Oral health related-quality of life before and during the COVID-19 pandemic in patients with non-alcoholic fatty liver disease.

BACKGROUND: Since the beginning of the COVID-19 pandemic, the number of medical appointments and the offer and use of oral health services have decreased sharply with the lockdown period. Restriction to regular dental care can increase the risk of oral diseases, capable of affecting general health and oral health-related quality of life, particularly among medically compromised patients. This study aimed to assess health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) of patients with non-alcoholic liver disease (NAFLD) before and during the COVID-19 pandemic. MATERIAL AND METHODS: Prospective cohort of 58 patients with NAFLD followed up from March 2020 (before the pandemic) to December 2021 (during the pandemic). RAND 36-Item Health Survey and Oral Health Impact Profile 14 (OHIP-14) questionnaires were used to assess HRQoL and OHRQoL, respectively, in the two points of time. RESULTS: The scores of all scales HRQoL and of the question about health change in the last year decreased substantially with the advent of the pandemic. Large (>0.50) effect sizes were estimated for the scales Role functioning/physical, Pain, General health, and Energy/fatigue. Patients who had COVID-19 presented better HRQoL and OHIP-14 mean scores than those who did not have the disease. The OHIP-14 total score increased 3.6 points with the advent of the pandemic, representing a large effect size (0.62). Patients presented high probability (84.3%) of increasing OHIP14 score during the pandemic. CONCLUSIONS: The HRQoL and the OHRQoL scores of NAFLD patients decreased substantially with the advent of the pandemic. However, these decreases were not associated with the COVID-19 disease by itself, but probably to other factors related to the deep social changes brought by the social isolation measures to combat the pandemic.

Nuclear F-actin Cytology in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma.

Oral cavity cancer has a low 5-y survival rate, but outcomes improve when the disease is detected early. Cytology is a less invasive method to assess oral potentially malignant disorders relative to the gold-standard scalpel biopsy and histopathology. In this report, we aimed to determine the utility of cytological signatures, including nuclear F-actin cell phenotypes, for classifying the entire spectrum of oral epithelial dysplasia and oral squamous cell carcinoma. We enrolled subjects with oral potentially malignant disorders, subjects with previously diagnosed malignant lesions, and healthy volunteers without lesions and obtained brush cytology specimens and matched scalpel biopsies from 486 subjects. Histopathological assessment of the scalpel biopsy specimens classified lesions into 6 categories. Brush cytology specimens were analyzed by machine learning classifiers trained to identify relevant cytological features. Multimodal diagnostic models were developed using cytology results, lesion characteristics, and risk factors. Squamous cells with nuclear F-actin staining were associated with early disease (i.e., lower proportions in benign lesions than in more severe lesions), whereas small round parabasal-like cells and leukocytes were associated with late disease (i.e., higher proportions in severe dysplasia and carcinoma than in less severe lesions). Lesions with the impression of oral lichen planus were unlikely to be either dysplastic or malignant. Cytological features substantially improved upon lesion appearance and risk factors in predicting squamous cell carcinoma. Diagnostic models accurately discriminated early and late disease with AUCs (95% CI) of 0.82 (0.77 to 0.87) and 0.93 (0.88 to 0.97), respectively. The cytological features identified here have the potential to improve screening and surveillance of the entire spectrum of oral potentially malignant disorders in multiple care settings.

Residual (ghost) sockets in bisphosphonate use--evidence of poor healing and slow bone turnover.

Patients taking bisphosphonate drug therapy have demonstrated extremely poor alveolar bone healing after relatively minor oral surgical procedures. It would seem logical that extraction sockets could remain visible radiographically for an extended period after surgery, even in cases with soft tissue healing. This article chronicles the case of a patient who had been taking zoledronic acid chronically for metastatic cancer and who demonstrated numerous residual sockets (also known as ghost sockets), with lamina dura outlines that were visible radiographically.

Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement.

