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The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.A class IIb medical preparation, packaged in appropriate syringes, was tested. Patients were instructed how to use the gel for 10 days: finger rub application (3 times daily) on the dried lesion after meals, without eating, drinking, or speaking for at least 30 min thereafter. The Wilcoxon signed-rank test was used to assess whether there were any differences in the distributions of reported pain and lesion dimension. A microbiological examination was also performed with oral swabs; chi-squared test was used to compare the difference in the presence of microorganisms before and after treatment.Thirty patients were treated. A significant improvement in reported outcome and a significant reduction in the initially measured largest dimension of the lesion were observed after use of the clinical protocol. Additionally, a significant reduction in the pathogen count was found.Even if with limitations, data showed that this medical preparation facilitated prompt recovery from reported pain, without adverse reactions. Further work with a larger study population, and possibly a randomized control medication, will be needed.

Background Italy was the first western country severely affected by the Covid-19 pandemic attesting more than 16 million cases since the outbreak began. Po Valley regions have been most afflicted, with Piedmont ranking sixth at 25,899 cases/100,000 inhabitants. Within this area, air dispersion is hampered making Po Valley a recognised air pollution hotspot. We aimed to explore the potential association between the environment and Covid-19 incidence. Methods Daily key air pollutants (NO2, NO, CO, O3, PM10, and PM2.5), meteorological parameters (temperature, %humidity, wind speed and solar radiation), pollens and Covid-19 cases were collected from 01/01 to 31/12/2021 in Turin, Italy. This ecological study preliminarily tested correlations (Spearman) between air pollutants and Covid-19 cases. Results The Covid-19 pandemic followed a seasonal trend with the highest number of cases (/100,000 inhabitants) in winter and spring (3.1) followed by autumn (1.3) and summer (0.5) (KW test p < 0.0001). Likewise, all air pollutants showed peaks in winter and autumn and sensibly decreased during spring and summer apart from pollens and O3. O3 follows the photochemical processes reaching its peak in the sunniest periods, while pollens undergo their natural vegetative process. Daily Covid-19 cases were positively correlated with daily-averaged NO2 (0.50, p < 0.0001), NO (0.48, p < 0.0001), CO (0.81, p < 0.0001), PM10 (0.36, p < 0.0001), PM2.5 (0.39, p < 0.0001), pollens (0.15, p = 0.073) and inversely with O3 (-0.44, p < 0.0001). We plan future analyses to test the hypothesized association by enhanced models with lagged air pollution variables, with demographic characteristics and meteorological data as potential confounders. Conclusions Results from ecological studies may support researchers’ preliminary understanding of the interplay between environment and Public Health issues, including pandemics. A multidisciplinary approach is mandatory to deepen the complexity of this topic across European regions Key messages • The Covid-19 pandemic may be associated with environmental conditions and air pollution but further research is needed. • Atmospheric particulate matter, including aeroallergens, can favour many airborne-related diseases by acting as immune suppressor and/or carrier, but these hypotheses deserve future research.

Oral lichen planus (OLP) is a chronic immune disease. In this paper, we evaluated the overall characters, clinical presentation, and outcome of gingival lesions in OLP Italian patients.A retrospective cohort study was accomplished: a total of 1319 charts were investigated, of whom 922 were female (69.9%): 617 patients (46.8%) manifested white lesions and 702 red ones (53.2%). While most patients had several oral sites of involvement, the gingiva was the unique location in 103 cases. Symptoms were reported in 480 patients (36.4%): 286 patients with erosive OLP, 103 with atrophic form, and 91 with a white form. Long-lasting surveillance showed that only 40 patients (3.03%) had a total clinical signs remission. Regarding OLP medical treatment provided, patients attending less frequently a dental office underwent more often a specific therapy.To the best of our knowledge, this is the biggest collections of patients with gingival OLP ever described; exclusive gingival lesions are, however, rare and unlikely to undergo a malignant transformation. Moreover, gum lesions seemed to anticipate the appearance of oral lesions and a higher rate of OLP therapy was observed in patients with less frequent dental check-ups and oral hygiene instructions.

