longer for the dentist to figure out the underlying cause. Treatment relies on the elimination of the bad habit and lesions could be easily treated with topical corticosteroids in orabase. However, no therapy is successful unless patient does not stop the factitious habit. This article emphasizes that certain lesions of the oral mucosa might result from the self-inflicted habits of which patient is sometimes unaware of.

Bioimpedance measurements mostly depend on the degree of mucosal keratinization. Demographic and clinical factors (Gender, smoking and the amount of saliva) probably affect bioimpedance measurements, but further research including a larger number of subject is needed to clarify their role.

Oral medicine (stomatology) is a recognized and increasingly important dental specialty in many parts of the world that recognizes and fosters the interplay between medical health and oral health. Its dental activities rely greatly on the underlying biology of disease and evidence-based outcomes. However, full recognition of the importance of oral medicine to patient care, research, and education is not yet totally universally acknowledged. To address these shortcomings, we outline the birth, growth, and future of oral medicine globally, and record identifiable past contributions to the development of the specialty, providing an accurate, unique, and valuable resource on oral medicine. Although it was challenging to gather the data, we present this information as a review that endeavors to summarize the salient points about oral medicine, based on MEDLINE, other internet searches, communication with oral medicine and stomatological societies across the world, the web page http://en.wikipedia.org/wiki/List-of-dental-organizations, and discussions with a wide range of key senior persons in the specialty. © 2016 Elsevier Inc.

Objective To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. Methods The device was tested on a sample of patients with xerostomia due to Sjogren's syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. Results A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P < 0.002), xerostomia frequency (P < 0.05), quality of life impairment (P < 0.01), and swallowing difficulty (P < 0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P < 0.0001), xerostomia frequency (P < 0.0001), oral discomfort (P < 0.001), speech difficulty (P < 0.02), sleeping difficulty (P < 0.001), and resting salivary flow rate (P < 0.01). Conclusion Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

“Non-Aromatic Very rich in Steranes” (NAVS) naphthalan is a purified natural oil derivative, abundant in steranes (geogenic „steroids“). The purpose of this study was to evaluate the effectiveness of NAVS in the treatment of oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS). We used NAVS oil in adhesive paste in 11 patients with clinically and histologically proven OLP (open label), and in 7 patients with RAS (double blind randomized; topical betamethasone in adhesive paste used as control). The severity of the OLP lesions was objectively scored. The number and diameter of RAS lesions were assessed on days 0, 3, and 5. The intensity of pain and discomfort was determined using visual analogue scale (VAS) and „Oral health impact profile“ (OHIP-14) before and after therapy. OLP cumulative activity scores on days 0 and 28 were 101.5 and 48.5, respectively (t=5.99; P=0.0001). Using NAVS for 28 days resulted in 52.2% overall clinical improvement. Cumulative OHIP-14 scores on days 0 and 28 were 210 and 142, respectively (t=5.65; P=0.0002). Out of a total of 7 patients with RAS, 4 of them were treated with NAVS and 3 with topical corticosteroids. There were no statistically significant differences in improvement rate between the two groups (lesion number (day 3 P=0.29; day 5 P=0.32); lesion diameter (day 3 P=0.64; day 5 P=0.74)). NAVS successfully reduced the clinical signs and symptoms of OLP, and reduced the number, diameter, and symptoms in patients with RAS, statistically comparable with corticosteroids.

Burning mouth syndrome (BMS)represents oral pain disorder without an apparent lesion of oral mucosa. Despite the large number of proposed etiologic factors, genesis of BMS still remains unclear. The aim of this investigation was to establish the oral mucosal sensibility pattern to galvanic stimulation and to investigate its possible alteration in BMS patients. For producing measurable stimuli, dental iontophoretic apparatus was used. Thirty-eight BMS patients, and a control group consisting of 31 sex- and age- matched subjects, were investigated. Sensory thresholds were determined on 15 oral regions. Current intensities that reached the sensory threshold nged from 0.1 mA to 8.5 mA. Results were compared between groups using the T-test. Interregional differences were significant in every tested subject, and the pattern was similar for every participant in both groups. Sensory thresholds were lower in patients with BMS in every tested region, but the statistical significance (p

We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products.

Evaluation of tumor markers in patients with burning mouth syndrome

Mastication is a highly coordinated neuromuscular function that involves fast effective movements of the jaw and continuous modulation of force. The aim of this study was to determine the chewing pattern of masticatory muscles during different chewing tasks. The purpose was also to evaluate the possible effects of prolonged continuous isometric contraction on functional capacity of the masticatory muscles. Twenty-four young adults participated in this study. Surface EMG recordings were obtained from anterior temporal, masseter and digastric muscles. EMG recordings were made during different chewing tasks that included chewing a moderately hard gum and empty chewing as well as during continuous isometric contraction in intercuspal position. The highest values for elevator muscles were found during the gum chewing, and the lowest during empty chewing. Depressor muscles showed maximum activity during gum chewing, while their activity decreased during continuous isometric contraction. During testing period the greatest change in muscles activity was observed after the first minute.

