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The study aimed to present the characteristics of the three most prevalent oral potentially malignant disorders, leukoplakia, oral lichen planus (OLP), and actinic cheilitis, using data from 62 patients collected at the “Sfântul Spiridon” Emergency Clinical Hospital in Iași, Romania, between January 2015 and January 2023. The results revealed a higher prevalence of these lesions among older adults, particularly those over 50 years old, and a significant gender disparity in the incidence of actinic cheilitis, which was more common in males (68%). Leukoplakia was frequently observed on the tongue and lower lip, whereas OLP commonly affected the buccal mucosa. Actinic cheilitis was primarily noted on the lower lip, attributed to chronic sun exposure. The study highlighted the importance of early detection and regular monitoring of these conditions to prevent malignant transformation.

Oral lichen planus (OLP) is a chronic inflammatory condition that poses significant therapeutic challenges. Emerging evidence suggests that topical Janus Kinase (JAK) inhibitors could represent a novel treatment paradigm for OLP. This review explores the pathophysiology of OLP, highlighting the role of the JAK-STAT pathway in its pathogenesis. We discuss the current landscape of topical JAK inhibitors, including their mechanism of action, efficacy, and safety profile. The review also examines recent clinical trials and observational studies that shed light on the potential of these agents in managing OLP. Finally, we provide a perspective on the future of JAK inhibitors in the context of OLP treatment, considering both their therapeutic potential and the need for further research.

This narrative review highlights the emerging role of salivary markers in the detection of oral cancer. Saliva contains diverse biomolecules that can provide valuable information on physiological and pathological processes in the body, including specific biomarkers that indicate the presence and progression of oral squamous cell carcinoma (OSCC). Salivary markers have the potential to transform the diagnosis and management of malignant oral lesions by offering a non-invasive approach to screening and monitoring the disease. This review examines the current state of knowledge regarding salivary markers in oral cancer, including their advantages over traditional biopsy-based techniques, limitations, and the need for further research. It concludes by outlining the future prospects of salivary biomarkers in oral cancer detection and management.

In general terms, neoplastic conditions are characterized by increasing in cell proliferation and decreasing in cell apoptosis. The multiplication of atypical neoplastic cells, through their invasive capacity, leads to the infiltration of tissues or organs through the bloodstream or the lymphatic system. In this context, chemotherapy remains one of the most used treatment modalities, contrary to the progress made in recent years regarding the management of cancer in the Oro-Maxillo-Facial (OMF) sphere. This is applied either alone or associated with other therapeutic methods to block abnormal cell proliferation. The great inconvenience of chemotherapy is the lack of selectivity because it acts both on tumor cells and normal cells in the body. The oral cavity is very vulnerable to the direct and indirect toxic effects of chemotherapy. This fact is primarily due to local peculiarities that include: a high rate of mucosal cell turnover, the presence of a complex and diverse microflora in the oral cavity as well as the small traumatic injuries present as a result of the exercise of normal oral functions (mastication, swallowing, phonation).

Menopause is a non-pathological change which involve the permanent cessation of menstruation for at least 12 months and occurs in women with an average age of 51 years in the context of non-pathological estrogen deficiency. The effects of menopause are closely related to the lack of ovarian hormones, a fact that induces a physical and emotional instability of the woman with a direct impact on the health of the oral cavity. This paper reviews the changes in the oral mucosa in the peri- and post-menopause phases. The most frequently reported changes are: dryness of the oral cavity, sensation of decreased amount of saliva, burning sensation, dysgeusia, altered tolerance to pain and the possibility of neurological manifestations. The dentist and general practitioner must recognize the variety of signs and symptoms that occur in the context of this physiological stage and, at the same time, must focus on the symptomatic management of oral health changes.