A systematic review was carried out to identify if periprocedural administration of systemic antibiotics could decrease risk of medication-related osteonecrosis of the jaws (MRONJ) in patients under antiresorptive and/or biologic agents for teeth extraction. PubMed/MEDLINE and Scopus were systematically searched for case-series with more than 10 patients, retrospective/prospective studies, and trials concerning this issue. Manual searching of references from previous reviews was also carried out. Of 1,512 results, 17 studies were included, focusing on antibiotics for extraction in patients under intravenous bisphosphonates (8 studies), oral bisphosphonates (2 studies), oral and intravenous bisphosphonates (6 studies), and denosumab (1 study), of which 12 performed dental extraction with surgical flap. With no trials found, "quality in prognosis studies" (QUIPS) tool was used to evaluate risk of bias. First-line treatment was 2-3 grams of oral amoxicillin in 76.4% of studies; 300-600 mg of clindamycin was the alternative treatment in 23.5% of studies. Treatment ranged from 3 to 20 days, consisting of 6-7 days in 47% of studies. No microbiologic insight was provided. A significantly higher risk of MRONJ for patients unexposed to antibiotics was provided in one retrospective study. QUIPS tool revealed moderate-high risk of bias. With empirical data from bias-carrying, heterogeneous observational studies, the validity of antibiotics is yet to be established.

Background In oral medicine, colchicine is a therapeutic alternative for idiopathic recurrent aphthous stomatitis (RAS), Behcet disease (BD), periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome, and mouth and genitals ulcers with inflamed cartilage (MAGIC) syndrome. The present review aims to evaluate reliability of colchicine against recurrent oral ulcers. Methods A systematic review was conducted, with the following PICO (Patient, Intervention, Control, Outcome) question: "In populations with idiopathic or secondary recurrent oral ulcers, is colchicine more effective in improving pain and accelerating healing, compared to other intervention or placebo?" Results Seven RCTs and 3 OCTs were considered eligible. Four RCTs focused on BD, two RCTs and three OCTs on RAS, and one RCT on PFAPA syndrome. Heterogeneity between RCTs prevented from meta-analysis. Regarding BD, no significant difference between colchicine and placebo was found in two of three placebo-controlled RCTs, whereas the third RCT showed benefit. A comparative RCT found ciclosporin more effective than colchicine for oral lesions of BD. One open-label RCT showed promising but partial results on colchicine in reducing PFAPA attacks, when compared to corticosteroids. Concerning RAS, colchicine appeared less effective than clofazimine, thalidomide and dapsone, and with outcomes similar to low-dosage corticosteroids but higher gastric discomfort than prednisolone. One OCT reported positive results compared with no treatment but a RCT found no difference with placebo. Conclusion Role of colchicine as treatment for idiopathic or secondary recurrent oral ulcers is still controversial. Further standardized RCTs and crossover trials are needed.

To describe oral cavity changes in patients who underwent a hematopoietic stem cell transplantation (HSCT).A group of 32 patients was studied after a mean period of 48.8 months (±11.22) from HSCT; oral, dental, and periodontal status were collected and compared with those of healthy matched controls. Unstimulated whole salivary flow (UWS) and salivary pH were also measured. A validated questionnaire (EORTC QLQHN-35) was used for reported quality of life. Fifty-nine percent of patients were affected by chronic graft-versus-host disease (cGVHD). Dental health and periodontal status were statistically worse than in controls (P = .003 and P = .008, respectively). Regarding the HSCT group, UWS was statistically lower, and EORTC QLQHN-35 significantly higher than those reported in controls (P = .000 for both). There was no statistical correlation between hypo-salivation and conditioning, presence of cGVHD, type of medication used before and after transplantation, and time of follow-up. A reduction in salivary pH has been noted only for patients with erosive oral lesions.The oral cavity of HSCT patients appeared to undergo substantial modifications and the quality of life was deeply compromised.

