Common Oral Lesions.

Familiarity with common oral conditions allows clinicians to observe and treat patients in the primary care setting or refer to a dentist, oral surgeon, otolaryngologist, or other specialist. Recurrent aphthous stomatitis (canker sores) is the most common ulcerative condition of the oral cavity. Recurrent herpes simplex labialis and stomatitis also commonly cause oral ulcers. Corticosteroids, immunocompromise, antibiotics, and dentures can predispose patients to oral candidiasis. Benign migratory glossitis (geographic tongue) occurs in up to 3% of the population but generally lacks symptoms, although some people experience food sensitivity or a burning sensation. Hairy tongue is associated with a low fiber diet, tobacco and alcohol use, and poor oral hygiene in older male patients. Generally, hairy tongue is asymptomatic except for an unattractive appearance or halitosis. Tobacco and alcohol use can cause mucosal changes resulting in leukoplakia and erythroplakia. These can represent precancerous changes and increase the risk of squamous cell carcinoma. Mandibular and maxillary tori are common bony cortical outgrowths that require no treatment in the absence of repeat trauma from chewing or interference with dentures. Oral lichen planus occurs in up to 2% of individuals and can present as lacy reticulations or oral erosions and ulcerations. Traumatic buccal mucosal fibromas and labial mucoceles from biting can be excised.

Ending the neglect of global oral health: time for radical action.

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

Long-term complications of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN): the spectrum of chronic problems in patients who survive an episode of SJS/TEN necessitates multidisciplinary follow-up.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse reactions to drugs that cause a life-threatening eruption of mucocutaneous blistering and epithelial sloughing. While the acute complications of SJS/TEN are well described, it is increasingly recognized that survivors may develop delayed sequelae, some of which can be associated with significant morbidity. Studies of long-term SJS/TEN outcomes mostly focus on mucocutaneous and ocular complications. However, other internal organs, such as the respiratory tract and gastrointestinal tract, can be affected. Psychological sequelae are also frequent following the trauma of widespread epidermal necrolysis. An appreciation of the 'chronic' phase of SJS/TEN is needed by clinicians caring for individuals who have survived the acute illness. This review aims to provide an update on the breadth and range of sequelae that can affect patients in the months and years following an acute episode of SJS/TEN.

Access and management of HIV-related diseases in resource-constrained settings: a workshop report.

With advancement of medical interventions, the lifespan of people living with HIV has increased globally. However, low- and middle-income countries (LMICs) which bear the greatest burden of the HIV pandemic face a constant challenge in addressing the treatment needs of immune-suppressed patients. An analysis of the current management protocols and access to medication in resource-poor settings was conducted at this workshop, with emphasis on the situation in resource-poor settings. The participants developed a consensus document based on the need to respond to the constantly changing HIV pandemic. Provision of oral health care must be guided by interconnecting principles based on population based strategies that address upstream determinants of health. Basic oral health coverage in developing countries can only be realized with a strong foundation at the primary health level. Early diagnosis of HIV-related comorbidities including the adverse effects of ARVs is essential for the improvement of treatment outcomes. Standardization of oral health care delivery mechanisms will facilitate evaluation at national and regional levels. Oral health care workers have a moral obligation to participate in sustained campaigns to reduce the social stigma associated with HIV/AIDS in their work places at every stage of the referral chain. Future research also needs to realign itself towards prevention using the common risk factor approach, which has a broader impact on non-communicable diseases, which are increasingly affecting patients with HIV/AIDS as their life expectancies increase.

Oral manifestations and their treatment in Sjögren's syndrome.

Sjögren's syndrome (SS) is a complex, chronic, systemic, autoimmune disease that mainly affects the exocrine glands, especially the salivary and lacrimal glands, leading to dryness of the oral and ocular mucosae. Several factors have been studied that could explain the glandular hypofunction primarily related to water transport. Recent reports have shown alterations in secretory route and trafficking in labial salivary glands, explaining alterations in the saliva quality. The decrease in salivary flow and qualitative alterations in saliva could explain many of the oral manifestations. The exocrine manifestations and systemic involvement significantly impact the patient's perception of health-related quality of life. For this reason and given its systemic nature, the treatment of these patients should be multidisciplinary. This review addresses some particular oral health aspects of SS patients and focuses on relevant topics concerning the treatment and prevention of common oral disorders associated with this disease.

Orthodontic treatment for disabled children: a survey of parents' attitudes and overall satisfaction.

BACKGROUND: Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities. METHODS: The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed. RESULTS: Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children. CONCLUSIONS: Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.

An assessment of the educational value of service-learning community placements in residential aged care facilities.

