Vitamin B12 deficiency may play an etiological role in atrophic glossitis and its grading: A clinical case-control study.

BACKGROUND: Existing studies have reported the significant association between atrophic glossitis (AG) and hematinic deficiencies, including iron, folate and vitamin B12 deficiency. However, these findings were inconsistent. AG can be graded as partial or complete atrophy. It is still unclear whether hematinic deficiencies are associated with the grading of AG. METHODS: 236 AG patients and 208 sex- and age-matched healthy controls were enrolled in this study. Hematological tests including complete blood count, and serum levels of folate, ferritin and vitamin B12 were performed. The AG group was divided into those with partial AG and those with complete AG according to the extent of papillary atrophy. Statistical analysis was performed to assess whether hematinic deficiencies are risk factors for AG and its grading. RESULTS: Compared with the healthy controls, AG patients had significantly higher frequencies of vitamin B12 deficiency (68.22%), ferritin deficiency (13.98%) and anemia (21.61%). The differences in hematinic deficiencies and anemia between AG patients and healthy controls changed according to gender and age. The frequencies of serum vitamin B12 deficiency and anemia in the complete AG subgroup were significantly higher than those in the partial AG subgroup. Logistic regression analysis revealed that vitamin B12 deficiency and anemia were significantly correlated with AG and its grading. The AG patients with vitamin B12 deficiency responded well to supplement therapy. CONCLUSION: AG could be an important clinical indicator for potential vitamin B12 deficiency, especially when the degree of tongue atrophy more than 50% and complete atrophy. Vitamin B12 deficiency might play an etiological role in the development of AG.

Investigation of oral atopic diseases: Correlation between geographic tongue and fungiform papillary glossitis.

INTRODUCTION: The correlation between oral lesions and atopy is not new, but few studies have investigated the prevalence of mucosal changes in diseases within the atopic spectrum, leading to conflicting data. Some studies found a possible relationship between geographic tongue, transient lingual papillitis and atopic diseases. AIM: To investigate the frequency of geographic tongue and fungiform papillary glossitis in patients with atopic diseases, and its correlation with serum IgE levels and skin test results. MATERIAL AND METHODS: The sample was comprised of participants with atopic diseases paired with participants who received negative puncture skin tests. All were submitted to stomatological and medical evaluations, prick test and oral cytopathological. RESULTS: The female sex was more numerous in both groups. Mean age was 21 years. A total of 60 diagnoses of atopic diseases were obtained, with allergic rhinitis being the most prevalent. Fungiform papillary glossitis was the most frequent oral lesion in both groups, while geographic tongue was present in 2 cases (2%) in the test group and 2 (2%) in the control group. Atopic patients with fungiform papillary glossitis presented high serum IgE levels. In atopic patients with geographic tongue, the prick test positively identified extracts of Dermatophagoides pteronyssinus (100%) and Dermatophagoides farinae (100%). CONCLUSION: Due to the low frequency of geographic tongue lesions found in the study, it is no possible to conclude if that could be an oral manifestation of atopy. However fungiform papillary glossitis is a common alteration in atopic and non-atopic patients and has a relationship with high IgE serum levels. However, the consolidation of this result requires a larger sample size.

Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis.

OBJECTIVE: In this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases. METHODS: An experimental rat model of chronic acid reflux esophagitis was surgically created. The oral cavities were observed histologically every 2 weeks until 20 weeks after surgery. RESULTS: At 10 weeks after surgery, molar crown heights in GERD rats were shorter than that in control rats, and inflammatory cell infiltration by gastric acid reflux was found in the periodontal mucosa of GERD rats. Furthermore, dental erosion progressed in GERD rats at 20 weeks after surgery, and enamel erosion and dentin exposure were observed. During the same period, inflammatory cell infiltration was observed in the mucosa of the posterior part of the tongue. These findings suggest that gastric acid reflux may be one of the exacerbating factors of dental erosion, periodontitis and glossitis. CONCLUSION: We investigated oral changes in an experimental rat model of GERD and observed development of dental erosion, periodontitis and glossitis. Our findings suggested chronic gastric acid reflux may be involved in the pathogenesis of oral disease.

