Immune mechanisms in oral lichen planus.

Oral lichen planus (OLP) is a T cell-mediated inflammatory disease of the oral mucosa that has been extensively researched over many years but as yet the mechanisms of pathogenesis are still not fully understood. Whilst the specific aetiological factors driving OLP remain ambiguous, evidence points to the development of a chronic, dysregulated immune response to OLP-mediating antigens presented by innate immune cells and oral keratinocytes leading to increased cytokine, chemokine and adhesion molecule expression. These molecules recruit T cells and mast cells to the diseased site and orchestrate a complex interplay between cells that culminates in keratinocyte cell death, mucosal basement membrane destruction and long-term chronicity of the disease. The main lymphocytes involved are thought to be CD8+ cytotoxic and CD4+ Th1 polarised T cells although recent evidence indicates the involvement of other Th subsets such as Th9, Th17 and Tregs, suggesting that a more complex immune cell relationship exists during the disease process. This review provides an overview of the immune mechanisms at play in OLP pathogenesis with particular emphasis on the role of the different Th subsets and how these recent discoveries may guide research towards identifying potential therapeutic targets.

Arab dentists' refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools.

OBJECTIVE: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention. MATERIALS AND METHODS: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients. RESULTS: The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54). CONCLUSIONS: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

Systematic review of the changing pattern of the oral manifestations of HIV.

The purpose of the present study paper was to review the reported prevalence of the oral manifestations of HIV (OM-HIV) worldwide since 1980, and to determine the global variation in its prevalence over time. PubMed, Scopus, Embase and Google Scholar were searched. The filter "English" was used. The timeframe searched was 1980- 2015. The PRISMA flow chart was used. Data were extracted using the Joanna Briggs Institute standardized data extraction form and transferred to SPSS version 22 for analysis. The systematic review of 97 studies (70 low bias risk) showed that the prevalence of OM-HIV continue to be significant in developing countries. Globally and through all the decades, oral candidiasis remained the most commonly encountered OM-HIV, including among patients on antiretroviral therapy (ART) (26.2%). Hairy leukoplakia was more prevalent in Europe and America compared with Africa and Asia. Oral warts were reported more often in studies on patients receiving ART. Interestingly, salivary gland disease decreased in the developed world and increased in developing countries over time. Despite the changing pattern of these conditions over time, there is no evidence that the OM-HIV have become of less significance globally. Maintaining the drive for high-quality research in the subject will have an impact on less developed countries to help address oral health inequalities.