Oral potentially malignant disorders - An assessment of knowledge and attitude to future education in undergraduate dental students.

INTRODUCTION: The aim of this study was to assess the knowledge and clinical experience of oral potentially malignant disorders (OPMDs) in undergraduate dental students in six European countries (Croatia, France, Italy, Portugal, Spain and United Kingdom) and assess student's attitude and preference to future education on the topic. A secondary aim was to identify gaps in student's knowledge and clinical practice. The study was a part of the Erasmus+ project "Oral Potentially Malignant Disorders: Healthcare Professionals Training" (Grant No: 2020-1-UK01-KA202-078917). MATERIALS AND METHODS: An online questionnaire was distributed to all final-year students in six partner universities. This consisted of four parts assessing: (1) knowledge on OPMDs, (2) clinical experience with this group of patients, (3) self-rated competence in the management of OPMDs and (4) preferences with regard to future education. RESULTS: Two hundred and sixty final-year dental students from six partner universities responded to the questionnaire. Response rates varied from 12% to 92% between partner universities. Significant differences in clinical experience and knowledge were found between students. Students with more clinical exposure to OPMDs rated their knowledge and competence in the management of OPMDs higher than students with less clinical experience. The majority of students were interested in future education on OPMDs, preferably via short educational videos. CONCLUSION: The majority of students have received theoretical knowledge of OPMDs during their undergraduate studies, however, not all had clinical exposure to this group of patients. Students were open to further education on OPMDs. Important deficiencies in knowledge were identified that need to be addressed and it is anticipated that the e-learning platform and e-book that are in development by partner institutions will help to improve overall knowledge of OPMDs.

The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis.

Inflammatory bowel disease has a wide range of possible oral manifestations, many of which overlap with those seen in other conditions, including orofacial granulomatosis. The precise etiology remains unclear, as is the exact relationship between orofacial granulomatosis and Crohn's disease. Overall, there is growing evidence that orofacial granulomatosis and oral Crohn's disease are distinct clinical disorders with optimal management requiring a multidisciplinary approach with input from appropriate specialists in oral medicine, gastroenterology, allergy, dietetics, and clinical psychology. This review details the etiopathogenesis, clinical presentation, epidemiology, extra-intestinal, and oral manifestations of inflammatory bowel disease and orofacial granulomatosis. It also assesses the current role of investigations in the diagnosis of orofacial granulomatosis and critically reviews the available evidence in relation to medical and surgical interventions for the condition, and its relationship to Crohn's disease.

Streptococcus Salivarius: A Potential Salivary Biomarker for Orofacial Granulomatosis and Crohn's Disease?

BACKGROUND: Orofacial granulomatosis (OFG) is a rare disease characterised by chronic, noncaseating, granulomatous inflammation primarily affecting the oral cavity. Histologically, it is similar to Crohn's disease (CD), and a proportion of patients have both OFG and CD. The cause of OFG remains elusive, but it has been suggested that microbial interactions may be involved. The aim of this study was to compare the salivary microbial composition of subjects with OFG and/or CD and healthy controls. METHODS: Two hundred sixty-one subjects were recruited, of whom 78 had OFG only, 40 had both OFG and CD, 97 had CD only with no oral symptoms, and 46 were healthy controls. Bacterial community profiles were obtained by sequencing the V1-V3 region of the 16S rRNA gene. RESULTS: There were no differences in richness or diversity of the salivary bacterial communities between patient groups and controls. The relative abundance of the Streptococcus salivarius group was raised in patients with OFG or CD only compared with controls, whereas that of the Streptococcus mitis group was lower in CD compared with both OFG and controls. One S. salivarius oligotype made the major contribution to the increased proportions seen in patients with OFG and CD. CONCLUSIONS: The salivary microbiome of individuals with OFG and CD was similar to that found in health, although the proportions of S. salivarius, a common oral Streptococcus, were raised. One specific strain-level oligotype was found to be primarily responsible for the increased levels seen.

Update on Orofacial Granulomatosis.

Orofacial granulomatosis (OFG) is a condition manifesting clinically with chronic swelling of the mouth and/or face, notably with swelling of the lips and oral mucosa, a full-thickness, erythematous gingivitis and mucosal ulceration of various clinical types. Some patients may also present with neurological findings, for example facial palsy. Biopsy of affected tissue shows lymphoedema, with or without granulomatous inflammation. The oral lesions in OFG are histologically indistinguishable from the oral lesions in Crohn's disease (CD) and other systemic granulomatous disorders. It is a condition which may respond to the exclusion of certain food-related chemicals from the diet in up to 60% of patients and, as such, is distinct from gastrointestinal CD. CD is a relapsing systemic inflammatory disease which predominantly affects the gut, and patients suffering from this disease frequently present with abdominal pain, fever and altered bowel habit. A proportion of patients with clinical OFG (without other systemic disease) may have asymptomatic gastrointestinal involvement or go on to develop gut CD suggesting an association between the two diseases. It is estimated that 1% of CD sufferers may have a diagnosis of OFG, but the majority of patients in specialist OFG clinics do not have gut symptoms.

Outcome of minimally invasive management of salivary calculi in 4,691 patients.

OBJECTIVE: To evaluate the application of minimally invasive techniques in the management of salivary stones. BACKGROUND: The incidence of salivary calculi is 60 cases/million/year, with most stones situated in the mid or proximal duct. The current treatment of these stones is adenectomy. This paper reports the results of minimally invasive methods of stone removal that avoid gland excision. METHODS: Observational study of 5,528 consecutive patients treated by lithotripsy, endoscopy, basket retrieval, and /or surgery in five centers from 1990 to 2004 inclusive. A total of 567 cases were excluded, leaving 4,691 patients (parotid n = 1,165, submandibular n = 3,526) for analysis. RESULTS: Salivary calculi were eliminated in 3,775/4,691 (80.5%) of cases and partly cleared in 782/4,691 (16.7%). Salivary glands were removed in 134/4,691 (2.9%) of patients with symptoms in whom treatment failed. CONCLUSIONS: Minimally invasive techniques move treatment of salivary calculi to an outpatient or a day case setting. They are reliable ways of both retrieving stones and eliminating symptoms, and mean that the gland rarely has to be removed.

A revolution in the management of obstructive salivary gland disease.

UNLABELLED: Salivary gland obstruction is the commonest cause of salivary gland disease presenting to the general dental practitioner. To date, with the exception of the most surgically accessible stones found within the anterior ducts, there has been little treatment to offer patients except surgical removal of the gland, with the associated risks to the facial and trigeminal nerves. In the last 10 years, more conservative treatment modalities have been developed, opening up a range of treatment options which combine to provide an alternative management of these cases. This paper presents data from one unit in which lithotripsy, which is the destruction of stones (calculi) using shock waves, basket retrieval, a modified minor surgical technique, and balloon dilatation have been used to treat salivary gland obstruction successfully. Over 70% of stones can now be retrieved leaving a functioning gland. CLINICAL RELEVANCE: Salivary gland obstruction is a clinical problem presenting to the general dental practitioner, and requires an understanding of the range of treatment options available.

Minimally invasive radiologically guided intervention for the treatment of salivary calculi.

PURPOSE: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. METHODS: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. RESULTS: Of 86 cases of sialolithiasis treated, in 55 (64%) it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. CONCLUSIONS: Stone removal from the salivary duct system by radiologically guided, minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.