This meta-analysis of observational studies (PROSPERO registration number CRD42021236054) sought to investigate strength and generalizability of the association of herpes simplex virus type 1 (HSV-1) in subjects with plaque-induced gingivitis and periodontitis, since the data from literature are contrasting.Case-control and cross-sectional studies, investigating HSV-1 in subgingival plaque/crevicular fluid and periodontal status, were searched through MEDLINE via PubMed, Scopus, Web of Science and Google Scholar. From each study the crude odds ratio (OR) with 95% confidence interval (95CI) was extracted, and the pooled OR was assessed for periodontitis, chronic and aggressive, and gingivitis. The meta-analytic method was chosen based on the level of heterogeneity. The generalizability of results, determined by the meta-analysis bias, was investigated through secondary analyses including sensitivity analyses for study quality, publication bias, and study inclusion, and subgroup analyses for quality of scientific journals that published the primary studies, world Region, subgingival plaque sampling method and study design.Twelve studies were included (738 cases, 551 controls). The pooled ORs were 4.4 (95CI, 1.9-10.2) for any periodontitis; specifically, 2.8 (95CI, 1.0-8.3) for chronic periodontitis, 11.8 (95CI, 5.4-25.8) for aggressive periodontitis and 4.8 (95CI, 2.1-11.0) for gingivitis. These estimates were statistically significant, excluding for chronic periodontitis, resulting marginally significant (p = .05). Secondary analyses on any and aggressive periodontitis, and, partly, chronic periodontitis corroborated the results, while the material was insufficient for secondary analyses on gingivitis.The results obtained indicated that HSV-1 is associated with periodontitis, while data about gingivitis are inconclusive. HSV-1 investigation in subgingival plaque could help assess periodontitis risk and severity and, if causal association were confirmed, could contribute to its control.

Ulcers in the oral mucosa is a relatively common, although challenging, entity in oral medicine, as it can arise due to a wide range of traumatic, infective, autoimmune, and neoplastic disorders. Although histopathology of lesional and peri‑lesional tissues remains the gold standard for persistent oral breaching, optical coherence tomography (OCT) has been recently suggested as a potential ally to enhance the early or non-invasive diagnosis of likely causation. The aim of the present study was to provide an in-vivo OCT analysis and description from a sample of 70 patients affected by traumatic or neoplastic-related ulcers, located on the buccal mucosa, tongue or gingiva, and compare the OCT data with those of 20 patients with healthy oral mucosa. OCT dynamic scans revealed clear distinction of epithelial layer (EP), lamina propria (LP) of healthy buccal mucosa, gingiva, and tongue as well as allowing observation of the keratin layer in gingiva, and the subepithelial vascularization of each site. Traumatic lesions had an EP of reduced in thickness, with an irregular, if not disrupted surface. Interestingly, LP seemed to preserve its reflectiveness and vascularization only in the traumatic lesions. Among neoplastic lesions, regardless their site of onset, both EP integrity/homogeneity, and LP reflectiveness/vascularization were lost and unrecognizable when compared to their healthy counterparts. OCT scanning allowed some differentiation between traumatic and malignant ulcers and thus may a useful and non-invasive means of determining the need and/or urgency of histopathological examination of oral lesions.

