The mediator role of treatment response on oral health related quality of life in Behçet's syndrome.

BACKGROUND: The aim of the study was to analyse the effects of Treatment Response with oral ulcers on oral health related quality of life in Behçet's syndrome (BS). MATERIAL AND METHODS: In the cross-sectional study, 339 BS patients (F/M: 179/160, mean age: 36,13±9,81 years) were included. Data were collected by clinical examinations and patient reported outcome measures (PROMs) regarding Oral Health Impact Profile-14 (OHIP-14) questionnaire and self-reported Treatment Responses coded by a 5-point Likert-type scale (1: symptoms were cured- 5: symptoms were worsened). Moderated Mediation analysis (MA) was used to understand how oral ulcer activity (independent variable; X) influenced OHIP-14 score (outcome variables, Y) through self-reported Treatment Response (M1) and age (M2) as possible mediator variables (M) and disease course (mucocutaneous and musculuskeletal involvement vs. major organ involvement) as a possible moderator variable (W) on these relationships. RESULTS: In Moderated MA, OHIP-14 score (Y) was mediated by the presence of oral ulcer (X) (p=0.0000), the negative Treatment Response (M1) (p=0.0001) and being young (M2) (p=0.0053) with mucocutaneous involvement (W)(p=0.0039). CONCLUSIONS: Self-reported Treatment Response as an underestimated issue has a Mediator role in relation to oral ulceration on oral health related quality of life in the framework of patient empowerment strategies. Therefore, study results give clues to assist physicians and dentists for better understanding of patients' perspective.

Oral health related quality of life and disease severity in autoimmune bullous diseases.

BACKGROUND: There is an increased risk of long-term dental and periodontal disease in autoimmune bullous diseases (AIBD). AIMS: In this cross-sectional study, we aimed to determine whether the oral health-related quality of life status (OHRQoL) was associated with disease severity and activity in patients with AIBD. SUBJECTS AND METHODS: 67 patients with AIBD were enrolled in this study. Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) was used to evaluate the disease severity. The score was categorized as a significant course (≥17) and moderate course (<17). Oral health impact profile-14 (OHIP-14) questionnaire was filled to assess the OHRQoL. Self-reported oral health status and oral lesion related pain score were also evaluated in the study group. RESULTS: OHIP-14 score was significantly higher in active patients (42.28 ± 13.66) than inactive patients (29.08 ± 12.25) (P = 0.004) and it was correlated with the pain score (6.33 ± 2.78; r = 0.409, P = 0.013). Furthermore, OHIP-14 score was higher in patients with a significant disease course (45.18 ± 15.08) (P = 0.010) than in patients with a moderate course (36.09 ± 9.73). CONCLUSIONS: OHRQoL may be useful in the disease management and treatment. Since it can be affected by both presence of oral erosions and disease severity, a collaboration between dermatologists and dentists could be crucial to the disease management in AIBD.

Relationship between salivary calprotectin levels and recurrent aphthous stomatitis: A preliminary study.

AIM: Recurrent aphthous stomatitis (RAS) is an inflammatory condition of the oral mucosa. The etiology of RAS remains unclear. Calprotectin is a major cytoplasmic protein contained in granulocytes, monocytes/macrophages and epithelial cells, and its level is increased body fluids in some inflammatory diseases. The aim is to determine the relationship between salivary calprotectin and RAS. MATERIAL AND METHODS: In the cross-sectional study, 67 patients with active lesions of RAS (F/M: 43/24, mean age: 30.27 ± 9.14 years) and 42 healthy controls (HC, F/M: 30/12, 30.54 ± 9.49 years) were included. Calprotectin levels were evaluated in unstimulated whole saliva samples by using the ELISA method in both groups. RESULTS: Salivary calprotectin levels were significantly higher in RAS group (23.72 ± 4.28 mg/L) compared to the HC group (21.59 ± 4.27 mg/L) (P = 0.013). No significant relationship was found between calprotectin levels and age or gender in both groups (P >0.05). CONCLUSION: RAS is a very common inflammatory ulcerative condition of the oral cavity and its etiology is uncertain. Regarded as an inflammatory mechanism, releasing a high level of calprotectin in saliva has been suggested that it may play a role in pathogenesis of RAS.

Fatigue in systemic lupus erythematosus : Association with disease activity, quality of life and psychosocial factors.

OBJECTIVE: The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients. METHODS: This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS). RESULTS: A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0-16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients. CONCLUSION: Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.

