RESUMO
OBJECTIVES: Self-injury (SI) is defined as a behavioral disturbance consisting of a deliberate harm to one's own body without suicidal intent, it is not uncommon and ranges in severity from simple nail-biting to more extreme forms of self-mutilation. The head neck region may be the target of such lesions. SI is associated with several medical conditions, of which it can represent the first clinical sign. Aim of this paper is to describe a series of oral SI, giving special emphasis to the clinical findings, etiology and the management of lesions. MATERIAL AND METHODS: A total of 19 patients with oral SI were prospectively examined; attention was paid to the occurrence and characterization of oral lesions. The management of the lesion also varied depending on the patient medical history, on the etiology of the psychiatric behavior, and on the severity, frequency, and method of inflicting injury. Periodic examinations were performed (after two weeks, three months and six months) and registered. RESULTS: All the patients healed gradually and healing was conditioned by the disease underlying. The treatment consisted of behavior modification in 11 cases, pharmacological treatment in 11 cases, psychotherapy in 2 cases, mouth guard in 9 cases, surgery in 2 cases, extractions in 1 case. CONCLUSIONS: Oral SI are uncommon in the clinical practice. They may be associated with a known disease or may be the consequence of this, but often they may be the first sign of a psychiatric disorder.
Assuntos
Boca/lesões , Comportamento Autodestrutivo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Comportamento Autodestrutivo/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/etiologia , Adulto JovemRESUMO
This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39â¶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous (<1 month, 1-3 months, >3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: 'Personal experience of cancer' (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11-0.99; polytomous delay: P=0.006, Chi-square=10.224) and 'Unawareness' (dichotomous delay: P<0.01, OR=4.96, 95% CI=2.16-11.37; polytomous delay: P=0.087, Chi-square=4.77). Also 'Denial' (P<0.01, OR=6.84, 95% CI=2.31-20.24) and 'Knowledge of cancer' (P=0.079, Chi-square=8.359) were found to be statistically significant both for dichotomous and for polytomous categorization of delay, respectively. The findings of this study indicated that, in the investigated cohorts, the knowledge about cancer issues is strongly linked to the patient delay. Educational interventions on the Mediterranean population are necessary in order to increase the patient awareness and to emphasize his/her key role in early diagnosis of OSCC.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Cognição , Diagnóstico Tardio , Neoplasias Bucais/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Conscientização , Carcinoma de Células Escamosas/psicologia , Estudos de Coortes , Negação em Psicologia , Medo/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/psicologia , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
PURPOSE: To investigate the plaque inhibiting effects of two commercially available mouthrinses containing essential oils (EO). Both products contained the same concentration of EO, but one of them did not contain ethanol. METHODS: The study was an observer-masked, randomized, 4 x 4 Latin square cross-over design, balanced for carryover effects, involving 12 participants in a 4-day plaque regrowth model. A 0.12% chlorhexidine (CHX) rinse and a saline solution served as positive and negative controls, respectively. On Day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On Day 5, subjects were scored for disclosed plaque. RESULTS: Differences among treatments were highly significant (P < 0.0001), with greater plaque inhibition by CHX compared to EO rinse containing ethanol (P = 0.012), which, in turn, was significantly more effective than the rinse without ethanol and the saline (P < 0.001). The reduction in plaque regrowth seen with the EO rinse without ethanol was quite similar to that elicited by saline (P > 0.05).
Assuntos
Placa Dentária/patologia , Doenças da Gengiva/prevenção & controle , Antissépticos Bucais , Óleos Voláteis , Estudos Cross-Over , HumanosRESUMO
Modern pharmaceutical science has provided us with a wide range of substances to be administered with a wide large variety of dosage forms. Local drug delivery systems have been used for a long time; in particular, for the local therapy of diseases affecting the oral cavity. Although these diseases are often extremely responsive to local therapy, the mouth often presents various difficulties in the application of topical compounds (owing to saliva and the mouth's different functions), resulting in a short retention time of dosage forms with a consequent low therapeutic efficacy. To resolve these limitations, research today concentrates on the development of bioadhesive formulations. This review focuses on the permeability features of oral mucosa, the rationale of oral local drug delivery, and new potential bioadhesive local delivery systems. Furthermore, the most promising mucoadhesive systems proposed to locally treat oral diseases are discussed.
