Changes in salivary oxidative status, salivary cortisol, and clinical symptoms in female patients with temporomandibular disorders during occlusal splint therapy: a 3-month follow up.

BACKGROUND: Differences in the expression of oxidative stress (OS) markers between female patients with temporomandibular disorders (TMD) and healthy individuals indicate that OS plays a role in the pathogenesis of TMD. Because chronic exposure to stress generates oxidative damage during continuous stimulation of the hypothalamic-pituitary-adrenal axis, we expected that higher levels of cortisol might be associated with higher oxidative damage. Our aim was to test the association between OS markers, stress perception, and salivary cortisol (SC) in chronic, female TMD patients. We tracked changes in OS markers and SC during occlusal splint therapy in order to evaluate the influence of treatment on oxidative status. We hypothesized that the effects of TMD therapy would differ among individuals depending on the source and intensity of pain. METHODS: Sixteen female patients were recruited, and 12 finished the study. Clinical assessment and saliva sampling were performed at the baseline and follow-up appointments. Repeated measures analysis of variance and Pearson's correlation were used for analyzing the data. RESULTS: After 3 months, a significant reduction in afternoon total antioxidant capacity (TAC) was observed (p < 0.05). A significant reduction in afternoon malondialdehyde (MDA) (p = 0.021) and a decrease in afternoon MDA to superoxide dismutase ratios (p = 0.017) were present in high-intensity pain patients. At baseline, higher levels of perceived stress were significantly associated with higher morning cortisol (ρ = 0.67). At the end of the therapy,  reduced  perceived stress was positively correlated with morning SC changes when considering all TMD patients, but the association between perceived stress with OS markers was present only in myofascial pain (MP) group. The effect of treatment on the self-perceived quality of life was more pronounced in female MP patients while the reduction of spontaneous pain was significantly greater in high-intensity pain patients. CONCLUSION: Our data indicate that occlusal splint therapy in female TMD patients contributes to increasing their capacity to remove free radicals. The question remains whether or not TAC decreases in this process as a result of avoiding unnecessary processes, once the increase in antioxidants effectively compensates for OS. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers and their association with perceived stress and SC in TMD patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03029494 . Registered on 2017-01-19.

Human- and mouse-derived neurons can be simultaneously obtained by co-cultures of human oral mucosal stem cells and mouse neural stem cells.

OBJECTIVE: To observe simultaneous differentiation and analyse possible interactions between co-cultured human oral mucosal stem cells (hOMSC) and mouse neural stem cells (mNSC). MATERIALS AND METHODS: hOMSC and mNSC were co-cultured in mouse and in human medium, and their immunocytochemical characterization to detect survival rate and differentiation pattern was performed. Co-cultures in different media were compared to hOMSC in human medium and mNSC in mouse medium as controls. RESULTS: Co-culture of hOMSC and mNSC in medium for human cells led to normal differentiation pattern of human cells, while mNSC were directed towards astrocytes. When the same cells were cultivated in the mouse medium, both cell types succeeded to form neurons, although mNSC showed a tendency to overgrow hOMSC. hOMSC alone in the human-specific medium differentiated towards ectodermal (Oct4, Map2) and mesodermal (Osterix) cell populations. mNSC in the mouse-specific medium differentiated towards Map2-, ß3-tubulin- and NeuN-positive neurons. CONCLUSIONS: hOMSC and mNSC can form co-cultures. Different media considerably affected the differentiation pattern of co-cultures, whereas one cell population itself modestly influenced differentiation of the other cell type. The in vitro differentiation pattern of hOMSC in the mouse neural tissue environment suggested that hOMSC could be beneficial in the brain tissue affected by ischaemia.

Impact of reassurance on pain perception in patients with primary burning mouth syndrome.

