Central sensitization in burning mouth syndrome: a practical approach using questionnaires.

OBJECTIVES: Some experts have suggested that burning mouth syndrome (BMS) should be included in the family of central sensitivity syndromes, a group of similar medical disorders linked by the central sensitization (CS) mechanism. Our objective is to assess the presence of CS in patients with BMS by performing a clinical examination and administering questionnaires to measure the generalized extent of pain, the presence of associated symptoms, and the number of other concurrent chronic pain conditions. STUDY DESIGN: We conducted a case-control study in 82 subjects (40 patients with BMS and 42 controls). Patients with BMS were diagnosed using The International Classification of Headache Disorders 3rd edition, beta version (ICHD-IIIß) criteria. The Widespread Pain Index (WPI) and Symptom Severity (SS) Score questionnaires were used to determine the degree of central sensitivity. The number of other concurrent chronic pain conditions was determined with the Neblett inventory. RESULTS: Data indicative of CS show a statistically significant association with BMS. Both SS Score and Widespread Pain Index scores higher in patients with BMS. Additionally, patients with BMS reported a significantly higher number of other central sensitivity syndromes. CONCLUSIONS: Patients with BMS could present a CS component as well as other chronic pain conditions. The use of questionnaires may be useful to determine the degree of central sensitivity in patients with BMS.

The pattern of lip cancer occurrence over the 1990-2011 period in public hospitals in Madrid, Spain.

BACKGROUND: Some regions of Spain along with Canada and Australia have the highest rates of lip cancer in the world. The objective of this study was to examine the trends in the pattern of occurrence of lip cancer in Madrid, Spain. METHODS: Data were extracted from the Central Tumour Registry of Madrid, between 1990 and 2011. Variables examined were age, sex, topographic and morphological location and tumour histology. Two consecutive periods, 1990-2001 and 2002-2011, were studied by descriptive and analytical methods, and the data from the two periods were statistically compared. RESULTS: A total of 881 cases were registered during the period 1990-2011. Comparing data between the two periods (1990-2001 and 2002-2011), subtle variations in age, histology and location were noted. Gender ratios remained constant. The mean age increased from 66.3 to 69.7 years (P < 0.05). In the second period, the histological distribution showed an increase in frequency of basal cell carcinoma, from 2.1% to 4.7%, while the frequency of squamous cell carcinomas remained constant. Basal cell carcinoma no longer predominantly occurred in women, decreasing from 80% to 21.1% (P < 0.001). The distribution by gender of squamous cell carcinoma had become more equal due an increase in its frequency in women (P < 0.001). Frequency of tumours on lip mucosa and commissure had increased between the two periods (P < 0.004). CONCLUSIONS: The pattern of lip cancer reported to Public Hospitals of Madrid is changing: declining rates are noted since 2001-02. However, it is necessary to monitor these data to confirm the observed trends in future years.

Ability of Dental Students in Spain to Identify Potentially Malignant Disorders and Oral Cancer.

The aim of this study was to assess the ability of students at the School of Dentistry, Complutense University of Madrid, Spain, to diagnose oral cancer and other potentially malignant disorders, as well as to compare their ability at different stages of the learning process and evaluate their knowledge retention. Students were surveyed after they had studied oral medicine and oral pathology at two time points: midway through and near the end of their studies. The survey consisted of questions about 40 photographs of benign oral lesions, malignant oral lesions, and potentially malignant disorders. The response rate for all groups was greater than 70%. The results showed that these students' overall success rate in differentiating benign from malignant lesions averaged 73.9%. When the distinction for potentially malignant disorders was included, their average overall success rate decreased to 42.8% (p<0.001). Furthermore, the students' average success rate was at its lowest at the end of the dental program (p<0.001). Results from this study suggest that, given these students' difficulties in identifying potentially malignant disorders, an increased emphasis on cancer education in the dental curriculum may be needed for future practitioners to master this ability.