Bone Marrow-derived Cell Therapy for Oral Mucosal Repair after Irradiation.

Oral mucositis (ulcer) is a serious and painful side effect for patients with head and neck cancer following radiation therapy. However, current clinical strategies cannot efficiently prevent the occurrence of oral mucositis. In this study, we investigated whether bone marrow-derived cells (BMDCs) prevented the occurrence and/or decreased the severity of radiation-induced oral mucositis. Fresh concentrated BMDCs from male C3H mice were transplanted intravenously into female mice after tongue irradiation. For 14 days postirradiation, the changes of body weight and the time courses of ulceration were observed. Until the ulcer reached maximum size (7 days postirradiation), macroscopic and histologic analyses of harvested tongues were performed to detect the behavior of donor BMDCs. Between 2 and 5 days postirradiation, BMDCs-transplanted mice showed more expression of stem cell markers (c-Kit, Sca-1) and EGFR and fewer apoptotic cells when compared with nontransplanted control mice (irradiation group). On day 7, there were fewer and smaller ulcers observed in the BMDCs-transplanted group. Tongues of these mice had preserved their epithelial thickness, and regenerative activities (blood vessels formation, cell proliferation) were higher than they were in the irradiation group. Fluorescently labeled BMDCs were not detected in tongue epithelium but rather in connective tissue (dermis) just below the basal cell layer. These findings suggest that exogenous BMDCs behave to reduce radiogenic oral mucositis in a paracrine manner.

Papillary atrophy of the tongue and nutritional status of hospitalized alcoholics / Glossite atrófica e estado nutricional de alcoolistas hospitalizados

BACKGROUND: Atrophy of the papillae, mucosa, and dorsum of the tongue are considered classical signs of nutritional deficiencies. OBJECTIVE: To assess the nutritional status of hospitalized alcoholics with or without papillary atrophy of the tongue. METHODS: This study was performed with 21 hospitalized alcoholics divided into Atrophic Glossitis Group (n=13) and Normal Tongue Group (n=8). Healthy, non-alcoholic volunteers composed the Control Group (n=8). Anthropometry and bioelectric impedance were performed, and serum vitamins A, E, and B12 were determined. RESULTS: There were no statistical differences in relation to age (46.7±8.7 vs. 46.8±15.8 years) or gender (92.3% vs. 87.5% male), respectively. Control Group volunteers were also paired in relation to age (47.5±3.1 years) and male predominance (62.5%). In relation to hospitalized alcoholics without atrophic lesions of the tongue and Control Group, patients with papillary atrophy showed lower BMI (18.6 ± 2,5 vs 23.8 ± 3.5 vs 26.7 ± 3,6 kg/m² ) and body fat content 7.6 ± 3.5 vs 13.3 ± 6.5 vs 19.5 ± 4,9 kg). When compared with the Control Group, alcoholic patients with or without papillary atrophy of the tongue showed lower values of red blood cells (10.8 ± 2.2 vs 11.8 ± 2.2 vs 14.5 ± 1,6g/dL) and albumin (3.6 ± 0.9 vs 3.6 ± 0.8 vs 4.4 ± 0.2g/dL). The seric levels of vitamins A, E, and B12 were similar amongst the groups. CONCLUSION: Hospitalized alcoholics with papillary atrophy of the tongue had lower BMI and fat body stores than controls, without associated hypovitaminosis.