AIMS: The aim of this study was to determine whether dental hygiene students attending residential aged care facilities (RACFs) during a placement programme gained any knowledge about the oral care of elderly patients and the RACF environment. LOCATION: Aged Care Facilities on the Central Coast of New South Wales, Australia. METHODOLOGY: Final year dental hygiene students undertook a 12-week placement, one day per week, in one of 17 residential aged care facilities on the NSW Central Coast. They were asked to complete pre-placement and post-placement questionnaires, which recorded their knowledge of medical, dental and environmental issues related to older people. The placement questionnaires used five point Likert scales, ranging from strongly agree to strongly disagree, pre- and post-mean scores were produced for each question and P values calculated using a paired t-test. RESULTS: Thirty-three students attended the placement, 26 (79%) completed both the pre- and post-placement questionnaires. Post-placement mean scores as compared to pre-placement mean scores showed significant improvement in student knowledge of medical (P < 0.05) and dental (P < 0.05) conditions specific to the older person and improvement in knowledge (P < 0.05) about the residential aged care facility environment. CONCLUSION: The placement programme enhanced student knowledge across three subject categories; medical and dental conditions of the older person and the structure and services of the residential aged care environment.

[Using Mexidol Dent for prevention of oral mucosa disorders in patients with xerostomia].

The aim of the study was to evaluate clinical efficiency of oral hygiene agents Mexidol Dent (Farmasoft) for prevention of oral mucosa diseases. Eighty-three xerostomia patients (55 female and 28 male) aged 44 to 62 years were included in the study and divided in 4 groups according to oral hygiene agents: toothpaste Mexidol Dent Fito (20 patients), mouthwash Mexidol Dent Professional (23 patients), both toothpaste and mouthwash (21 patients) and control group of 19 patients who were free to choose their own oral hygiene means. After one year of the study in the experimental groups oral mucosa disorders were revealed in 9.6% of cases, which is 2.7 times lower than in control group.

[Lupoid perioral dermatitis as a special form of perioral dermatitis: review of pathogenesis and new therapeutic options]. / Lupoide periorale Dermatitis: Einblick in die Pathogenese und neue Therapieoptionen.

Lupoid perioral dermatitis is classified as a special form of perioral dermatitis with dense aggregations of red-brown papules which display a lupoid infiltrate on diascopy. There are various treatment options ranging from total avoidance of all topical substances to different topical treatment. Cases resistant to therapy require systemic treatment, which, however, is off-label use. In our case we were able to achieve a significant improvement with systemic therapy with isotretinoin over a period of 6 months.

Submandibular-space abscess from loss of a bonded molar tube during orthognathic surgery.

The use of bonded orthodontic molar tubes is becoming more prevalent in orthodontics because they have some advantages over conventional bonding. However, a bonded apparatus can become detached, leading to complications. This article presents the case of a submandibular-space abscess associated with a molar tube that detached during orthognathic surgery and became embedded in the soft tissues. The site became infected, and antibiotics were prescribed. Eventually, the molar tube migrated and could be removed under local anesthesia.

Effects of radiotherapy to the jaws. I: The scale of the problem.

Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.

Neurogenic and endothelial nitric oxide regulates blood circulation in lingual and other oral tissues.

Blood flow in oral tissues, including the tongue, salivary glands, gingiva, dental pulp, and lip, plays an important role in modulating the complex oral functions involved in food intake. Oral tissue circulation is regulated by nitric oxide (NO) synthesized by neuronal NO synthase mainly present in parasympathetic vasodilator neurons and also by endothelial NO sythase. Electrical stimulation of parasympathetic nerves causes vasodilatation and blood flow increase in the tongue, submandibular gland, and lip in various mammals in vitro and in vivo. Lingual arteries isolated from Japanese monkeys respond to perivascular nerve stimulation by electrical pulses and nicotine with relaxations that are mediated via neurogenic NO. There is evidence supporting the hypothesis that the superior salivatory nucleus delivers central information through the geniculate ganglion and greater petrosal nerve to the pterygopalatine ganglion, which sends off impulses through nitrergic nerves to oral tissues. Endothelial NO also plays an important role in improving oral blood circulation not only in resting conditions but also under conditions activated by chemical and physical stimuli in the tongue, submandibular and parotid glands, dental pulp/gingiva, and cheek pouch. Maintenance of health in oral circulation by minimizing factors responsible for impairment of endothelial and neurogenic NO bioavailability would be important for the prophylaxis of life-style related diseases.

[Stomatologic complications of eating disorders]. / A pszichoszomatikus evészavarok sztomatológiai szövodményei.

Since the 1990s numerous international experts have reported about the somatic complications of eating disorders including those having a dental and stomatological nature. Several reports emphasised that deformations in the oral cavity resulting from this grave nutritional disease typical of the young generation could already appear in the early stage and, therefore, dentists are among the first to diagnose them. Dentists are still often unaware of the importance of their role in multidisciplinary treatment. Even if they knew what the disease was about and recognised it on the basis of deformations in the oral cavity in time, their advice that their patients should brush their teeth more often would fail to eliminate the root cause of the problem. Not only the earliest possible treatment of the complications of the bingeing-purging mechanism and the maintenance of oral hygiene are important, but controlling and curing pathological habits with active participation of psychiatrists are also required to ensure full recovery. Due to the multidisciplinary nature of the disease, manifold communication is required. For this reason, publishing the dental ramifications of organic and systemic diseases at dental conferences and in technical journals, as well as providing information about oral complications of eating disorders for general practitioners and specialists are particularly important.