Aims To assess the efficacy of nonpharmacologic treatments for burning mouth syndrome (BMS). Methods PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were systematically searched. Reference lists from the latest systematic reviews (2015 to 2020) on BMS treatment in the PubMed, Scopus, Web of Science, and Cochrane Library databases were also scrutinized. Randomized controlled trials (RCTs) or clinical controlled trials (CCTs) in English were considered eligible. Trials on photobiomodulation were excluded to avoid redundancy with recent publications. Risk of bias was established through the Cochrane Risk of Bias tool for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool for CCTs. Results This review included 27 RCTs and 6 open clinical trials (OCTs) describing 14 different nonpharmacologic interventions. Eleven trials experimented with 600 to 800 mg/day of alpha-lipoic acid for 30 to 120 days, with 7 placebo-controlled studies showing significant pain relief. Four trials tested topical and systemic capsaicin for 7 to 30 days, with 2 placebo-controlled studies revealing significant efficacy. Four of the 5 trials testing acupuncture offered favorable evidence of pain relief. Two trials reported significant pain relief after a 2- to 3-month regimen with tongue protectors and showed no difference after aloe vera addition. Short-term pain relief was reported in anecdotal placebo-controlled trials deploying tocopherol, catuama, ultramicronized palmitoylethanolamide, group psychotherapy, cognitive therapy, and repetitive transcranial magnetic stimulation of the prefrontal cortex. Most therapies were safe. Conclusion Evidence was collected from highly biased, short-term, heterogenous studies mainly focused on BMS-related pain, with scarce data on quality of life, psychologic status, dysgeusia, and xerostomia. Long-term effectiveness of nonpharmacologic treatments should be further investigated, with a more rigorous, bias-proof study design.

Oral biopsy is a common surgical practice. To date, few authors have described the healing of mucosal wounds following oral biopsy. The aim of the present single-center, prospective, randomized, controlled study is to evaluate the differences between two chlorhexidine (CHX) mouthrinses and a treatment-free approach in the immediate postoperative period following oral mucosal biopsy. 354 patients were included in this study and were randomly allocated to three groups: A) CHX 0.12% mouthrinse (twice daily, 10 mL rinse for 30 s), B) CHX 0.20% mouthrinse (twice daily, 10 mL rinse for 30 s), and C) no topical treatment. 118 patients were treated in group A and 115 in group B; 121 received no therapy in group C, reporting the greatest improvement in related symptoms. Outcome variables included the age, gender, site and size of lesions, visual analog score (VAS), Oral Health Impact Profile questionnaire (OHIP-14), and number of painkillers taken during the first week post-surgery. Use of a CHX 0.12% mouthrinse exhibited the poorest outcome. On the other hand, best clinical healing was found for patients treated with CHX 0.20%. These findings suggest that regardless of its concentration, CHX was found to be ineffective in reducing related symptoms, whereas CHX 0.20% can be recommended to facilitate enhanced healing.

Angular cheilitis (AC) is a clinical entity first described in the XIX century, characterized by erythema, rhagades, ulcerations, and crusting of one or both lip commissures and perilabial skin, responsible of an unpleasant and painful discomfort. Aim of this manuscript was to examine and evaluate the therapeutic options actually available for AC. Despite antifungals being the first-line treatment for most of clinicians, very limited scientific evidence supports their reliability, with just two RCTs published between the 70's and the 80's. Furthermore, alternative topical treatments, various techniques of occlusal vertical dimension restoration, B-vitamin supplementation, anti-drooling prosthetic device, and photodynamic therapy have been experimented and proposed, mostly in the form of case reports or case series on a small number of individuals. Our group found in 1% isoconazole nitrate (ISN) and 0.1% diflucortolone valerate (DFV) ointment the most consistent AC treatment, due to the broad spectrum of ISN against many species of dermatohpytes and bacteria, and the anti-inflammatory properties displayed by DFV. However, further and well-designed trials on larger samples of patients are needed to assess the differential profile of consistency of the treatments outlined in literature and claimed by the authors of this paper.