FUNDAMENTOS: A deficiência crônica de nutrientes pode levar à hipotrofia das papilas e da mucosa e do dorso da língua, considerada um sinal clássico de subnutrição protéico-energética. OBJETIVO: O objetivo do presente estudo é comparar o estado nutricional, incluindo as dosagens dos níveis séricos de vitaminas A, E e B12 em pacientes alcoolistas com ou sem alterações tróficas das papilas linguais. MÉTODOS: O estudo caso-controle incluiu 21 pacientes adultos alcoolistas internados em um hospital universitário. Utilizando-se de um sistema de fotografia da cavidade oral, dois clínicos independentes classificaram os indivíduos alcoolistas de acordo com a presença ou não de alterações tróficas na língua. Foram registrados os dados antropométricos, a composição corporal pela impedância bioelétrica e os exames laboratoriais para avaliação clínica e nutricional, incluindo dosagens das vitaminas A, E e B12. O estudo incluiu ainda voluntários saudáveis, não alcoolistas como Grupo Controle (n=8). A comparação entre os grupos foi feita por ANOYA-F ou pelo teste de Kruskal-Wallis, de acordo com a curva de normalidade dos resultados. Foram considerados significativos diferenças com p < 0,05. RESULTADOS: De acordo com a presença de alterações tróficas nas papilas linguais, os pacientes alcoolistas foram alocados no Grupo Língua Despapilada (n=13) e Grupo Língua Normal (n=8), sem diferença estatística quanto à idade (46,7 ± 8,7 vs 46,8 ± 15,8 anos) e gênero masculino (92,3 vs 87,5%). Os voluntários do Grupo Controle apresentaram 47,5 ±3,1 anos, sendo 62,5% do gênero masculino. Os pacientes alcoolistas com hipotrofia papilar apresentaram menor IMC (18,6 ± 2,5 vs 23,8 ± 3,5 vs 26,7 ± 3,6 kg/m2) e gordura corporal (7,6 ± 3,5 vs 13,3 ± 6,5 vs 19,5 ± 4,9 kg), quando comparados com os demais grupos. Em relação ao Grupo Controle, os alcoolistas apresentaram menores valores de hemoglobina (10,8 ± 2,2 vs 11,8 ± 2,2 vs 14,5 ± 1,6 g/dL) e albumina sérica (3,6 ± 0,9 vs 3,6 ± 0,8 vs 4,4 ± 0,2 g/dL). Os níveis plasmáticos de vitaminas A, E e B12 foram similares entres os grupos. CONCLUSÃO: Os pacientes alcoolistas com achados físicos de hipotrofia de papilas linguais apresentam menores valores em medidas antropométricas, de hemoglobina e albumina séricas que os grupos Controle ou de alcoolistas sem língua despapilada. Não houve evidências de hipovitaminoses associadas.

Glositis romboidal media: revisión a propósito de un caso clínico / glossitis Rhomboid average: review of a clinical case

La glositis romboidal media (GRM) es una alteración benigna, poco frecuente, que afecta ligeramente más a los varones. Suele localizarse en la línea media del dorso de la lengua por delante de la “V” lingual, en forma de área rojiza, romboidal, de superficie plana, como una mácula o a veces exofítica, mamelonada, que puede sobresalir de 2 a 5 mm y en la que no se observan papilas filiformes. Se presenta el caso clínico de un varón de 50 años de edad que consulta por presentar una lesión en dorso de lengua, situada en la línea media.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual “V”, appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by2- 5 mm. This paper reports a case of rhomboid glossitis in a 50-year-old man who consulted for a lesion on the dorsum of the tongue, in a medial location.

Glossal abscess as a complication of tongue-base suspension surgery.

Approximately 60 cases of tongue abscess have been reported in the English-language literature over the past 30 years. We report what we believe is the first case of a glossal abscess that arose as a complication of tongue-base suspension surgery. The patient was a 31-year-old man who presented with a several-day history of odynophagia, tongue swelling, voice changes, and increased snoring. Two years earlier, he had undergone a tongue-base suspension procedure for the treatment of obstructive sleep apnea. Computed tomography (CT) revealed a tongue abscess. During peroral incision and drainage, a knotted 0 Prolene suture was discovered within the abscess cavity. The suture was removed, the area was thoroughly irrigated, the drain was placed in the abscess cavity, and the incision was loosely closed. On postoperative day 5, repeat CT revealed resolution of the abscess, and the patient was discharged on oral antibiotics. Although glossal abscess is very rare, physicians should consider it in the differential diagnosis of any patient who presents with lingual swelling following tongue-base suspension surgery.

The development and inflammatory features of radiotherapy-induced glossitis in rats.