OBJECTIVES: In spite of extensive research, no effective treatment of primary burning mouth syndrome (BMS) still exists. The aim of this study was to determine the impact of informative intervention/reassurance on pain perception and quality of life in patients with primary BMS. MATERIALS AND METHODS: Informative intervention/reassurance was undertaken in 28 patients diagnosed with primary BMS. Patients received information about all aspects of BMS verbally and in an informative leaflet. Numerical scale (0-10), Pain Catastrophizing Scale and Oral Health Impact Profile-14 (OHIP-14) were used to assess pain intensity, pain perception, and quality of life before the intervention and 6 months after. No other treatment was given to the patients. RESULTS: Significant reduction in symptom intensity, pain catastrophizing along with positive increase in the quality of life compared with baseline, was observed on a follow-up examination 6 months after the informative intervention (P < 0.001). CONCLUSIONS: The results of this study confirm that objective informing/reassurance of patients with primary BMS can result in decreased catastrophizing and improvement in the quality of life. By eliminating/changing negative patterns of behavior, a reduction in symptoms comparable with pharmacological treatment can be achieved.

Effect of L-arginine dietary supplementation on salivary urea concentration and pH in physically active individuals.

BACKGROUND: The aim of this study was to assess if the consumption of 3 g of a commercially available L-arginine dietary supplement causes a postabsorptive rise in urea concentration or pH of unstimulated saliva in a group of physically active individuals. METHODS: Salivary urea and pH were determined for 117 participants in a randomized double-blinded placebo-controlled study. Samples were collected by 'spitting' method in fasting conditions. One hour prior to their second visit, participants consumed three tablets of L-arginine or placebo. RESULTS: Urea concentration was significantly lower at second measurement for both the study and control group. The magnitude of the change was not significant between the groups. pH was higher for both groups at second measurement, but only significant for the study group. The magnitude of the change was significant between the groups. Participants who intermittently ingested protein dietary supplements and those with a Body Mass Index (BMI) higher than 25 had significantly higher basal urea concentration. CONCLUSIONS: The results of this study did not confirm the hypothesis. Further studies are needed to determine the effects of different doses of L-arginine supplements on the biochemical composition of saliva and the influence of their long-term consumption on the risk of developing dental diseases.

Risk factors for bruxism among Croatian navy employees.

The aim of the study was to evaluate the relationship between bruxism, and sociodemographic parameters, symptoms of temporomandibular disorders (TMD), personality and war experience among Croatian navy employees. The sample included 1092 subjects, aged 20-60 years (mean age 37·06 ± 7·85). An individual's bruxism status was based on clinical oral examination and participants' report of bruxism. Subjects with bruxism index values ≥ 90th percentile were included in severe bruxism group (n = 111), and those with scores below 90th percentile were labelled as negligible bruxism group (n = 981). No differences were found in gender distribution between the two groups. The proportion of military personnel presenting with bruxism is double the proportion of administrative employees with bruxism. A total of 23·34% subjects in negligible bruxism group and 48·65% in severe bruxism group participated in the war. Subjects in severe bruxism group presented more TMD-related signs and symptoms than those in negligible bruxism group. Higher prevalence of neuroticism and psychoticism was found in severe bruxism group. According to logistic regression, the probability of severe bruxism was significantly associated with marital status [Odds ratio (OR) 6·859, 95% confidence interval (CI) 3·869-12·158 P < 0·001], neuroticism (OR 2·842, 95% CI 1·434-5·632 P = 0·003), psychoticism (OR 2·618, 95% CI 1·193-5·746 P = 0·016), military duty (OR 1·828, 95% CI 1·013-3·298 P = 0·045) and masticatory muscles tenderness (OR 9·372, 95% CI 4·923-17·841 P < 0·001). Smokers had a 2·72-fold (95% CI 1·706-4·335 P < 0·001) higher risk of bruxism than non-smokers. Subjects who participated in war were more represented in severe bruxism group. Further studies, including other potential risk factors, are required to clarify these relationships.

Jaw elevator silent periods in complete denture wearers and dentate individuals.