At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Precancer in the United Kingdom issues related to potentially malignant disorders of the oral cavity were discussed by an expert group. The consensus views of the Working Group are presented in a series of papers. In this report, we review the oral epithelial dysplasia classification systems. The three classification schemes [oral epithelial dysplasia scoring system, squamous intraepithelial neoplasia and Ljubljana classification] were presented and the Working Group recommended epithelial dysplasia grading for routine use. Although most oral pathologists possibly recognize and accept the criteria for grading epithelial dysplasia, firstly based on architectural features and then of cytology, there is great variability in their interpretation of the presence, degree and significance of the individual criteria. Several studies have shown great interexaminer and intraexaminer variability in the assessment of the presence or absence and the grade of oral epithelial dysplasia. The Working Group considered the two class classification (no/questionable/ mild - low risk; moderate or severe - implying high risk) and was of the view that reducing the number of choices from 3 to 2 may increase the likelihood of agreement between pathologists. The utility of this need to be tested in future studies. The variables that are likely to affect oral epithelial dysplasia scoring were discussed and are outlined here; these need to be researched in longitudinal studies to explore the biological significance of a low-risk or high-risk dysplasia.

Tumoral calcinosis of the temporomandibular joint: CT and MR findings.

In this article, the CT, three-dimensional CT, and MR findings are reviewed in a 59-year-old woman with tumoral calcinosis involving the temporomandibular joint.

Identification and semi-quantification of estrogen and progesterone receptors in peripheral giant cell lesions of the jaws.

Cases of peripheral giant cell lesions of the jaws (PGCL) were evaluated for the detection of estrogen and progesterone receptor proteins (ERS/PRS) utilizing immunoperoxidase staining. Staining for ERS was strongly positive in three cases when examining the mononuclear cell population. Another two cases were weakly positive. In addition, an occasional ER + multinucleated giant cell could be observed in three of the cases examined. PRS immunoreactivity was essentially negative in all cases. It is well known that the PGCL has a marked female predilection. This, coupled with the present findings, gives further evidence that some PGCL may be at least partially under hormonal influence.

Orofacial considerations for pediatric, adult, and elderly victims of abuse.

Health care providers must take the time to educate themselves about domestic violence, its signs and symptoms, and the proper care of victims of child, spouse, or elder abuse. It is not enough to treat the immediate injuries without offering necessary and appropriate intervention on behalf of the victim. No one deserves to be beaten, sexually abused, or emotionally mistreated. If abuse is suspected, report it to the proper authorities. By focusing attention on this major health problem, physicians can provide a leadership role in using health care response to reduce the incidence of abuse and, ultimately, to save lives.

Oral verrucous carcinoma. Incidence in two US populations.

Much is known about the clinical appearance, biological behavior, and treatment of verrucous carcinoma of the oral cavity. However, the epidemiologic characteristics are completely unknown. This cancer is considered to be rare in Western cultures because it is not common in oral pathology biopsy services, but there is no epidemiologic evidence for this belief. To provide this evidence, 2 population-based incidence investigations were carried out, one in Rochester, Minn., and the other in the state of West Virginia. The results were as follows: the age-adjusted average annual incidence rate for oral verrucous carcinoma among Rochester residents was 0.1/100,000 person-years (0.2 for males, 0.0 for females), whereas the incidence rate for all intraoral carcinomas was 3.6/100,000 person-years (5.4 for males, 2.1 for females). Among men over 64 years of age, the incidence rate for verrucous carcinoma was increased to 3.2/100,000 person-years. Verrucous carcinoma was among the least common of the oral carcinomas in this population, representing only 3% of the total. The age-adjusted incidence rate for oral and pharyngeal verrucous carcinoma among West Virginia residents was somewhat greater, 0.3/100,000 person-years, and showed an even gender predilection (0.28 for males, 0.29 for females). The incidence rate for all oral/pharyngeal cancers in West Virginia was 8.8/100,000 person-years (13.4 for males, 5.7 for females), which was below the US average. The conclusion is that oral verrucous carcinoma is a rare tumor of older people, diagnosed in only 1 to 3 of every 1,000,000 persons each year.