Osteonecrosis of the Jaws (ONJ) related to bisphosphonates (BPs) or denosumab is a concern for osteoporosis and Rheumatoid Arthritis (RA) patients. In a context of increasing prescription rate of BPs and denosumab amid those patients in the last decade, incidence and/or prevalence of ONJ in these categories of patients remain uncertain, with lack of solid epidemiologic data from observational studies. As an almost unique experience, the present work provides a multicenter, retrospective overview of ONJ in non malignant disease patients over a timespan of 15 years (Jan 1st 2004 - Dec 31st, 2018) from the oral care centers of Piedmont and Valle d’Aosta. In detail, data from 165 patients (8 M, 157 F) were acquired. Mean age was of 74 (38-91) years, with more than half (64.2%) of patients diagnosed with ONJ between 70 and 89 years. Underlying diseases were osteoporosis (80%), RA (5.4%), osteoporosis and RA (3.6%), other bone disorders (11%). Treatment administered were alendronate (51.8%), ibandronate (12.3%), zoledronic acid (6.8%), others (29.1%). Concerning the latter, since 2014, 7 cases were related to denosumab (60 mg every 6 months), of which 5 to denosumab alone, 2 in patients switched from BPs to denosumab. Sites of ONJ were mandible (67%), maxilla (25%), mandible and maxilla (7%). Finally, an overall rise of ONJ occurrence was observed, with a median of 7 (2-13) yearly ONJ cases in the 2004-2010 period, gone up to 11.5 (6-24) yearly ONJ events in the 2011-2018 period. Such worrisome trend underlines the importance of eventual prevention measures and recurring assessment of oral health to reduce ONJ risk in non-malignant disease patients.

Simple Summary Up to 1–4% of OLP patients could develop oral cancer, and identifying factors that could help in early detection could be extremely useful. The aim of our cohort study was to assess the clinical characteristics of one of the biggest populations ever reported with a histologically confirmed diagnosis of OLP. We identified that OLP patients who developed oral cancer usually underwent less frequent periodical follow-up visits, and older age increased the risk of death. As a significant number of OLP patients have a risk of malignant transformation, there is a critical need to review these patients preferentially, by trained clinicians, at least once a year, possibly for a lifetime. Abstract Background: Oral lichen planus (OLP) is considered an oral potentially malignant disorder. The aim of our study was to estimate the risk for oral cancer in patients diagnosed with OLP. Methods: A population-based cohort study between January 1988 and December 2020 at one hospital in Northern Italy was performed. The primary endpoint of the study was that of the histopathological diagnosis of oral cancer during the follow-up period. Results: The study population comprised 3173 patients. During the follow-up period, 32 men and 50 women developed an oral squamous cell carcinoma (2.58%), with a mean time of 103.61 months after the initial diagnosis of OLP, and 21 patients died because of oral cancer. Almost half of the deceased patients had the last follow-up visit before cancer diagnosis in a period of more than 12 months. Older age, having a red form of OLP and fewer sites of involvement, increased the risk of having cancer, while age and no treatment increased the risk of death. Conclusion: This is the largest group of OLP patients with such a long follow up ever reported. Due to the increased risk of having a malignant transformation, especially in elderly subjects, OLP patients should be regularly followed up, particularly in the Northern Italian population.

Objective To evaluate the use of a Cannabis sativa oil in the management of patients diagnosed with primary burning mouth syndrome (BMS). Design Prospective, open-label, single-arm pilot study. Setting University hospital. Subjects Seventeen patients with diagnosed BMS were included. Methods Subjects were treated for 4 weeks with a full cannabis plant extract, which was prepared from standardized plant material (cannabis flos) in specialized pharmacies by means of Romano-Hazekamp extraction and was diluted in oil (1 g of cannabis in 10 g of olive oil). The primary outcome was the change in pain intensity (assessed by the visual analog scale, Present Pain Intensity scale, McGill Pain Questionnaire, and Oral Health Impact Profiles) at the end of the protocol and during the succeeding 24 weeks; the neuropathic pain was also investigated with a specific interview questionnaire (DN4-interview [Douleur Neuropathique en 4 Questions]). Levels of anxiety and depression were considered as secondary outcomes, together with reported adverse events due to the specified treatment. Results Subjects showed a statistically significant improvement over time in terms of a clinical remission of the oral symptoms. Levels of anxiety and depression also changed statistically, displaying a favorable improvement. No serious reactions were detailed. None of the patients had to stop the treatment due to adverse events. Conclusions In this pilot evaluation, the C. sativa oil provided was effective and well tolerated in patients with primary BMS. Further bigger and properly defined randomized controlled trials, with different therapeutic approaches or placebo control, are needed, however.