Functional meaning and underlying mechanisms of jaw elevator silent period (SP) have still not been completely understood. Since complete denture wearers (CDWs) have no periodontal receptors in their jaws, the aim was to examine SPs in CDWs and to compare it with dentate individuals (DIs). Thirty six DIs (skeletal/occlusal Class I) and 24 eugnath CDWs participated. EMG signals were registered using the EMGA-1 apparatus from the left and the right side anterior temporalis (ATM) and masseter muscles (MM). Ten registrations of an open-close-clench (OCC) cycle were obtained for each individual. DIs had the average latency between 12.5 and 12.9 ms and always one single short inhibitory pause (IP) with complete inhibition of motoneurons (20.1-21.1 ms). On the other hand, in CDWs various types of SPs emerged: single or single prolonged SPs, double SPs, SPs with three IPs, periods of depressed muscle activity following the first, or the second IP, SPs with relative inhibition of motoneurons or even in several registrations the SP was missing. Unless more than one IP emerged, complete duration of inhibitory pauses (CDIP) was measured. CDIP varied from 37.17 to 42.49 ms. Average latencies were from 16.22 to 16.76 ms. Based on the results of this study it is obvious that both, the duration and the latencies were significantly longer in CDWs than in DIs (p<0.05), which can be explained by different mechanisms responsible for the muscle reflex behaviour.

Delayed contact sensitivity on the lips and oral mucosa due to propolis-case report.

We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products.

The influence of age and dental status on elevator and depressor muscle activity.

The objective of this study was to determine whether the muscle activity at various mandibular positions is affected by age and dental status. Thirty edentulous subjects (E), 20 young dentate individuals (G1) and 20 older dentate individuals (G2) participated in this study. Surface electromyographic (EMG) recordings were obtained from the anterior temporal (T), masseter (M) and depressor muscles (D). Muscle activity was recorded during maximal voluntary contraction (MVC), maximal opening (O(max)) and in six different mandibular positions. One way anova and the Bonferroni tests were used to determine the differences between groups. Significant differences between the three tested groups were found at MVC and O(max) for all examined muscles (P < 0.001). The differences in muscle activity in dentate subjects of different age were found in protrusion for depressor muscles (P < 0.05) and in lateral excursive positions for the working side temporal (P < 0.05) and non-working side masseter and depressor muscle (P < 0.05). There was a significant effect regarding the presence of natural teeth or complete dentures in protrusion and maximal protrusion for all muscles (P < 0.05) and in lateral excursive positions for non-working side temporal (P < 0.05) and working side masseter muscle (P < 0.05). Muscle activity at various mandibular positions depends greatly on the presence of the prosthetic appliance, as edentulous subjects had to use higher muscle activity levels (percentages of maximal EMG value) than age matched dentate subjects in order to perform same mandibular movement. Different elevator muscles were preferentially activated in the edentulous subjects when compared with dentate group in lateral excursive positions of the mandible. The pattern of relative muscle activity was not changed because of ageing.

The significance of salivary interleukin 6 and tumor necrosis factor alpha in patients with oral leukoplakia.

It is well known that cytokines play an important role in oral diseases. Furthermore, increased levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) have been reported in patients with cancer and premalignant lesions such as oral lichen planus and oral submucous fibrosis. The aim of this study was to assess salivary IL-6 and TNF-alpha levels in 30 patients with histopathologically confirmed leukoplakia (age range 24-78, mean 52.3 years) in comparison to 34 controls (age range 27-79, mean 52 years). Salivary IL-6 and TNF-alpha were determined by enzyme linked immunoadsorbent assay. Statistical analysis was performed by use of Mann-Whitney test for independent samples and values lower than 0.05 were considered as significant (p<0.05). Significantly higher levels of salivary IL-6 and TNF-alpha in patients with oral leukoplakia when compared to healthy controls were found. The levels of salivary IL-6 and TNF-alpha did not correlate with the size of leukoplakia (lesions) nor with its localization regarding high and low risk sites for malignant transformation. Levels of salivary IL-6 and TNF-alpha were not influenced by smoking habits. We can conclude that increased salivary IL-6 and TNF-alpha might play a certain role in oral leukoplakia.