Objectives: Despite the extensive ammount of published literature upon burning symptoms in patients with clinically healthy appearence of the oral mucosa, as well as burning mouth syndrome (BMS) itself, they both remain still challenging topics. The aim of this study was to determine the real prevalence of “ true” BMS in comparison to other patients with burning symptoms with clinically healthy appearance of the oral mucosa and then to compare "true“ BMS patients with healthy controls regarding gastrointestinal disturbances and intake of anxiolytics and ACE inhibitors. Study design: In 150 patients with burning symptoms of clinically healthy oral mucosa, local and systemic investigations were performed and they included detection of candidal infection, salivary flow rate, presence of oral galvanism and parafunctional habits as well as complete blood count, serum ferritin, serum glucose levels, serum antibodies to Helicobacter pylori together with detailed medical history with special regard to medication intake. After "true“ BMS patients were identified they have been compared to the controls with regard to the presence of gastrointestinal disturbances and the intake of anxiolytics and ACE inhibitors. Results: Our results show that gastrointestinal disturbances were significantly more present among "true" BMS patients and that they also significantly more intake anxiolitics, when compared to the control group. Conclusions: Our findings might lead to the conclusion that every "true“ BMS patient should be referred to the gastroenterologist and psychiatrist.

Special petroleum fraction, so called naphthalane , has been traditionally applied in the treatment of a wide range diseases, often related to damaged skin and mucous membranes. Traditional naphthalane is mostly composed of saturated and aromatic compounds. As the bioactive components, the compounds of CPPHP (cyclopentanoperhydrophenatrene), i.e. sterane structure, are considered. Since among aromatics there are carcinogens, a new non-aromatic naphthalane preparation was produced (in Croatian: "Ne-Aromatski Visoko-Steranski", NA VS). It is a rather complex mixture composed of genuine petroleum compounds of different structures, and contains high proportion of steranes. These steranes were studied in great details for the type and quantity. There were paid attention to, since those in NA VS naphthalane have conserved molecular skeleton similarity to their biological precursors, for example as cholesterols in the phospholipid bilayer of eukaryotes. In the living nature there are plenty of steroides that are bioactive compounds, including provitamins D1-D4, sex and cortico-adrenal hormones and bile acids. Some medicaments, as corticosteroids, have the same type of skeleton. Since NA VS naphthalane satisfied the strict requirements oh Ph. Eu. And FDA regarding its non-aromatic character, it was applied in clinical study for treatment of psoriasis vulgaris in 15 patients. Achieved results were very good: significant betterment in 14 patients, 1 patient with status quo and no exacerbation occurred. NA VS Naphthalane was proved neither to be haemato-, nephro-or hepatotoxic. The results encourage further investigation of NA VS naphthalane in order to approve it as a modern non-aromatic healing medium for treatment of skin and mucous membrane.

Background and Purpose: Naphtalane, special petroleum oil cery rich in steranes, has been used for decades for treating patients with dermatological and locomotor diseases. Due to naphtalane`s promising clinical results in treating patients with psoriasis, and due to its structure which is very similar to corticosteroids and vitamin D, the aim of the study was to investigate the antiproliferative properties of three groups of preparations processed from oil from Križ near Ivanić Grad (Croatia). Aromatic compounds present in this oil were removed from the tested preparations, because they could be potentially carcinogenic. Materials and Methods: Squamous cell carcinoma (SCC VII) adherent cell cultures were exposed to three preparations derived from original oil. Single preparations and the combinations of all of them were used in the final concentrations of 10%, 1% and0.1%. Experiments were performed on murine fibroblast L929 cell cultures. Besides in vitro experiments, in vivo effect was studied on CH3 mice, which were injected with suspension of SCC VII cells. The tumor growth dynamics was recorded. Results: In vitro results showed marked dose-dependent cell proliferation inhibition of SCC VII cells, determined by 3H thymidine incorporation. The highest concentrations used, depending on investigated fraction, inhibited 3H thymidine incorporation from 65.5% to 98.3%, compared to the controls. The SCC VII cells were viable after exposition, so the effect is described as inhibitory rather than cytotoxic. However, the same preparations didn`t affect proliferation of L929 cells. In vitro results did not prevent tumor development, but inhibited its growth and delayed tumor nodule forming in the treated group for 14 days compared to controls. Conclusion: Non-aromatic compounds derived from natural oil have remarkable bioactive effects which deserve further attention in order to optimize their possible clinical applicability.