The role of oral microbiome in respiratory health and diseases.

The oral cavity (mouth) has various microbial habitats, including, teeth, gingival sulcus, gingiva, tongue, inner cheek, hard palate, and soft palate. The human oral cavity houses the second most diverse microbiome in the body harboring over 700 bacterial species. The fine-tuned equilibrium of the oral microbiome ecosystem maintains oral health. Oral dysbiosis caused by food habits and poor oral hygiene leads to various oral diseases such as periodontitis, caries, gingivitis, and oral cancer. Recent advances in technology have revealed the correlation between the oral microbiome and systemic diseases such as pulmonary diseases, cardiovascular diseases, rheumatoid arthritis, Alzheimer's disease, and other metabolic diseases. Since the oral cavity directly connects with the upper respiratory tract, the oral microbiome has easier access to the respiratory system compared to other organ systems. Direct aspiration of oral microflora in the respiratory system and oral dysbiosis-induced host immune reaction and inflammation are mainly responsible for various pulmonary complications. Numbers of literature have reported the correlation between oral diseases and pulmonary diseases, suggesting the possible role of the oral microbiome in respiratory diseases such as chronic obstructive pulmonary diseases, pneumonia, lung cancer, etc. This paper reviews the current evidence in establishing a link between the oral microbiome and pulmonary diseases. We also discuss future research directions focusing on the oral microbiome to unravel novel therapeutic approaches that could prevent or treat the various pulmonary complications.

The Impact of Diet, Nutrition and Nutraceuticals on Oral and Periodontal Health.

Oral and periodontal diseases can determine severe functional, phonatory and aesthetic impairments and are the main cause of adult tooth loss. They are caused by some specific bacteria that provoke an intense local inflammatory response and affect-with particular gravity-susceptible subjects, because of reasons related to genetics and lifestyles (e.g., smoking and home oral hygiene habits). They are more frequent in the disadvantaged segments of society and, in particular, in subjects who have difficulty accessing preventive services and dental care. Some systemic diseases, such as uncontrolled diabetes, can increase their risk of development and progression. Recently, in addition to the obvious considerations of severe alterations and impairments for oral health and well-being, it has been noted that periodontitis can cause changes in the whole organism. Numerous clinical and experimental studies have highlighted the presence of a strong association between periodontitis and some systemic diseases, in particular, cardiovascular diseases, diabetes, lung diseases and complications of pregnancy. The purpose of this editorial is to provide a current and thoughtful perspective on the relationship of diet and natural agents on oral, periodontal diseases, and chewing disorder preventions which may reflect good systemic conditions and related quality of life or to analyze indirect effects through the contribution of diet and nutrition to systemic health in order to obtain a modern diagnostic-therapeutic approach.

The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review.

BACKGROUND: Positioning stent in head and neck radiotherapy seems to have benefit to prevent oral complications but it hasn't been summarized by an evidence-based method. OBJECTIVES: This review aims to evaluate the efficacy of positioning stents in preventing oral complications after radiotherapy. METHODS: We conducted an electronic search in MEDLINE, EMBASE, Cochrane CDSR, and Cochrane CENTRAL database for randomized-controlled clinical trials, controlled clinical trials and cohort studies that assessed oral complications after head and neck radiotherapy with positioning stents. Two reviewers extracted information on radiotherapy, follow-up period, oral complications and assessments independently. RESULTS: Three RCTs and two cohort studies were included in this review. Oral complications such as mucositis, xerostomia, taste alteration, trismus, salivary changes, dysphagia and pain on swallowing were assessed by different methods in these studies. CONCLUSIONS: Oral complications were common in patients after head and neck radiotherapy. There is insufficient evidence that positioning stents have a preventive effect against xerostomia, and it needs more high-quality and prospective trials with long-term follow-up to support it.

Oral manifestations of vitamin B12 deficiency: a case report.

Megaloblastic anemias are a subgroup of macrocytic anemias, in which distinctive morphologic abnormalities occur in red cell precursors in bone marrow, namely megaloblastic erythropoiesis. Of the many causes of megaloblastic anemia, the most common are disorders resulting from cobalamin or folate deficiency. The clinical symptoms are weakness, fatigue, shortness of breath and neurologic abnormalities. The presence of oral signs and symptoms, including glossitis, angular cheilitis, recurrent oral ulcer, oral candidiasis, diffuse erythematous mucositis and pale oral mucosa offer the dentist an opportunity to participate in the diagnosis of this condition. Early diagnosis is important to prevent neurologic signs, which could be irreversible. The aim of this paper is to describe the oral changes in a patient with megaloblastic anemia caused by a dietary deficiency of cobalamin.