The effects of chronic pain on oral health related quality of life in patients with anterior disc displacement with reduction.

AIM: The aim of this study was to evaluate the effects of chronic pain on oral health related quality of life (oral QoL) in patients with anterior disc displacement with reduction (DDwR). MATERIAL AND METHODS: Thirty-seven patients who had disc displacement with reduction (DDwR, F/M: 23/14, median age: 29, range: 23-49) were selected. These patients had chronic pain and had not been undergoing any treatment protocols for the previous six months. Age- and gender-matched healthy subjects healthy control, F/M: 23/14, mean age: 33.0 +/- 15.7 years) were used as a control group. Data were collected by means of a clinical examination and a questionnaire about pain status which included a jaw disability checklist RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Pain status was scored between 0 (no pain) and 10 (poor pain status) by the patients. Oral health related quality of life (oral QoL) over the previous six months was evaluated by an oral health impact profile-14 (OHIP-14) questionnaire. RESULTS: OHIP-14 score was significantly higher in patients with DDwR (median:17, min-max:6-39) than healthy controls (9, 0-18) (p = 0.000). The median duration of orofacial pain was 12 (range 7-120) months. Statistically significant correlations were observed between OHIP-14 score and the worst pain intensity in the past six months (7, 0-10) (r = 0.5 p = 0.007) and average pain intensity in the past six months (5.5, 1-10) (r = 0.4 p = 0.018). In addition, an increase in OHIP-14 score was observed in patients experiencing difficulty in smiling/laughing, cleaning their teeth or face, swallowing or talking, according to the jaw disability checklist (p = 0.042, p = 0.001, p = 0.023 and p = 0.007, respectively). CONCLUSION: Poor oral QoL was related to chronic pain and limitations in jaw function in patients with DDwR.

Assessment of minimal clinically important improvement by using Oral Health Impact Profile-14 in Behçet's disease.

OBJECTIVE: The aim of this prospective study was to detect minimal clinically important improvement (MCII) of oral health impact profile-14 (OHIP-14) for assessing the effect of treatments for oral ulcers in Behçet's disease (BD). METHODS: BD patients with active oral ulcers (F/M:36/22) were selected. Baseline and follow-up data were collected by clinical examinations and questionnaires. Patients rated their global impression of change (PGIC) measured by a transitional question. MCII was defined as the difference in mean change from baseline in OHIP-14 between patients with no response to therapy and patients with next higher level of response. RESULTS: Approximately one third (29.3 %) of the patients expressed an improvement during control examinations. A significant correlation was observed between raw change in OHIP-14 score and change in number of oral ulcers (r=0.69 p=0.017). Inactive patients increased from 44.1% in baseline to 58.8% in follow-up examination. A trend towards decreased number of oral ulcers was observed in follow-up (0.64+/-0.93) compared to baseline (1.44+/-1.92) in the improved group (p=0.096). According to regression analysis, PGIC was a significant predictor of change in raw OHIP-14 score. The threshold levels generated from the ROC analyses in OHIP-14 score best associated with clinically important improvement were -3.5 points (sensitivity: 80%, specificity: 88.6%) and -38.1% (sensitivity: 86.7%, specificity: 97.1%) respectively. CONCLUSION: Changes in OHIP-14 scores seem to be a sensitive and valuable tool for the determination of MCII during follow-up of Behçet's disease patients for oral disease assessment.

Association of salivary S. mutans colonisation and mannose-binding lectin deficiency with gender in Behçet's disease.

OBJECTIVE: The present study aimed to investigate the interactions among salivary S. mutans colonisation, serum mannose binding lectin level (MBL), oral ulcer activity and disease course in patients with Behçet's disease (BD). METHODS: One hundred and six BD patients, 25 patients with rheumatoid arthritis (RA) and 42 healthy controls (HC) were included in the study. BD patients were grouped as active (n=52) or inactive (n=54) according to oral ulcer status of the previous 3 months. Salivary colonisation of S. mutans levels were investigated by standard Caries Risk Test (CRT) Bacteria kits (Ivoclar, Vivadent). S. mutans colonies were categorized as high (> or =10(5) colony forming unit (CFU)/ml of saliva) or low (10(5)CFU/ml). Serum mannose binding lectin (MBL) levels were measured by ELISA. RESULTS: High levels of salivary S. mutans colonisation was significantly more present in BD (50%) than HC (28.6%)(p=0.039), whereas no significant difference was observed between RA and other groups (p>0.05). S. mutans presence in saliva was associated with oral ulcers (61.5% in patients with active oral ulcers vs 38.9% in inactives) (p=0.020). S. mutans colonisation in saliva was significantly higher among male BD patients with a severe disease course than a milder disease (p=0.04). Increased salivary S. mutans colonisation was also related to very low serum MBL (<100 ng/ml) in BD compared to controls (p=0.04). CONCLUSION: The relationship between increased presence of S. mutans and MBL deficiency with active disease pattern may indicate an impaired innate immune response in BD patients which may predispose to oral infections and a severe disease course.