The early detection and accurate diagnosis of potentially malignant oral lesions, such as actinic cheilitis, leukoplakia, and oral lichen planus, are crucial for improving patient outcomes. Dermatoscopy, a non-invasive diagnostic technique, offers enhanced visualisation of these lesions, enabling precise assessment of morphological features critical for early recognition and differential diagnosis. This article aims to present dermatoscopic findings from cases of these common conditions, highlighting their importance in refining clinical management. Dermatoscopy not only improves diagnostic accuracy by revealing detailed lesion characteristics but also assists in evaluating malignancy risk, monitoring progression, and guiding the decision-making process for biopsy and treatment. While biopsy remains definitive for diagnosis, dermatoscopy serves as a valuable preliminary tool. Future research should focus on establishing standardised dermatoscopic criteria for oral lesions and integrating dermatoscopy into regular oral health evaluations to advance patient care.

Geographic Tongue (GT), also known as benign migratory glossitis, is a benign inflammatory condition characterised by irregular, smooth, red patches on the tongue surface, often with a white or light-coloured border. Despite being a common oral condition, its pathophysiology remains poorly understood. This review aims to shed light on the latest insights into the pathophysiology of GT, exploring its etiological factors, immunological aspects, and potential genetic predispositions. We discuss the role of environmental factors, such as stress and dietary habits, and delve into the immunopathological mechanisms that may contribute to the manifestation of GT. The review also examines the possible genetic and epigenetic factors involved in GT and their interaction with environmental triggers. Recent advancements in molecular biology and genetics offer new perspectives in understanding the complex nature of GT, paving the way for improved diagnostic and therapeutic approaches. This review concludes with a discussion on the potential future directions in GT research, focusing on the need for larger epidemiological studies and the exploration of novel therapeutic targets.

Recurrent Aphthous Stomatitis (RAS) is a prevalent oral mucosal disorder characterized by recurring painful ulcers. The pathogenesis of RAS remains incompletely understood, but emerging evidence suggests a significant link between gut microbiota and the development of RAS. This review aims to explore the existing literature on the interplay between gut microbiota and RAS, focusing on how intestinal dysbiosis may influence the onset and severity of RAS. We discuss the role of gut microbiota in immune modulation, the breakdown of oral tolerance, and the possible pathways through which gut bacteria can affect oral health. Additionally, we examine the impact of diet, antibiotics, and probiotics on the gut microbiota and, subsequently, on RAS. The review concludes with potential therapeutic strategies targeting gut microbiota to manage and prevent RAS, paving the way for novel interventions in this field.

Immunodeficiencies induced by chemotherapy make cancer patients vulnerable to to reactivation of latent viruses and to primary viral infections caused by exposure to environmental factors, such as air, water, microbial flora and debris. Patients with hematological cancers are more prone than patients with solid tumors to develop viral infections that affect the oral cavity due to high-dose chemotherapy regimens and prolonged immunosuppression. Viruses of the Herpetoviridae family (herpes simplex, varicella, cytomegalovirus, Epstein-Barr) and human papillomavirus cause mouth pain with difficulties in eating and oral ulcerations that can spread, leading to life-threatening systemic infection. Therapeutic approaches for the more severe and atypical oral manifestations seen in cancer immunosuppressed patients include inhibitors of virus replication, antivirals, surgical excision and analgesics, but the painful oral lesions are associated with longer healing times. The differential diagnosis of a oral ulcers in cancer patients is broad, but it should include various viral infections.

Angular Cheilitis (AC) represents a multifaceted oral pathology characterized by erythematous lesions at the labial commissures. Despite its prevalence, AC is often inadequately addressed due to its polymorphic etiology, which can encompass infectious agents, nutritional deficits, and systemic conditions. This article provides a systematic review of the pathophysiology, clinical presentation, and etiological factors of AC, including nutritional deficiencies, infectious agents, and systemic diseases. Emphasizing a multidisciplinary strategy, we discuss the collaborative roles of dental, medical, and dermatological expertise in the accurate diagnosis and effective management of AC. We outline diagnostic criteria, appropriate laboratory tests, and imaging techniques tailored to address the multifaceted nature of the condition. Management strategies encompass a range of options from topical treatments and medications to dietary modifications and preventative measures, with an emphasis on evidence-based practices. This review advocates for integrated care models to optimize treatment efficacy, patient compliance, and to mitigate the recurrence of AC. Our analysis aims to enhance the understanding of AC and to provide a framework for its management, contributing to better patient care and opening avenues for future research.