Oral cancer in a tobacco-chewing US population--no apparent increased incidence or mortality.

OBJECTIVE: Smokeless tobacco use is an accepted risk factor for oral cancer in the United States, but the major proof of this is based largely on a single epidemiologic (case-control) comparison of women, whereas the chewing of tobacco is predominantly a habit of men. The present investigation sought to compare gender-specific oral cancer mortality and incidence rates in West Virginia, the state with the highest per capita consumption of smokeless tobacco, with rates from other states and with the US average rates. It was hypothesized that the cancer rates for West Virginia males would be significantly greater than the US average and greater than the rates for states with less smokeless tobacco consumption. STUDY DESIGN: Data from the West Virginia Cancer Registry for the years 1993 through 1995 were compared with data from contemporary Surveillance and Epidemiology End Results for the US (with respect to incidence) and from the Center for Disease Control and Prevention's National Center for Health Statistics (with respect to mortality). RESULTS: The average annual incidence rates (per 100,000 population) for oral/pharyngeal cancer in West Virginia males and females were 13.4 and 5.1, respectively; these compared with rates of 15.4 and 5.7 for the US. The average annual mortality rates (per 100,000 population) for the disease in West Virginia males and females were 4.2 and 1.6, respectively; these compared with 4.4 and 1.5 for the US. West Virginia oral/pharyngeal mortality rates for both genders were statistically significantly lower than US rates throughout the years 1950 through 1980. Among other potential oral cancer etiologic factors, the very low prevalence of alcohol abuse in West Virginia seemed to be relevant. CONCLUSIONS: The hypothesis was not confirmed by data analysis. West Virginia is the state with the highest per capita consumption of smokeless tobacco, yet it has less oral/pharyngeal cancer than the US average. The authors strongly urge additional and improved epidemiologic evaluation of the oral cancer risk of smokeless tobacco use in US males.

Intraosseous salivary tissue: jawbone examples of choristomas, hamartomas, embryonic rests, and inflammatory entrapment: another histogenetic source for intraosseous adenocarcinoma.

PROBLEM: Hundreds of primary salivary neoplasms have been found to be completely enclosed within the marrow spaces of the maxilla and mandible, yet nonneoplastic salivary tissue has never been convincingly identified within marrow, either separately or adjacent to such neoplasms. This situation has forced the acceptance of an inherently awkward odontogenic origin for all intramedullary salivary carcinomas and adenomas. OBJECTIVE: The purpose of this study was to microscopically evaluate a large number of maxillofacial marrow samples for the presence of intramedullary salivary tissue. STUDY DESIGN: We microscopically reviewed 5034 maxillofacial bone samples from the Latvala Inflammatory Bone Registry for evidence of heterotopic salivary inclusions within the marrow tissues. Contributing surgeons were contacted for each identified case of intraosseous salivary tissue to assure that all submitted tissue was removed from within the marrow spaces rather than from overlying soft tissue. RESULTS: Thirteen of 5034 marrow samples (0.3%) contained heterotopic acinic hamartomas, salivary choristomas, embryonic salivary rests, or entrapped surface glands. Four additional hamartomas of the condyle are described. We report also the chance finding of incipient odontogenic epithelial neoplasms (n = 6) and odontogenic epithelial rests (n = 84) within the fatty marrow and outside the periodontal ligament spaces, confirming that not all odontogenic neoplasms are necessarily of periodontal ligament origin. CONCLUSION: The frequency rate for salivary choristomas, hamartomas, embryonic rests, and displaced surface glands within alveolar bone is no less than 2.6 of 1000 biopsied marrow samples. This provides an additional and quite logical histogenetic explanation for the presence of intraosseous salivary neoplasms.

Thrombophilia, hypofibrinolysis, and alveolar osteonecrosis of the jaws.