Assuntos
Preparações Farmacêuticas Odontológicas/administração & dosagem , Adesivos , Administração Bucal , Administração através da Mucosa , Administração Sublingual , Química Farmacêutica , Formas de Dosagem , Sistemas de Liberação de Medicamentos , Humanos , Mucosa Bucal/metabolismo , Permeabilidade , Preparações Farmacêuticas Odontológicas/química , Preparações Farmacêuticas Odontológicas/farmacocinéticaRESUMO
Since the activity of several conventional anticancer drugs is restricted by resistance mechanisms and dose-limiting side-effects, the design of formulations for local application on malignant lesions seems to be an efficient and promising drug delivery approach. In this study, the effect of locally applied 5-FU on cell death was evaluated both in a SCC4/HEK001 model and in a newly proposed 3D outgrowth model of oral squamous cell carcinoma (OSCC). Initially, the optimal drug dose was established by delivery of solutions containing different amounts of 5-FU. The solution containing 1% (w/v) of 5-FU resulted effective in inducing cell death with complete eradication of cell colonies. Buccal tablets were designed to deliver 5-FU locoregionally to the cancer lesions of the oral cavity. Tablets were prepared using a drug loaded matrix of acrylic/methacrylic acid copolymer containing 1% (w/w) of 5-FU and applied on 3D outgrowths. The drug release from tablets appeared to be sufficient to induce cell death as confirmed by transmission electron microscopy and enzymatic assay (TUNEL). After 120 h of treatment, when about 90% of the drug had been discharged from the tablets into the culture environment, 5-FU caused loss of cell-cell communications and apoptotic cell death. After 192 h, a complete disaggregation of the 3D oral outgrowths and the death of all the cells was observed. Buccal matrix tablets could be considered a promising new approach to the locoregional treatment of OSCC. Risks of systemic toxicity are avoided since very low drug doses are delivered.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Fluoruracila/farmacologia , Neoplasias Bucais/tratamento farmacológico , Acrilatos/química , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Carcinoma de Células Escamosas/patologia , Comunicação Celular/efeitos dos fármacos , Técnicas de Cultura de Células , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Excipientes/química , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Metacrilatos/química , Microscopia Eletrônica de Transmissão , Neoplasias Bucais/patologia , ComprimidosRESUMO
Oral Lichen Planus (OLP) is a chronic inflammatory condition implicating T cell-mediated cytotoxicity, and involving oral mucosal surfaces. Several therapeutic regimens have been evaluated to treat OLP and pain related, but often without high level of evidence. Topical formulations are the favourite for the majority of cases; bioadhesive formulations have been considered very useful and practical for local drug delivery in oral mucosa, due to the increased residence time on the oral mucosa of the dosage forms and better therapeutic efficacy. In this narrative review, authors try to illustrate the current topical managements for OLP from the accessible literature on this topic. Steroids are very helpful in discomfort and making better quality of life: they are considered the first-line treatment even if they could cause secondary candidosis, and sometimes bad taste, nausea, dry mouth, sore throat or swollen mouth. Other substances or devices by topical administration are adopted especially when the first line approach is refractory. This is the case when retinol with its synthetic and natural analogues (retinoids), hyaluronic acid, or Aloe Vera are chosen. Recent topical applications for OLP therapy include phototherapy and low/high energy pulsing light; the treatment with extracorporeal photochemotherapy is also reasonable and promising. Finally, calcineurin inhibitors (i.e. cyclosporine, tacrolimus and pimecrolimus), antioxidant and biologics (i.e alefacept, efalizumab, basiliximab, TNF-α inhibitors - infliximab, rituximab) may be alternative approaches when OLP does not respond to the standard protocols. In this scenario, there are several studies on molecules different from glucocorticosteroids, but not sufficient or statistically adequate to justify their evidence-based use in OLP; large randomized placebo controlled trials are required to evaluate the safety and effectiveness of these non conventional therapies. In conclusion, since OLP is a chronic disease and requires long-term management, the dental/medical practitioner, who treats OLP patients, needs to know the natural history of OLP, how to monitor, and how to treat, taking in account all of the available modalities conventional and not, with pros and cons.