Corticosteroids, including glucocorticoids, mineralocorticoids, and androgenic hormones, are hormonal mediators produced by the adrenal glands and are widely used in the treatment of various conditions, including dental diseases. While systemic corticosteroid therapy offers significant therapeutic benefits, it is crucial to understand the potential adverse effects on oral health. This paper aims to highlight the impact of systemic corticosteroid therapy on oral health, focusing particularly on the associated complications and management strategies. The paper emphasizes specific complications that may occur in the oral cavity as a result of corticosteroid use, the most important being an increased susceptibility to oral infections such as candidiasis and impaired bone metabolism, with a significant reduction in the mineral density of the mandibular bone (BMD), as well as delayed wound healing, the occurrence of oral ulcers, and changes in the oral microbiome. Furthermore, the importance of rigorous oral care and regular dental monitoring for patients undergoing systemic corticosteroid therapy is underlined. The role of oral health specialists in the early detection and efficient management of oral complications, as well as patient education regarding proper oral hygiene practices and possible side effects, is of crucial importance. In conclusion, it is essential for healthcare providers to be vigilant regarding the potential oral health complications associated with systemic corticosteroid therapy, and early detection, prevention, and the implementation of appropriate management strategies are fundamental for optimizing oral health outcomes in patients undergoing corticosteroid treatment.

Aim of the study. Dental anxiety has an important role in the development of the periodontal disease. The aim of the current study is to investigate the relationship between dental anxiety and periodontal disease. Material and methods: Data was collected between 2022 and 2023 using a self-reporting questionnaire created with the Google Forms platform. Results: High dental anxiety is correlated both with poor periodontal health (p=2.11E-86) and with strong psychosocial impact that dental aesthetics has on the quality of life (p=4.46E-56). These directly influence the frequency of visits to the dentist (P values: 4.89E-07, 9.53E-17 and 5.29E-07), as well as the time elapsed since the last professional dental hygienization (P values: 0.0008, 1.57E-17 and 5.62E-10). These three are also interconnected with general health (P values: 0.015, 3.73E-09 and 1.95E-05) and stress (P values: 5.09E-10, 1.64E-08 and 9.87E-07). In addition, BMI shows a direct relationship with dental anxiety (p=0.020), as well as with periodontal health, along with the quality of eating habits (p=0.017 and p=0.001). Conclusion: the results indicated that the severity of the periodontal disease is a result of dental anxiety, and vice versa. Therapy should be personalized for each individual following a comprehensive evaluation and should be based on the experience and expertise of the dentist, the intellectual capacity of the patient, age, cooperation, and clinical situation of the patient.

Childhood viral and bacterial infections may cause oral symptoms that might help early diagnosis and treatment and support the prevention efforts of pediatricians and parents. Oral lesions can clinically mimic malignancy and genetic disorders. The inflammatory changes of oral mucosa during childhood infectious diseases pose some challenges during differential diagnosis, due to the wide range of etiologies. Global migration and gaps in vaccination coverage have allowed viral infections to expand and reemerge. This review highlights the clinical features and treatment recommendations of childhood infections that can be encountered in dental practice, with a short description of the underlying systemic illness. Thorough patient history and physical examination are essential for determining the infectious agent that affects oral cavity. Treatment strategies customized for the pediatric age group are guiding the management of oral and perioral lesions from infancy through adolescence. The clinical features, diagnosis criteria, and treatment algorithms of the most common pediatric infectious diseases are summarized based on their prevalence. Dentists can play an important role in early identification of various childhood infections through soft tissue lesion investigation. Due to the numerous oral complications, vaccination awareness is another important task assigned to dentists