OBJECTIVES: Our specific aim in 49 patients (42 women, 7 men) with osteonecrosis of the jaw was to determine whether thrombophilia (increased tendency to intravascular thrombosis) or hypofibrinolysis (reduced ability to lyse thrombi) were associated with this regional avascular necrosis. STUDY DESIGN: Determinants of thrombosis and fibrinolysis were compared in healthy controls and in 42 women and 7 men who had biopsy-proven idiopathic osteonecrosis of the jaw with severe chronic jaw or facial pain syndromes and failure to respond to conventional medical and dental treatments. RESULTS: Of the 49 patients, 35 (71%) had thrombophilia or hypofibrinolysis and only 14 were normal. Thrombophilia as a sole coagulation defect was found in 10 patients, 7 with resistance to activated protein C and 3 with low protein C (deficiency of an antithrombotic protein). Hypofibrinolysis with low stimulated tissue plasminogen activator activity and high lipoprotein (a) (an atherogenic, hypofibrinolytic lipoprotein) were found as sole coagulation defects in seven and eight patients, respectively. Ten patients had mixed defects; 7 of these 10 had thrombophilia with resistance to activated protein C. Sinusoidal dilatation was a constant feature in maxillary and mandibular bone biopsies, suggesting venous occlusion with intramedullary hypertension. Marrow fibrosis and occasional fibrin plugs were additional microscopic features believed to impair venous drainage and to contribute to ischemic necrosis of the alveolar bone. CONCLUSIONS: Primary thrombophilia and hypofibrinolysis appear to be common, heritable, pathophysiologic risk factors for idiopathic osteonecrosis of the jaws. These coagulation defects may also contribute to alveolar neuralgia, atypical odontalgia and facial neuralgia, idiopathic trigeminal neuralgia, and to treatment failures so often encountered in patients with alveolar osteonecrosis and disabling chronic facial and jawbone pain syndromes.

A preliminary pilot study of treatment of thrombophilia and hypofibrinolysis and amelioration of the pain of osteonecrosis of the jaws.

OBJECTIVES: In a preliminary pilot study of 30 treatments in 26 patients with osteonecrosis of the jaws and chronic disabling facial pain, our specific aim was to determine whether, to what degree, and how safely therapy of hypofibrinolysis and thrombophilia would ameliorate the chronic pain associated with osteonecrosis of the mandible and maxilla. STUDY DESIGN: Thrombophilia was treated with Coumadin (DuPont) in 10 patients; hypofibrinolysis was treated with Winstrol (Sanofi-Winthrop) in 20 patients, including 4 who had mixed thrombophilia and hypofibrinolysis and had previously been treated with Coumadin. The initial treatment period was targeted to be 4 months. Each patient was asked to keep a daily written pain-relief numeric rating score and side-effects diary and to provide a summary pain-relief numeric rating score and side effects compilation for the total treatment period. RESULTS: There were 4 men and 22 women in the study group; their mean age was 49 +/- 11 years. The mean onset of their osteonecrosis pain was at age 45 +/- 12 years, and the mean duration of their facial pain prior to therapy was 4.5 +/- 4.2 years. Ten patients had one or more thrombophilic traits (there were two patients with protein C deficiency, five with resistance to activated protein C and/or the mutant Factor V Leiden gene, and four with high anticardiolipin antibodies). The 10 patients who were thrombophilic were treated with Coumadin (the international normalized ratio was targeted to 2.5-3.0) for 22 +/- 9 weeks. By self-reported pain-relief numeric rating scores, 6 of the 10 patients with thrombophilia (60%) had > or = 40% pain relief, 2 (20%) had no change, and 2 (20%) had increased pain (30% and 80% worse). Nine of the 10 patients with thrombophilia (90%) had no Coumadin-related side effects; 1 patient (10%) stopped Coumadin therapy (after 28 weeks) because of nosebleeds. Winstrol (6 mg per day) was used for 16 +/- 9 weeks in 20 patients with hypofibrinolysis, some of whom had one or more hypofibrinolytic traits (10 had high levels of plasminogen activator/inhibitor activity, usually accompanied by low stimulated tissue plasminogen activator activity; 13 had high Lp[a] lipoprotein). Of these 20 patients with hypofibrinolysis, 9 patients (45%) had > or = 40% pain relief, 3 patients (15%) had 20% to 30% relief, 5 patients (25%) had no improvement, and 3 patients (15%) had increased pain (30% worse, 60% worse, and 70% worse). Six of the 20 patients with hypofibrinolysis (30%) had no Winstrol-related side effects, while 14 (70%) had side effects that could be attributed to Winstrol, including weight gain, peripheral edema, increased facial and body hair, and acne--all of which were reversed within 6 weeks of stopping Winstrol therapy. CONCLUSIONS: We postulate that thrombophilia and hypofibrinolysis lead to impaired venous circulation and venous hypertension of the mandible/maxilla with subsequent development of osteonecrosis and chronic facial pain. In many patients, facial pain can be ameliorated by treating the pathogenetic coagulation defects with Coumadin or Winstrol. Large, double-blind, placebo-controlled crossover studies will be required in the future to validate these preliminary results and to determine whether pain relief with Coumadin or Winstrol justifies the risks and side effects associated with these medications, especially for long-term use, in osteonecrosis of the jaws.