Diagnostic criteria in proliferative verrucous leukoplakia: evaluation.

OBJECTIVES: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. STUDY DESIGN: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. RESULTS: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. CONCLUSIONS: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease.

Simulation for training in oral cancer biopsy: a surgical model and feedback from GDPs.

OBJECTIVES: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees' perception. STUDY DESIGN: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific check-lists and by means of a self-applied questionnaire. RESULTS: The workshop was perceived as "very interesting" even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). CONCLUSIONS: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills.

The use of toluidine blue in the detection of pre-malignant and malignant oral lesions.

INTRODUCTION: The purpose of this study was to evaluate the efficacy of the toluidine blue (TB) test as a diagnostic tool in the detection of malignant and dysplastic lesions of the oral cavity. This study was carried out because of a lack of consensus among different authors on the utility of TB, as well as to determine useful adjuncts to detect oral pre-cancer and cancer. MATERIALS AND METHODS: The study included 160 patients with oral mucosal disorders that included suspicious or malignant lesions detected at clinical visual examination, confirmed by histopathological evaluation. All lesions were submitted to TB staining. RESULTS: The sensitivity and specificity for the detection of malignant or dysplastic lesions by this test were 65.5% and 73.3%, respectively. Overall, the detection rate with TB (sensitivity) was slightly lower compared with those reported by other authors but the specificity was comparable to several reports. Positive predictive value (35.2%) was also lower than previous studies, whereas negative predictive value (90.6%) was similar. CONCLUSIONS: The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.

Case report of necrotizing sialometaplasia.

INTRODUCTION: Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involve minor and major salivary glands. Gland tissue ischaemia has been proposed as the aetiology. CASE REPORT: A 21-year-old woman was referred with a 1-week history of bilateral painful swelling of the palate, with the development of two deep ulcers after the first 3 days. Ulcer edges were elevated but not indurated, and the bases had a necrotic appearance. An incisional biopsy of the margin of one ulcer confirmed the diagnosis of necrotizing sialometaplasia. The ulcers spontaneously healed within 8 weeks without treatment. DISCUSSION: The clinical and histological similarity between this entity and a malignant lesion implies a risk of unnecessary or inadequate treatment. This case illustrates the need for an incisional biopsy to be analyzed by an experienced pathologist to establish a correct diagnosis.

Proliferative verrucous leukoplakia: a proposal for diagnostic criteria.

Proliferative verrucous leukoplakia (PVL) is a rare form of oral leukoplakia, which was first described in 1985 by Hansen et al. Since then, various published case series have presented PVL as a disease with aggressive biological behaviour due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. PVL is a long-term progressive condition, which is observed more frequently in women and elderly patients over 60 years at the time of diagnosis. Eventually, PVL tends to become multifocal with a progressive deterioration of the lesions, making it more and more difficult to control. Tobacco use does not seem to have a significant influence on the appearance or progression of PVL. These lesions may occur both in smokers and non-smokers. Nevertheless, at present, the aetiology of PVL remains unclear as well as its management and diagnosis, which is still retrospective, late and poorly defined, lacking consensus criteria. Therefore, the aim of this study is to propose a set of diagnostic criteria to allow for the early and objective identification of PVL cases, and thereby conduct an adequate management. The proposal includes five major criteria and four minor criteria, as well as specific combinations among them in order to establish a correct and objective diagnosis of proliferative verrucous leukoplakia.

Implications of prion diseases for dentistry: an update.