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Squamous cell carcinoma is the most common epithelial neoplasm of the head and neck, and it is estimated to represent over 90% of oral neoplasms. Despite therapeutic advances, morbidity and mortality from oral squamous cell carcinoma have not improved significantly in the last 30 years, mainly due to the detection of cases in advanced stages. While tobacco and alcohol use are major risk factors for oral cancer, other known causes are: genetic mutations, dietary deficiencies, prolonged exposure to UV radiation, immunosuppressive conditions, oral or systemic infections. Poor oral hygiene, gingival or periodontal chronic inflammatory conditions, as well as chronic oral erosive lesions favor the appearance of oral infections. Bacterial colonization and adjacent pro-inflammatory status induce the initiation and progression of oncogenic processes by stimulating cell proliferation, angiogenesis, and mutagenic processes. Studies investigating the salivary microbiome, performed on people with precancerous or neoplastic lesions, have shown a decrease in microbial diversity and abundance, especially of the species Firmicutes and Actinobacteria together with the increase in the representation of Lactobacillus. Two theories are formulated to clarify the relationship between the salivary microbiome and oral squamous cell carcinoma. The first discusses bacterial colonization as a direct pathogenic cause of carcinoma, the second describes microbiome abnormalities after tumor onset. In both concepts, metagenomic and transcriptomic changes occur in the salivary microbiome and influence oral cellularity and the immune response. In addition, a combination of both theories is very likely to occur during the progression of oral carcinoma. The analysis of the salivary microbiome as a biomarker for the detection of potentially malignant oral lesions and early oral carcinoma is an innovative and non-invasive method that offers promising prospects. To standardize it, there are numerous molecular and genomic biology studies in progress, extensive studies, including new therapeutic approaches to oral carcinoma by correcting salivary microbiome dysfunctions.

Desquamative gingivitis (DG) is a clinical term that describes erythema, desquamation and erosions of the gingiva, of various etiologies. Although the clinical aspect is not specific for a certain disease, an accurate diagnosis of the underlying disorder is necessary because the disease course, prognosis and treatment vary according to the cause. DG may inflict significant oral discomfort, which is why patients typically present to the dentist for a first consultation, rendering it important for these specialists to be informed about this condition. Our paper aims to review the ethiopatogenesis and diagnostic approach of DG, focusing on the most common underlying disorders (autoimmune bullous dermatoses and lichen planus) and on the management of these patients. Potential etiological agents leading to an inflammatory immune response in the oral mucosa and DG appearance include genetic predisposition, metabolic, neuropsychiatric, infectious factors, medication, dental materials, graft-versus-host reaction and autoimmunity. A thorough anamnesis, a careful clinical examination, paraclinical explorations including histopathological exam and direct immunofluorescence are necessary to formulate an appropriate diagnosis. Proper and prompt management of these patients lead to a better prognosis and improved quality of life, and must include management in the dental office with sanitizing the oral cavity, instructing the patient for rigorous oral hygiene, periodic follow-up for bacterial plaque detection and removal, as well as topical and systemic therapy depending on the underlying disorder, based on treatment algorithms. A multidisciplinary approach for the diagnosis and follow-up of DG in the context of pemphigus vulgaris, bullous pemphigoid, cicatricial pemhigoid or lichen planus is necessary, including consultations with dermatologists, oral medicine specialists and dentists.

Hypersensitivity reactions affecting the oral mucosa present a significant clinical challenge due to their diverse manifestations and the wide range of potential allergens involved. This article explores the types of allergic reactions commonly observed in the oral cavity, including contact allergies and systemic allergic reactions, emphasising their clinical presentations and diagnostic approaches. Common allergens such as metals and resin-based dental materials are highlighted, discussing their impact on oral health. Diagnostic strategies, including clinical examination, history taking, cutaneous patch testing and histopathological evaluation, are assessed for their efficacy in establishing the diagnosis of an allergic reaction and in identifying specific allergens. Management and treatment options are also reviewed, focusing on allergen avoidance, pharmacological interventions, and the selection of hypoallergenic dental materials. This article underscores the importance of a multidisciplinary approach in improving diagnostic accuracy and therapeutic outcomes for patients with oral mucosal allergies.