A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis.

BACKGROUND: Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. METHODS: In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. RESULTS: Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. CONCLUSIONS: The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease.

BACKGROUND: The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD). METHODS: Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 +/- 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 +/- 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices. RESULTS: No significant difference was found in OHIP-14 scores between patients from UK (22.7 +/- 14.4) and Turkey (20.4 +/- 14.3) (P = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK (r = 0.4, P = 0.04) and the number of oral ulcers in Turkey (r = 0.4, P = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 +/- 2.8) compared with that in Turkey (1.5 +/- 2.5) (P = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK (P = 0.000). Similarly, the duration since the last dental visit (5.1 +/- 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 +/- 23.7 months) (P = 0.000). CONCLUSIONS: Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey.

The role of infectious agents in the pathogenesis, clinical manifestations and treatment strategies in Behçet's disease.

Behçet's disease (BD) is a multisystemic disorder characterized by oral, genital ulcers and involvement of the cutaneous (erythema nodosum, pustular vasculitis), ocular (anterior or posterior uveitis), musculoskeletal, vascular (both arterial and venous vasculitis), gastrointestinal and central nervous (meningoencephalitis) systems. It has an unpredictable clinical spectrum from mild mucocutaneous manifestations to severe ocular, vascular or neurological disability. In this review, the aetiology, clinical presentations and treatment modalities of BD are evaluated in the context of microbial factors within the existing literature. The relationships between microbial agents (streptococcia and herpes simplex virus), microbial antigens [heat shock proteins (HSP), lipoteichoic acid (LTA)] and immune mechanisms such as innate and adaptive responses against microorganisms are discussed.

Factors affecting dental job satisfaction: a cross-sectional survey in Turkey.

In this cross-sectional study, a randomly selected group of dentists (n = 855) from nine provinces of Turkey were interviewed for their levels of intrinsic, extrinsic, and overall job satisfaction. The proportion of overall job satisfaction was computed as the proportion of dentists who had mean general satisfaction scores > or = 4 on a 5-point, Likert-type scale and was found to be 40.8% for the sample as a whole. The significant factors that affected overall satisfaction were age, the type of social insurance possessed, income level, the presence of dental auxiliaries, and the number of patients examined per day. Multivariate analysis of the data revealed that the type of social insurance, the amount of monthly income, and the number of patients examined per day were the most common and statistically significant predictors of intrinsic, extrinsic, and overall satisfaction in Turkish dentists.

Utilisation of dental services in Turkey: a cross-sectional survey.

AIM: To assess the factors affecting the utilisation of dental service in Turkey. METHOD: A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews. RESULTS: 40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction. CONCLUSION: Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.

Hypocalcification type amelogenesis imperfecta in permanent dentition in association with heavily worn primary teeth, gingival hyperplasia, hypodontia and impacted teeth.

A female patient with hypocalcification type amelogenesis imperfecta in permanent dentition in association with heavily worn primary teeth, gingival hyperplasia, hypodontia and impacted teeth is presented.

Hemifacial microsomia: oral, clinical, genetic and dermatoglyphic findings.

Oral, clinical, genetic and dermatoglyphic findings of a female patient with hemifacial microsomia are described and compared with those cited in the literature.

The assessment of oral health-related quality of life by factor analysis in patients with Behcet's disease and recurrent aphthous stomatitis.

BACKGROUND: The aim of the study was to test multidimensional properties of oral health impact profile-14 (OHIP-14) in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS) patients with active oral ulcers. METHODS: Ninety-six BD patients, 28 patients with RAS and 117 healthy controls (HC) were included in this study. In patients with active oral ulcers, the frequency and healing time of ulcers were recorded. Multidimensional properties of OHIP-14 were examined by factor analysis. RESULTS: Factor analysis revealed three subscales and explained 66.49% of overall variance in these patients with active oral ulcers. The score of Subscale 1 was positively correlated with the recurrence of oral ulcers per month (P = 0.037). Subscale 3 scores of the patients treated with colchicine were worse than those treated with immunosuppressives (P = 0.035). CONCLUSIONS: The factor structure of OHIP-14 was found to be reliable and sensitive to clinical parameters and treatment modalities in active patients.