Cancer prevention in the dental practice: oral cancer screening and tobacco cessation advice.

OBJECTIVES: In this paper we describe the proportion of US adults who report receiving oral cancer screening and tobacco cessation counseling and assistance from dentists and other health professionals. METHODS: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of 12,035 adults 18 years of age and older, are analyzed. RESULTS: In 1992, less than 10 percent of adults reported oral cancer screening by a dentist or hygienist within the past three years. White adults (10.1%, 95% CI = 9.3, 10.9) reported an oral cancer screening three times more frequently than black (3.2%, 95% CI = 1.9, 4.5) or Hispanic (3.4%, 95% CI = 2.1, 4.7) adults. About half of adult current smokers had seen a dentist within 12 months, and of those only 24.1 percent (95% CI = 21.7, 26.5) had been advised to quit smoking. Heavy smokers (two or more packs a day) were more likely to have been advised to quit than light (pack or less per day) or occasional smokers. A similar proportion (24.3%, 95% CI = 17.6, 31.0) of white adult men who reported using smokeless tobacco products had been told by a dentist to quit using tobacco. CONCLUSIONS: Results from this population-based survey indicate that cancer screening and tobacco cessation advice are underutilized in the dental practice. Increased patient awareness and implementation of screening and tobacco cessation interventions could improve oral cancer incidence and mortality and have a public health benefit for other tobacco-related morbidity and mortality as well.

Reviewing oral leukoplakia: clinical concepts for the 1990s.

Microscopic evidence of dysplasia is not necessary to diagnose leukoplakia. Rather leukoplakia is clinically diagnosed not so much by defining appearances as by excluding other lesions also appearing as oral white plaques.

Common oral lesions found during a mass screening examination.

The first detailed study of common oral connective tissue and mucosal lesions in US adults is reported. More than 10% of the 23,616 white Americans who participated in a mass screening examination had at least one oral lesion. The 30 most common lesions, which represented more than 93% of all reported lesions, are ranked according to gender-specific prevalence rates. Leukoplakia was the most common mucosal lesion. Oral carcinoma ranked 24th overall. Data from this study are compared with data from other studies dealing with the prevalence of oral lesions.

Juvenile juxtavermilion candidiasis: yet another form of an old disease?

Five cases of a chronic, self-limiting Candida albicans infection of the lip vermilion and juxtavermilion skin in young persons are presented. These infections typically appeared as erythematous, pruritic, yellow crusting plaques of the juxtavermilion skin, with or without desquamation of vermilion surfaces. Evidence of intraoral candidiasis, especially loss of filiform lingual papillae, was present in several cases. The disorder mimics the early stage of chronic mucocutaneous candidiasis but remains within a few millimeters of the mucocutaneous junction and affected individuals appear (with a possible exception) to be immune competent. Mild trauma apparently triggers the infection. The authors emphasize that a scientifically sound cause-and-effect relationship between this new disease and Candida albicans is not herein established and present these cases in the hope that others will thereby be identified and a firmer causal relationship be established.