Assuntos
Líquen Plano Bucal/terapia , Mucosa Bucal/patologia , Qualidade de Vida , Administração Tópica , Sistemas de Liberação de Medicamentos , Humanos , Terapia a Laser/métodos , Líquen Plano Bucal/patologia , Fotoferese/métodos , Fototerapia/métodos , Fatores de TempoRESUMO
Intravenous bisphosphonates (BP) play a key role in the treatment of bone metastases. As a long-term side effects BP, a form of avascular osteonecrosis of the jaw has been reported. Although, invasive oral local procedures are often present in clinical history of patients suffering from bisphosphonates-related osteonecrosis of the jaws (BRONJ), about up to 50% of BRONJ are spontaneous. We report a case of a 68-year-old female with a spontaneous wide bone sequestration of the left mandibular body onset after infusion of zoledronic acid for 18 cycles for osseous metastasis due to metastatic anaplastic thyroidal carcinoma. Surprisingly the clinical aspects of the patient initially reminded us of the famous pathology described in 1899 called phossy jaw. This case is remarkable not only for the spontaneity of the osteonecrosis, but, above all, for the clinical similarity with cases of phossy jaw, described for the first time in the literature, thereby suggesting a potential common pathogenesis.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Doenças Mandibulares/diagnóstico , Idoso , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Carcinoma/tratamento farmacológico , Carcinoma/secundário , Difosfonatos/efeitos adversos , Feminino , Seguimentos , Humanos , Imidazóis/efeitos adversos , Neoplasias Pulmonares/secundário , Doenças Mandibulares/cirurgia , Neoplasias da Glândula Tireoide/patologia , Ácido ZoledrônicoRESUMO
Celiac disease (CD) is a lifelong, T cell-mediated enteropathy, triggered by the ingestion of gluten and related prolamins in genetically susceptible subjects, resulting in minor intestinal mucosal injury, including villous atrophy with crypt hyperplasia and intraepithelial lymphocytosis, and subsequent nutrient malabsorption. Although serological tests for antiendomysial (EMA) and anti-tissue transglutaminase (anti-tTG) autoantibodies are used to screen and follow up on patients with CD, diagnostic confirmation is still based on the histological examination of the small intestinal mucosa. Although the small intestinal mucosa is the main site of the gut involved in CD, other mucosal surfaces (such as gastric, rectal, ileal, and esophageal) belonging to the gastrointestinal tract and the gut-associated lymphoid tissue (GALT) can also be involved. A site that could be studied less invasively is the mouth, as it is the first part of the gastrointestinal system and a part of the GALT. Indeed, not only have various oral ailments been reported as possible atypical aspects of CD, but it has been also demonstrated that inflammatory changes occur after oral supramucosal application and a submucosal injection of gliadin into the oral mucosa of CD patients. However, to date, only two studies have assessed the capacity of the oral mucosa of untreated CD patients to EMA and anti-tTG antibodies. In this paper, we will review studies that evaluate the capacity of the oral mucosa to produce specific CD autoantibodies. Discrepancies in sensitivity from the two studies have revealed that biopsy is still not an adequate procedure for the routine diagnostic purposes of CD patients, and a more in-depth evaluation on a larger sample size with standardized collection and analysis methods is merited. However, the demonstration of immunological reactivity to the gluten ingestion of the oral mucosa of CD, in terms of IgA EMA and anti-tTG production, needs to be further evaluated in order to verify whether the oral mucosa is colonized by lymphocytes activated in the intestine or if gluten could stimulate naïve lymphocytes directly in the oral mucosa. This would have important implications for the pathogenesis, diagnosis, and treatment of CD.