Autoimmune diseases (AIDs) emerge due to an irregular immune response towards self- and non-self-antigens. Inflammation commonly accompanies these conditions, with inflammatory factors and inflammasomes playing pivotal roles in their progression. Key concepts in molecular biology, inflammation, and molecular mimicry are crucial to understanding AID development. Exposure to foreign antigens can cause inflammation, potentially leading to AIDs through molecular mimicry triggered by cross-reactive epitopes. Molecular mimicry emerges as a key mechanism by which infectious or chemical agents trigger autoimmunity. In certain susceptible individuals, autoreactive T or B cells may be activated by a foreign antigen due to resemblances between foreign and self-peptides. Chronic inflammation, typically driven by abnormal immune responses, is strongly associated with AID pathogenesis. Inflammasomes, which are vital cytosolic multiprotein complexes assembled in response to infections and stress, are crucial to activating inflammatory processes in macrophages. Chronic inflammation, characterized by prolonged tissue injury and repair cycles, can significantly damage tissues, thereby increasing the risk of AIDs. Inhibiting inflammasomes, particularly in autoinflammatory disorders, has garnered significant interest, with pharmaceutical advancements targeting cytokines and inflammasomes showing promise in AID management.

Canine impactions are frequently encountered in the pediatric population. Impacted canines may pose a functional and esthetic problem for patients and can affect the neighboring teeth (incisors and premolars). Early detection and management of such pathology may help the pediatric dentist and orthodontist to prevent many unwanted local and regional complications. Various surgical and orthodontic techniques may be used to recover impacted maxillary canines. The decision to surgically correct these impacted teeth is usually made by the orthodontist. The treatment of impacted teeth requires a multidisciplinary team comprising orthodontist, pediatric dentist, dento-alveolar surgeon, and sometimes a periodontist.

The medical and dental fields are experiencing a significant shift in approach thanks to the integration of artificial intelligence (AI). With a vast influx of patient data, there is a pressing need for sophisticated software capable of organizing and preserving this information effectively. The emergence of AI-driven models and computer vision techniques for identifying patterns in clinical and histopathological images related to oral pathology lesions holds promise for enhancing diagnostic accuracy and prognostic predictions. While microscopic morphology remains the gold standard in diagnostic pathology, its reliance on individual pathologists introduces variability. Consequently, AI presents a potential solution for achieving consistent and more precise diagnoses. Moreover, by analyzing extensive data from the patients’ medical chart the artificial neural network could provide a presumptive diagnosis and an invaluable screening tool in predicting individual risk for oral pathology based on information regarding their risk factors, systemic diseases and conditions and clinical pathological data. Within oral and maxillofacial pathology, AI stands poised to elevate diagnostic accuracy, tailor treatment, and ultimately enhance patient outcomes. Nevertheless, the integration of AI in healthcare demands meticulous attention to ethical, legal, and regulatory complexities. Moreover, given the nascent nature of AI technology, prudence is paramount when deploying it in this specialized domain.

Periodontitis patients are known to have increased circulating lipopolysaccharide activity and metabolic disturbances, which may be either the cause or effect of endotoxemia. This review approaches endotoxemia as a possible molecular mediator between periodontitis and increased risk of cardiometabolic disorders. Observations that bacteria disseminate into circulation after toothbrushing and periodontal procedures and assumptions that endotoxin may disseminate through inflamed periodontium and bleeding gums support the idea of endotoxemia in periodontitis. However, the evidence that periodontitis-associated dysbiosis contributes to endotoxemia is not as strong as in the case of gut microbiome dysbiosis. Although the causality is insufficiently demonstrated thus far, many studies have associated changes of the gut microbiome composition, function, and specific bacterial metabolites with cardiometabolic diseases, whereas research on the oral microbiome has severely fallen behind.