The aim of this study was to evaluate the effectiveness of surgical excision to prevent cancer in patients with nondysplastic oral leukoplakia (OL). This study was the first randomized controlled clinical trial comparing surgical treatment with standard care in this group of patients. Patients were divided into two groups. The first group underwent standard care, that is smoking counseling, follow-up visits every 6 months, and control biopsy when indicated. The second group underwent surgical excision, together with standard care. Oral cancer onset was the primary outcome; secondary outcomes included healing, recurrence after surgery, onset of new lesions, and worsening of the primary lesions. The differences in distribution of the patients' and lesions' characteristics were investigated through nonparametrical tests (Wilcoxon rank-sum and Fisher exact). Univariate and multivariate logistic regressions have been performed to estimate the odds ratio of the treatment on the recurrence or worsening of the lesions. A total of 260 patients took part in the study of which 132 were women (50.8%); during the follow-up period, two subjects developed oral cancer, one for each arm. Surgical treatment, when compared with standard care, was associated with a lower probability of the treated zone to remain healed during the follow up period (OR = 7.43; 95% confidence interval, 2.96–22.66). In conclusion, it is possible to assumed that regular clinical follow-up could be considered a reliable standard of care among patients with nondysplastic OLs. Prevention Relevance: Oral white patches can transform into cancer and none has provided clinical guidelines to prevent it. For the first time ever, we have showed that the clinical follow up of non dysplastic lesions was able to provide benefits if compared with surgical excision.

Oral lichen planus (OLP) is a common premalignant chronic inflammatory disorder. Optical Coherence Tomography (OCT) provides a real-time, non-invasive, and in-situ optical signature using light of varying wavelengths to examine tissue. Aim of the present study was to assess the possible role of OCT as diagnostic tool for atrophic-erosive OLP by examining OCT scans of healthy buccal mucosa, and comparing their ultrastructural features with those of a buccal mucosa affected by atrophic-erosive OLP, using their histopathological counterparts as the gold standard. Through grayscale (enface scan) and an application in which the vascularization of the tissue is visible (dynamic scan), it was possible to distinguish the healthy from the lichenoid pattern from 20 controls (12 M; 8 F; mean age: 41.32 years) and 20 patients with histologically confirmed atrophic-erosive OLP (7 M; 13 F; mean age: 64.27 years). In detail, mean width of stratified squamous epithelium (EP) and lamina propria (LP) were evaluated. Among controls, EP and LP showed a mean width of 300 (±50) and of 600 (±50) μm respectively; among cases, disruption of membrane basement prevented from any measurement. Furthermore, a differential pattern of EP and LP emerged between the two groups: a light-grayish, hypo-reflective, homogeneous area of EP recurring in controls turned into a hyper-reflective, non-homogeneous area among cases. Dynamic scan showed a differential profile of LP vascularization, varying from a hypo-reflective red area with small blood vessels in the control group, to a hypo/hyper-reflective area, completely overrun by a denser, wider blood flow amid OLP cases. Although histopathological examination remains the gold standard for OLP diagnosis, OCT could be a potentially helpful tool for the clinician and the pathologist, since it allows analysis of the vascularization of the sample without adversely affecting histological processing.

Objective To present a case of early diagnosis mandibular Paget's disease of bone (PDB), recognised by a general dentist. Background PDB is responsible of rapid bone resorption and disorganised bone formation. Materials and methods The patient was a 72-year-old female patient complaining of dental malposition and blatant prognathism. Conclusion Clinicians should consider PDB in differential diagnosis for an elderly patient undergoing unexplained alteration in face profile and occlusion.

The association between oral lichen planus (OLP) and hypothyroidism has been debated with conflicting results: some authors detected a statistically significant association between these two, while others did not confirm it. The aim of this study was to evaluate the thyroid status in patients with newly diagnosed OLP to test the null hypothesis that thyroid disease is not associated with an increased incidence of oral lesions, with a prospective case-control approach. A total of 549 patients have been evaluated, of whom 355 were female. Odds ratio (OR) and 95% confidence intervals (CIs) were obtained. Patients suffering from thyroid diseases were associated with an almost 3-fold increased odds of having OLP (OR 2.85, 95% CI: 1.65–4.94), after adjusting this analysis for age, gender, body mass index, smoking status, diabetes, hypertension and hepatitis C infection. It would be appropriate to further investigate the possible concomitance of OLP among patients with thyroid disorder; endocrinologists should be aware of this association, especially because OLP is considered a potentially malignant oral disorder.