Assuntos
Autoanticorpos/imunologia , Doença Celíaca/imunologia , Mucosa Bucal/imunologia , Transglutaminases/imunologia , Autoanticorpos/biossíntese , Biópsia , Doença Celíaca/diagnóstico , Glutens/imunologia , Humanos , Mucosa Bucal/metabolismo , Músculo Liso/imunologia , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Antibiotic prophylaxis (AP) still represents a common but often misused procedure in dental practice, thus aggravating the risk for antimicrobial resistance and adverse effects occurrence. AIMS AND METHODS: Our primary objective is to review the available scientific evidence regarding AP in dentistry both among healthy subjects and medically compromised patients. Additionally, the latest available guidelines provided by some of the most authoritative associations are here discussed. RESULTS AND CONCLUSIONS: AP is advisable only in a small percentage of patients where a risk of severe infective complications (i.e. infective endocarditis and prosthetic joint infection, septicaemia in severely immuno-compromised patients, bisphosphonate-related osteonecrosis of the jaw) exists. On the contrary, little or no scientific evidence exists for AP in subjects with other systemic diseases as well as in healthy individuals. This pioneering recommendation is strongly evidence-based, since a consistent association between any dental procedure and the development of local and distant infective complications is still lacking. In addition, the daily bacteraemia secondary to routine habits has been thought to be robustly associated with a greater risk of systemic disease bacterial-related than a single dental procedure exposure. Compliance of general dental or family practitioners to the current recommendations seems not to be optimal, thus, efforts to improve it should be planned and undertaken.
Assuntos
Antibioticoprofilaxia , Assistência Odontológica para Doentes Crônicos/métodos , Controle de Infecções Dentárias/métodos , Procedimentos Cirúrgicos Bucais , Resistência Microbiana a Medicamentos , Odontologia Baseada em Evidências , Humanos , Hospedeiro Imunocomprometido , Guias de Prática Clínica como Assunto , Fatores de RiscoRESUMO
BACKGROUND: Known as "the great imitator," secondary syphilis may clinically manifest itself in myriad of ways, involving different organs (including the oral cavity), and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians. CASE REPORT: We highlight an interesting case of a 45-year-old man on whose diagnosis of secondary syphilis was based on the presence of unusual oral lesions, consisting of a well delimited, raised, nonhomogeneous, and corrugated white plaque on the right buccal mucosa which mimicked, clinically and histologically, a "leukoplakia-like" plaque and several whitish oral mucous patches localized on the lower labial mucosa and the right lateral margin of the tongue. After the oral lesions, the patient developed a symmetric maculopapular cutaneous rash on the palms, soles, and the trunk of the body. Furthermore, during the anamnesis the patient stated an asymptomatic ulcerative lesion on the glans penis, which had appeared 7 months before the onset of the oral lesions and spontaneously disappeared after 2 weeks. The history of these genital and cutaneous lesions suggested performing serologic tests for syphilis, revealing strongly positive titers and leading us to making a diagnosis of secondary syphilis. CONCLUSION: This case is remarkable because it displays an unusual oral sign, associated with secondary syphilis; in fact, only occasionally does syphilis manifest itself with a "leukoplakia-like" plaque. Dentists should consider secondary syphilis in the differential diagnosis of white and/or ulcerative oral lesions, above all in at-risk patients, given the continuing rise of syphilis in western Europe.