Oral health related quality of life is affected by disease activity in Behçet's disease.

OBJECTIVES: This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behçet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires. SUBJECTS AND METHODS: Ninety-four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile-14 (OHIP-14), oral health related quality of life (OHQoL) and short form-36 (SF-36) questionnaires. RESULTS: OHQoL, OHIP-14 and SF-36 subscale scores were significantly worse in patients with BD compared with those in HC (P < 0.05). Both OHIP-14 and OHQoL scores were significantly worse in active patients compared with inactives in BD and RAS (P < 0.05). Scores of SF-36 Role physical, Role emotional and Vitality were also lower in active patients than in inactives in BD (P < 0.05). Scores of OHIP-14 and OHQoL were significantly worse in patients treated with colchicine compared with those treated with immunosuppressives (P < 0.05). CONCLUSIONS: Both oral and general QoL was impaired in BD and associated with disease activity and treatment modalities. Translated Turkish versions of OHIP-14 and OHQoL were also observed to be valid and reliable questionnaires for further studies.

Prevalence and distribution of oral lesions: a cross-sectional study in Turkey.

OBJECTIVES: The purpose of this study was to evaluate the prevalence and distribution of oral lesions (OLs) in Turkish population. SUBJECTS AND METHODS: In this cross-sectional study, 765 residents (F/M: 375/390) were selected by the cluster sampling method and examined according to WHO criteria. RESULTS: Excessive melanin pigmentation (6.9%) was the most common lesion in the study population. The tongue lesions observed in this study were as follows: fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue (1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%). In regression analysis, being 65 years old and over was found as a statistically significant risk factor for the occurrence of pigmentation, fissured tongue, varices, hairy tongue, denture stomatitis and petechiae (P < 0.05). CONCLUSIONS: Pigmentation, fissured tongue and denture stomatitis were observed to be the most common lesions in Turkish population. Elderly population was a significant risk factor for occurrence of some OLs.

Clinical and immunological effects of azithromycin in Behçet's disease.

BACKGROUND: The aim of this study was to evaluate the effects of azithromycin on mucocutaneous manifestations, oral health and immune response in Behçet's disease (BD). METHODS: Eight BD patients with active mucocutaneous symptoms were treated with azithromycin for 4 weeks. Oral health, clinical manifestations and in vitro interleukin (IL)-12, interferon (IFN)-gamma, IL-10 and monocyte chemotactic protein (MCP)-1 responses were evaluated before and after treatment. RESULTS: The number of folliculitic lesions, healing time of oral ulcers and scores of plaque indexes (PLIs) were lower after azithromycin treatment (P<0.05). Scores of PLIs correlated positively with the healing time of oral ulcers (P=0.02). Although a trend towards increased stimulated IL-10 responses with azithromycin was observed, no statistically significant difference was found. Stimulated and unstimulated MCP-1, IFN-gamma and IL-12 responses were similar before and after treatment (P>0.05). CONCLUSION: Azithromycin was observed to be effective in decreasing folliculitic lesions and fastening the healing time of oral ulcers in BD.

Spiral computed tomographic demonstration of C-shaped canals in mandibular second molars.

OBJECTIVES: The aim of this study was to evaluate the prevalence of C-shaped canals in single rooted mandibular second molars with spiral computed tomographic imaging in detail. METHODS: One hundred and twelve single-rooted mandibular second molar samples were selected from 491 extracted mandibular second molars. The teeth were scanned by spiral computed tomographic technique to examine canal configurations. RESULTS: The evaluation criteria of the shape of roots was based on Manning's category as round, oval and C-shaped. The prevalence of C-shaped canals was found to be 8.1% in mandibular second molars. The evaluation of the root canal configurations of C-shaped mandibular second molars with single roots (40 teeth) was based on Vertucci's classification. Vertucci type I canals were most frequently seen in C-shaped mandibular second molars (40%). Additionally, we disclosed three additional canal types. CONCLUSION: Results of this study demonstrated that high resolution visualization of the root canal shape can be achieved by spiral computed tomographic imaging.