This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root’s surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.

Background The systemic use of corticosteroid is the treatment of choice for patients with pemphigus vulgaris (PV), but adverse effects are frequent. To date, the use of rituximab (RTX) for PV patients is usually indicated when they failed first-line immunosuppressive therapies. The early use of RTX could theoretically lessen adverse effects. Methods We performed a single-center study on patients with predominantly oral PV, treated with systemic corticosteroid and the prompt use of 1000 mg of intravenous RTX two weeks apart. We evaluated the clinical response and the reported adverse effect during a period of 24 months, comparing those with a previously published series. Results The study group comprised 11 patients, while the control group comprised 98 patients. The average time to achieve complete clinical remission was 3.2 ± 2.72 months. Study group took steroids for a mean time of 11.09 ± 2.02 months, and they are all actually disease-free with no medication. Only three patients (27.3%) developed plain side effects. The effect of the length of the corticosteroid therapy on the side effects (also adjusted by sex, age, and clinical oral involvement) was statistically different in the two groups: the prompt use of RTX reduced of 94% the chance to have adverse effects (P = .001). Conclusions This is the first report of the use of RTX as first line of therapy for PV patients with predominantly oral involvement. With the proposed regimen, the adverse effects have been minimized compared with classic systemic corticosteroid-centered therapy. Multi-center randomized controlled trail is however necessary.

Oral lichen planus (OLP) is a common oral inflammatory condition. Against symptomatic atrophic-erosive OLP, topical steroids, or photobiomodulation (PBM) are deployed. Optical coherence tomography (OCT) provides a real-time, non-invasive, tissue investigation. Aim of this study was to evaluate modifications of OCT pattern in patients with painful atrophic-erosive OLP, before and after treatment with PBM, comparing those results with patients treated with topical steroid.Two groups of 20 OLP patients were evaluated. Group A underwent two daily application of 0.05 % clobetasol propionate for 8 weeks; group B was treated with eight weekly PBM sessions using a 980/645 nm diode laser. OCT scans were performed before and after treatment, and six months after end of the proposed protocol. Changes of width of stratified epithelium (EP) and lamina propria (LP) were quantified.After 8-weeks, both groups experienced a significant increase of EP width (p0.05), and a significant decrease of LP width (p0.05), with Δ-EP in Group A significantly higher than Group B (p = 0.0015); conversely, Δ-LP was not significantly different (p0.05). After six months, significant increase of EP width remained only in group B (p = 0.01), with no significant decrease of LP mean width in both groups (p0.05).Increase of EP and decrease of LP might be explained as consequence of clobetasol and PBM ability to promote epithelial healing, and to reduce interface inflammation. When investigated with OCT, clobetasol appears to provide more significant short-term structural changes, whereas PBM might guarantee long-term alterations.

Clinical studies have demonstrated the effectiveness of low-level laser therapy (LLLT) in [...]

This article describes a nonsurgical approach for treating gingival recessions and increasing gingival thickness around the natural teeth. Two female patients, presenting gingival recessions at the maxillary frontal teeth, were treated. Patient #1 had a discrepancy among the central maxillary incisors’ gingival margin, and tooth UL1 needed to be restored. Patient #2 presented a buccal gingival recession at tooth UL3. In both cases, the sulcular gingival margin was gently disephitelized with a diamond bur leaving the soft tissue healing by itself. After 4 weeks, the procedure was reperformed. After 6 months, the gingival margins appeared thicker and a creeping attachment was achieved in both cases, obtaining gingival symmetry, related to the adjacent or contralateral teeth, and root coverage. Gingival asymmetry, gingival recessions, and gingival thickness may be improved by means of a guided gentle nonsurgical stimulation, providing creeping attachment in the natural and also restored teeth, with a healthy and stable tissue after 24 months of follow-up.