Background and purpose: Pilocarpine, a muscarinic cholinergic agonist, has been shown to improve symptoms of oral dryness and to increase salivary output in patients with xerostomia. The aim of this study was to assess and compare the short-term and long-term effects of orally administered pilocarpine-hydrochloride (PHC) on minor salivary glands and whole saliva production in patients with decreased salivary flow. Materials and methods: Eighteen patients with xerostomia (12 with drug-induced xerostomia, 6 with diagnosed Sjögren’ s syndrome) were included in two consecutive single blind placebo controlled experiments. Experiment 1 comprised 7 repeated labial and palatal minor salivary glands flow measurements (in time intervals of 15-30 min.) and 5 repeated measurements of whole saliva (every 30 min.), from the baseline up to 2 h after single oral administration of 5 mg of PHC. Experiment 2 was designed to evaluate a possible presence of long-term effect of PHC on salivary flow rate. In this experiment, patients were instructed to take 5 mg of PHC, 3 times a day for 5 weeks. Minor salivary gland measurements were performed on weekly basis and whole saliva was measured on the baseline and at the end of 5-weeks treatment. In both experiments the flow rate of minor salivary glands was measured on lower lip and palate by means of Periotron™ 8000 and whole saliva was collected in calibrated test tubes. Dexpanthenol drops were used as placebo. Results: Experiment 1 showed that PHC increased salivary output in every patient. The differences were statistically significant, both compared to baseline and to placebo controls (p

We report a case of propolis allergy in an 18- year-old female patient. Medical history revealed self-prescribed topical use of propolis spray as a medication for gingival swelling caused by orthodontic molar bands. After 24 hours, the patient developed lip edema and erythema of the perioral skin accompanied by burning pain in her lips. Discrete erosions were present in the corners of her lips. Erythema of the right infraorbital region was also observed. The patient was prescribed betamethasone propionate cream two times daily. Complete recovery was observed after 10 days. Propolis allergy was confirmed by a patch test. We believe that the use of propolis for the treatment of oral diseases should be avoided due to sparse evidence of its efficacy and numerous cases of allergic reactions.

The aim of present study was to evaluate the symmetry of masticatory muscles' activity at various clenching levels in the intercuspal position in patients with functional disorders and in healthy subjects. The purpose was also to determine the effect of full-arch maxillary stabilization splint on the asymmetry of masticatory muscle activity in patients with temporomandibular dysfunction. In this study 6 TMD patients and 12 healthy subjects were investigated. Surface EMG recordings were obtained from left and right anterior temporal, left and right masseter and from the sub-mandibular group in the region of the anterior belly of the digastric muscle on the left and right side during clenching with the maximum 100% voluntary contraction (MVC) as well as during clenching at 50% and 25% of the maximum activity in the position of maximal intercuspation of teeth. In order to quantify asymmetrical masticatory muscle activity, the asymmetry index (AI) was calculated for each subject and for each muscle from the average anterior temporal, masseter and digastric potentials recorded during each test (100% MVC, 50% MVC and 25% MVC). In the group of patients EMG recordings were repeated during and after the splint therapy. The asymmetries of masticatory muscle activity was present in both groups, but in the group of TMD patients the asymmetry indices for anterior temporal muscle at 100% MVC (p = 0.049) and 50% MVC (p = 0.031) were significantly higher. Results have shown that the use of splint suppressed the asymmetry of all muscles, as during the splint therapy the asymmetry indices were lowered. After the therapy, the level of temporal muscle symmetry during submaximal clenching in the intercuspal position increased significantly (p = 0.046). This investigation points out that electromyography may be a valuable method of documenting that asymmetric activity of masticatory muscles improves after occlusal splint therapy in patients with TMD.

Objective A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. Study Design The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. Results Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. Conclusions The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

The purpose of this study is to determine the success in eliminating clinical symptoms in patients with disc displacement of temporomandibular joint (TMJ) after Michigan splint (MS) treatment. 40 patients with a form of DD in at least one TMJ were included in this study. The diagnoses were given on the basis of clinical examinations and with magnetic resonance imaging of TMJ. The most frequent symptoms felt by the patients were pain (97.7% joints) and clicking (93% joints) in TMJ. Only two patients showed symptoms of burning mouth syndrome. There is no significant difference between patients classified by sex or the form of DD (with or without reduction) depending on lower or higher evaluation of pain by AVS and no significant statistical frequency of pain is shown as to the subjectively greater intensity of pain before treatment (p>0, 05). Applying MS eliminated pain at 42.4% TMJs, at 35.6% TMJs pain was eliminated with joint sound still present, and pain was still present at 22% TMJs. MS is the most frequent reversible and unspecific form used in successful reduction of temporomandibular joint pain. Relevance: Temporomandibular pain constitutes the most common cause of musculoskeletal pain in the orofacial region. Initial symptomatic treatment by MS is suggested, but there is actually no treatment that represents the gold standard of chronic TMJ pain conditions.