Prions are normal proteins present in all mammals, especially in the central nervous system (CNS) and lymphoreticular tissue. Their transformation into a highly infectious molecule gives rise to a group of diseases known as transmissible spongiform encephalopathies (TSEs), which cause vacuolar degeneration of gray matter and produce a fatal neurodegenerative disorder. Prion diseases have attracted considerable attention in recent years, and this review of the literature was designed to determine their implications for dentistry, studying the possibility of cross-transmission in the dental office and describing their oral manifestations. The main oral manifestations are dysphagia, dysarthria, paresthesias, dysesthesias, and dysgeusia. The most frequently involved oral tissues are the trigeminal ganglion, posterior third of the tongue, tonsils, and, much less commonly, alveolar nerves, gingiva, and salivary glands. Although no contagion has been reported in the dental setting to date, prions resist the usual dental sterilization systems and transmission of this type of disease remains a potential risk. It is therefore important for dentists to be aware of these diseases, to identify high-risk patients by obtaining an adequate clinical history, and to know the appropriate procedures to be followed.

Genotypic determination by PCR-RFLP of human papillomavirus in normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma samples in Madrid (Spain).

BACKGROUND: Human papillomaviruses (HPVs), especially genotypes 16 and 18, are considered to be human carcinogens by the International Agency for Research on Cancer (IARC). They are the most important etiological agents of uterine cervix cancer but their true role in oral carcinogenesis is controversial. OBJECTIVES: To detect the presence of HPV genome genotypes in oral leukoplakia and oral squamous cell carcinoma (OSCC) and analyze their relationship with clinicopathological variables. MATERIALS AND METHODS: Presence of genome ofHPV types 6, 11, 16, 18, 31, 33, 39, 42, 45, and 52 was studied by polymerase chain reaction in samples of normal mucosa (30 controls), oral leukoplakia (35 cases) and OSCC (33 cases). Results were compared between groups and differences were examined in relation to clinical and histological variables. RESULTS: HPV genome was detected in 23.3% of controls, 45.7% of oral leukoplakias, and 39.4% of OSCCs. Only HPV-16 was significantly (p=0.0005) more frequently detected in leukoplakias (40%) and OSCCs (33.3%) versus controls (0%). No significant relationship was found between the presence of viral genome and the main clinicopathological variables. CONCLUSION: According to these findings, the presence of HPV-16 is significantly associated with oral leukoplakia and OSCC lesions, therefore in our setting this virus may be a carcinogenic element in this disease.

Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature.

For centuries, mouthwashes have been used in order to provide us with oral health or cosmetic benefits. Nowadays, in most countries, there is a variety of formulas available for the general public in the form of products which may require prescription or not. Alcohol is used in mouthwashes as a solvent of other ingredients and as a preservative of the preparation. For years, different formulas of mouthwashes have been used, however, the question about its alcohol content being a threat for health or not has recently appeared. The high quantity of alcohol in some mouthwashes combined with the fact that they keep in contact with the oral mucosa for much more time than alcoholic drinks, can make us think about a harmful effect from a local mechanism. Mouthrinses increase the time of the mucosa being in contact with alcohol and it has been proved that those with a high content of alcohol do cause hyperkerastosic lesions both in human beings and laboratory animals. At the moment and with the data we have, it has not been possible to establish a causal relationship between the use of alcohol-containing mouthwashes and the development of oral cancer. There is neither an evidence of the fact that alcohol increases the effects of antiplaque agents in mouthwashes.

Effects of the consumption of alcohol in the oral cavity: relationship with oral cancer.

In an epidemiologic point of view the consumption of alcoholic beverages is found to be associated to an increased risk for developing an upper gastrointestinal tract cancer. The relation of the studies that establish this connection is complicated due to both the confluence of various risk factors within the same person such as alcohol and tobacco, and to the lack of data that can be verifiable by the clinician. For this reason the exact pathogenic mechanism responsible for this increase of risk is not known since ethanol per se was not confirmed to be carcinogenic. Different hypotheses have been proposed, explaining how ethanol, by oral or systemic route, can act as a risk factor for the development of oral cancer. This article serves as a review of the actual situation of the potential pathogenic mechanisms, dividing them in local and systemic effects. Within the aforementioned special reference is made on the alteration of the oral mucosa permeability, the action of acetaldehyde and the role of retinoids.