Rapid orthodontics with alveolar reshaping: two case reports of decrowding.

Two case reports demonstrate a new orthodontic method that offers short treatment times and the ability to simultaneously reshape and increase the buccolingual thickness of the supporting alveolar bone. A 24-year-old man with a Class I severely crowded malocclusion and an overly constricted maxilla with concomitant posterior crossbites and a 17-year-old female with a Class I moderately to severely crowded malocclusion requested shortened orthodontic treatment times. This new surgery technique included buccal and lingual full-thickness flaps, selective partial decortication of the cortical plates, concomitant bone grafting/augmentation, and primary flap closure. Following the surgery, orthodontic adjustments were made approximately every 2 weeks. From bracketing to debracketing, both cases were completed in approximately 6 months and 2 weeks. Posttreatment evaluation of both patients revealed good results. At approximately 15 months following surgery in one patient, a full-thickness flap was again reflected. Visual examination revealed good maintenance of the height of the alveolar crest and an increased thickness in the buccal bone. The canine and premolars in this area were expanded buccally by more than 3 mm, and yet there had actually been an increase in the buccolingual thickness of the overlying buccal bone. Additionally, a preexisting bony fenestration buccal of the root of the first premolar was covered. Both of these findings lend credence to the incorporation of the bone augmentation procedure into the corticotomy surgery because this made it possible to complete the orthodontic treatment with a more intact periodontium. The rapid expansive tooth movements with no significant apical root resorption may be attributed to the osteoclastic or catabolic phase of the regional acceleratory phenomenon. Instead of bony "block" movement or resorption/apposition, the degree of demineralization/remineralization might be a more accurate explanation of what occurs in the alveolar bone during physiologic tooth movement in these patients.

Oral leukoplakia--rationale for diagnosis and prognosis of its clinical subtypes or "phases".

The precancerous nature of the most common of chronic oral mucosal lesions, leukoplakia, is much better understood now than at any time since it was first brought to professional attention by Sir James Paget 143 years ago. Clinical research from the past decade now allows confident identification of high-risk features of oral leukoplakias and of those persons affected by them. This paper summarizes current understanding of this important disease and provides practical suggestions for appropriate management and classification of its various subtypes or "phases."

Exogenous estrogen may exacerbate thrombophilia, impair bone healing and contribute to development of chronic facial pain.

A 32 year old white female, in apparently good health, failed to respond to conservative wound care for alveolar osteitis after a routine mandibular first molar extraction. Curettage and biopsy of necrotic alveolar bone from the #30 socket escalated her pain such that hospitalization was necessary for pain management with intravenous morphine. Twelve months prior to admission she had been placed on exogenous estrogen (Premarin, 0.625 mg/day) after a partial oophorectomy. While hospitalized, she was found to have resistance to activated protein C (APCR). Premarin was discontinued. After discharge, weekly changes of an antibiotic impregnated dressing allowed for progressive regeneration of bone and epithelium with gradual reduction in her pain. She was found to be heterozygous for the mutant Factor V Leiden, a heritable factor for increased tendency to form thrombi, so-called thrombophilia. We speculate that the exogenous estrogen administration exacerbated the thrombophilia associated with the Factor V Leiden mutation by compounding the patient's resistance to activated protein C thereby contributing to her development of osteonecrosis and severe alveolar neuralgia.

Oral leukoplakia and erythroplakia: a review and update.

Soft tissue health in the oral cavity is essential for overall dental and medical health and a successful maintenance of any restoration. This article reviews the clinical, etiologic, and prognostic features of oral leukoplakia, the most common of all chronic mucosal lesions, affecting 3% of all adults. The newest definitions for leukoplakia, erythroplakia, and smokeless tobacco keratosis are offered, along with a rationale for predicting malignant transformation and for treatment planning of these most important precancers. The learning objective of this article is to update the information for the clinician for early diagnosis and treatment of these lesions.