Assuntos
Doenças da Boca/microbiologia , Sífilis/diagnóstico , Candidíase Bucal/diagnóstico , Cancro/diagnóstico , Diagnóstico Diferencial , Humanos , Leucoplasia Oral/diagnóstico , Doenças Labiais/microbiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/diagnóstico , Doenças do Pênis/diagnóstico , Sífilis Cutânea/diagnóstico , Doenças da Língua/microbiologiaRESUMO
BACKGROUND: Eosinophilic granuloma (EG) is a clinical variant of the Langerhans cell histiocytosis (LCH) characterized by unifocal or multifocal bone lesions which predominantly affects children, adolescents, and young adults. CASE REPORT: A case is reported of a 13-year-old Caucasian boy who presented unifocal EG in the mandible as the first clinic manifestation. Radiographic examination and skeletal scintigraphy revealed a further localization with an osteolytic lesion in the right femur. The therapeutic protocol used for the mandibular lesion included causal periodontal therapy, extraction of the compromised teeth, alveolar curettage, and intralesional injections of corticosteroids, in correspondence with femoral and mandibular bone lesions. CONCLUSIONS: Early diagnosis of LCH is considered an important factor which can improve the patient's prognosis and quality of life and also the cost-effectiveness of therapy. Dentists could play a fundamental role in the diagnosis and management of EG. The aim of the treatment is to eradicate EG lesions and provide adequate oral rehabilitation after the tooth loss. A careful multidisciplinary follow-up program is mandatory to identify any signs of local recurrence or dissemination.
Assuntos
Granuloma Eosinófilo/patologia , Adolescente , Reabsorção Óssea/complicações , Reabsorção Óssea/diagnóstico por imagem , Granuloma Eosinófilo/complicações , Granuloma Eosinófilo/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Osteólise/complicações , Osteólise/diagnóstico por imagem , RadiografiaRESUMO
INTRODUCTION: Contrary to early beliefs, celiac disease (CD) is relatively common; however, it still remains underdiagnosed since most cases are atypical, with few or no gastrointestinal symptoms and predominance of extraintestinal manifestations. As a consequence, the diagnosis of the disorder often requires a multidisciplinary approach. Also some oral ailments have been described in celiac patients. In this study, we review the papers that have reported oral manifestations in subjects with CD. METHODS: A comprehensive literature search was conducted in Medline and Embase databases using appropriate key words. Additional papers were selected by cross-referencing from the retrieved articles. RESULTS: Dental enamel defects are the oral lesions most closely related to CD. There are conflicting data on the association between CD and recurrent aphthous stomatitis. A correlation of CD with atrophic glossitis has been reported, although robust evidence in support of it is lacking. Patients with CD have caries indexes seemingly lower than healthy individuals, but they may experience delay in tooth eruption. Occurrence of other oral mucosal lesions in CD subjects is likely occasional. CONCLUSIONS: Patients with systematic dental enamel defects should be screened for CD even in the absence of gastrointestinal symptoms. CD screening tests for patients with oral aphthae or idiopathic atrophic glossitis should be selectively considered during a medical evaluation that focuses on all aspects of the patient's status.
Assuntos
Doença Celíaca/complicações , Doenças da Boca/etiologia , Desmineralização do Dente/etiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Saúde Global , Humanos , Programas de Rastreamento/métodos , Doenças da Boca/diagnóstico , Doenças da Boca/epidemiologia , Prevalência , Desmineralização do Dente/diagnóstico , Desmineralização do Dente/epidemiologiaRESUMO
Surgery, chemotherapy and radiotherapy are different therapeutical options for the management of the head and neck cancers. Their indication is strictly relate to some parameters (macro and microscopic characteristics of the tumor, the patient's general health and the remaining expectations of the life of the patients). Surgical treatment of the cancer, even if it represents the most radical approach and with the most therapeutical index, it always can't be practicable, since, often, it is associated to imposing aesthetical and functional alterations of the interested district. Chemotherapic agents are among the drugs with the lower therapeutical index, that are able to cause side effects, mainly due to the immunosuppression. About radiations, side effects could be indicates as immediates or acutes, and backward or chronic. Among the acute manifestations are enumerated: xerostomia, mucositis, bacterial infections, dysgeusia, dysphagia; among chronic forms: hyposalivation-xerostomia, caries, telangiectasis, infections, osteoradionecrosis, trismus, muscular fibrosis, necrosis of the soft tissues. Mucositis and xerostomia are the most common side effects, and they are a potential source of life-threatening infections. Few interventions are of proven efficacy to reducing severity and duration of mucositis, and there are no universally accepted treatment protocols, but research activity is increasing because of the upward recognition of the importance of mucositis, that need a complex and multidisciplinary clinical management.