BACKGROUND Despite the frequency of oral involvement, there are unexpectedly few studies of either on the oral manifestations of pemphigus or their long-term management, and diagnostic delay in Dentistry is frequent. METHODS We have examined outcome of patients presenting with predominantly oral pemphigus vulgaris (PV). Ninety-eight subjects were followed up for 85.12 months and treated with systemic steroids: 48 of them received adjunctive therapy with azathioprine, 16 with rituximab, 13 with mycophenolate mofetil, three with immunoglobulin and one with dapsone. RESULTS Clinical remission was achieved in 80 patients (84.21%); 39 of them were off therapy and 41 on therapy. Fifteen patients were not in remission, having been under systemic therapy for 72.16 months. Sixty-nine patients developed detectable adverse effects. Two fatal outcomes were recorded. Each additional year of steroid therapy ensured 47% chance of developing 1 or 2 side effects, and 64% chance of developing more than 3 (ORs 1.47, CI 1.162-1.903; ORs 1.64, CI 1.107-2.130, respectively). CONCLUSION In one of the largest available cohort with the longest follow-up ever reported, we observed that the management remains need-based and patient-specific, still relying on systemic corticosteroids.

The aim of this randomized, parallel-design, clinical trial was to investigate the effectiveness of an intensive plaque control programme with sonic versus manual toothbrushing on clinical outcomes and gingival crevicular fluid (GCF) levels of matrix metalloproteinases (MMP) in desquamative gingivitis (DG) patients.A total of 32 patients affected by DG secondary to oral lichen planus (OLP) were consecutively recruited and randomly assigned to a test (n = 16) and control (n = 16) group. Both groups were enrolled in an intensive control programme comprising supragingival scaling and polishing, and brush-specific instructions for a period of 8 weeks. The treatment of interest (test) was the use of a sonic-powered toothbrush, and the standard treatment (control) was the utilization of a soft-bristle manual toothbrush for twice-daily home oral hygiene procedures. Periodontal parameters, patient-centred outcomes, MMP-1 and MMP-9 GCF levels were evaluated at baseline and 8 weeks after starting the programme.The plaque control programme resulted in statistically significant reduction in periodontal parameters with consequent improvement in the clinical features, painful symptoms and severity of DG lesions in both groups (all P 0.001). When a sonic toothbrush was used, there was a more significant decrease in clinical indices, mucosal disease scores and GCF levels of MMP-1 and MMP-9.This clinical trial reported the effectiveness of a combined protocol based on professional oral hygiene and supervised toothbrushing in OLP patients with DG. The daily use of a sonic toothbrush would seem to perform better in the short term.

Objective: The purpose of this prospective analysis was to evaluate the efficacy of erbium-substituted yttrium aluminum garnet (Er:YAG) laser compared with that of conventional surgery, re...

No data are available in the literature on the extent to which the immune host-response and bacterial-elicited inflammation separately contributes to the increase in gingival crevicular fluid (GCF) levels of inflammatory biomarkers in patients affected by desquamative gingivitis (DG) secondary to oral lichen planus (OLP). The aim of this study was to investigate the effect of a structured plaque control intervention on GCF levels of MMP-1 and MMP-9 in OLP patients with DG and to compare them with those of non-OLP patients. The study population consisted of 18 unrelated Caucasian patients with DG, while 18 periodontally healthy subjects were recruited for the control group. Periodontal parameters and GCF biomarker amounts were evaluated at baseline and 2 months after a structured plaque control intervention, comprising professional oral hygiene sessions, manual toothbrushing, and interdental cleaning advice, only for DG patients. Determination of MMP-1 and MMP-9 levels was carried out by means of an enzyme-linked immunosorbent assay. Plaque control program led to improvement in all examined clinical parameters and resulted in significant decrease in GCF total amount and concentration of MMP-1 and MMP-9 in comparison to baseline (p