Dental health of elderly in retirement homes of two cities in south Croatia--a cross-sectional study.

OBJECTIVE: A survey of dental health status was conducted in institutionalized elderly in South Croatia in order to assess the oral health of the elderly population. PARTICIPANTS: In 274 institutionalised elderly from five retirement homes in Split and Korcula we registered dental status according to World Health Organization criteria. The mean age of the patients was 81 +/- 8; there were 220 female and 54 male subjects. RESULTS: A total of 192 (70.0%) were totally edentulous, and additional 39 (14.2%) were edentulous in one jaw. A significantly higher prevalence of edentulousness with the increasing age was recorded. The mean number of remaining sound teeth, decayed teeth and radices relictae in the elderly decreased with increasing age. CONCLUSIONS: The elderly population in retirement homes in South Croatia has poor dental health. This calls for action to improve dental health and implement some special features in the dental health service programs for the institutionalised elderly.

Non-aromatic naphthalane preparation; preliminary clinical study in the treatment of psoriasis vulgaris.

This study aimed to prove the similarity of the composition of non-aromatic Croatian naphthalane (NAN) with brown naphthalane (BN), which is used in the treatment of psoriasis vulgaris. The comparison of the compositions was performed by obtaining GC fingerprints, which were supported by GC-MS data. In spite of remarkable differences in general profiles of the GC chromatograms, lower and medium molecular weight components of NAN were found to be qualitatively the same as the saturated constituents of BN. Quantitatively, lower molecular weight components as well as all n-alkanes were comparatively lower in NAN. NAN, additionally, contained higher molecular weight components, among which there were saturated oligocyclic hydrocarbons (up to pentakishomohopanes), described as responsible for the curing effect of naphthalane. The composition characteristics of NAN including its non-aromatic character made it suitable for a clinical study. In the treatment, the efficacy was determined by means of comparison of Psoriasis Area Severity Indices, PASI, at the beginning and at the end of the therapy. Adult volunteer-patients, nine males and six females, applied NAN over the whole body, except the scalp, at the room temperature for 20 min and this was followed by the selective UVB radiation. After the 3-week therapy, all essential clinical manifestations as erythema, desquamation and infiltration were significantly reduced in 14 patients; in nine cases the improvement was 50-93%, while the state of five patients improved between 25 and 50%. In one case, there was no obvious change. No exacerbation occurred during the therapy period. No adverse effect on hematological or biochemical parameters was noticed.

Comparison of the composition of some petroleum samples which may be applied for skin and mucous membrane treatment.

A particular Croatian petroleum (sample P1) and its three derivatives (samples P2, P3 and P4), potentially applied as healing preparations for skin and mucous membrane treatment, were studied in order to learn their composition and to discriminate them according to two criteria: composition of natural petroleum compounds, and lacking aromatics. Elemental (C, H, N and S) and group composition (by LC, UV/VIS, IR and 1H NMR) were determined and the single component distributions were analyzed (by GC) and identified (by GC-MS). Focussed saturated compounds (n-alkanes, pristane and phytane, drimanes/eudesmanes, steranes and hopanes) were studied in order to emphasize the preservation or destruction of genuine petroleum structures in derivatives. Samples P2 (petroleum-brownish color, petroleum like smell) and P3 (colorless, transparent, slight pine-like odor), were found, now constituting petroleum, to still be composed of the components of their native structure. Compared to sample P1, they were missing light and heavy compounds. While sample P2 contained different compound classes, sample P3 comprised exclusively saturated hydrocarbons, satisfying pharmacopoeia's requirement regarding the low aromatics content. Almost a half of sample P3 was composed of cyclic moieties, including terpenoids, possibly responsible for the odor. Samples P1, P2 and P3 were found rather rich in steranes. Sample P4 (colorless, transparent, no smell) was found denaturalized. In spite of high similarity in bulk properties to sample P3, it comprised no detectable amount of n-alkanes, pristane and phytane, or drimanes/eudesmanes, steranes and hopanes (although found rich in oligocycles).