OBJECTIVES: To improve the existing animal models (mice, rats, and hamsters) for radiotherapy-induced oral mucositis (RTOM), thereby establishing a radiotherapy-induced glossitis (RTG) Sprague-Dawley (SD) rat model. STUDY DESIGN: A lead device was designed to limit radiation exposure to a 1x1 cm2 area of a rat 's dorsal anterior tongue with a single 30 Gy of X-ray radiation. The general conditions of the irradiated rats, such as body-weight and behavior, were observed. The oral mucositis index (OMI) of the RTG rats were measured daily. Histological changes of the irradiated tongue tissues were assayed by H &E staining. RESULTS AND CONCLUSION: No significant changes were clinically observed 3 to 4 days after irradiation. At 5 to 6 day, punctuation and confluenced redness of the mucosa were observed. The small blood vessels became more extensive, engorged, thin vessel walls. More infiltrating cells were observable, necrosis and exfoliation of the squamous cells appeared, and the formation of an ulcerative lesion could be observed. Seven to 15 days, the exfoliated epithelial layer was observed to have formed an ulcerative lesion, then aggravated ulcerative lesions consisting of pseudomembranous filament exudates could be observed. The structure of the epithelium had become completely disintegrated, forming deep, microscopic ulcerative lesions. Twenty-one days, the periphery of the ulcer was observed to have begun to heal, and granulation tissue could be observed at the bottom of the ulceration. At 35 days after irradiation, the epithelial structure presented again, but the epithelium was very thin. An RTG animal model was successfully established in SD rats, which provides a new research platform for the study of RTOM pathogenesis.

The correlation between the severity of radiotherapy-induced glossitis and endothelial cell injury in local tissues in a rat model.

OBJECTIVES: To explore the correlation between the severity of radiotherapy-induced glossitis (RTG) and endothelial cell injury in local tissues in a rat model. STUDY DESIGN: The RTG animal model was designed and used by our team. The Oral mucositis index(OMI) was documented daily. Immunohistochemistry (IHC) Staining of CD34 was utilized to identify endothelial cells in the RTG tissues. Apoptosis of endothelial cells in local lesions due to RTG was detected by the TUNEL assay. The dynamic relationship between the OMI and apoptotic endothelial cells was statistically analyzed by time. RESULTS AND CONCLUSIONS: The injury and apoptosis of endothelial cells were observed 3 day post-irradiation. The vascular lumens of the post-irradiation tongue lesions were irregular; thrombosis formation in the center of the lumens, unsmooth lumen walls and vasodilated vessels were observed. Also, endothelial cells detached from the basal membrane and were found in the lumens. The percentages (%) of apoptotic endothelial cells were 78.3 ± 0.31 (5 day); 89.3 ± 0.83 (8 day); 83.5 ± 0.41 (14 day); 69.3 ± 0.57 (21 day); and 47.3 ± 0.59 (28 day). The OMI was correlated with the percentage of apoptotic endothelial cells (R=0.67, P=0.034). Summary, endothelial cell injury was correlated with the pathogenic condition of RTG.

Oral signs in the diagnosis of celiac disease: review of the literature.

This study explores the possibility that the celiac disease (CD) may be correlated with the insurgence of some oral signs, as based on a systematic review of the literature. Should this correlation be proven, any dentistry's screening would then be important to diagnose early celiac sprue pathogenesis. A literature survey was accomplished by using the Medline database (Entrez PubMed). The survey, which covered the period from the year 1972 to 2009, provided 382 published articles. Of these, 29 articles were selected according to inclusionary/exclusionary criteria, and consequently qualified for the final review analysis. Manual searching through the reference lists of the selected articles allowed the obtainment of others 17 articles. Findings gathered through this literature's review corroborate the significance of a causal relationship between some oral signs and CD. There are enough evidence making the correlation between CD and oral defects scientifically sustainable. This recognition should lead dentists to play more significant roles in screening for CD, as otherwise, if not properly diagnosed and not treated with a gluten-free diet, may eventually cause some malignancies.

Pyostomatitis vegetans associated with inflammatory bowel disease--report of two cases.

Pyostomatitis vegetans (PV) is a rare, chronic mucocutaneous disorder associated with inflammatory bowel disease (IBD). Oral lesions of PV are distinct and present as multiple white or yellow pustules with an erythematous base that coalesce and undergo necrosis to form a typical "snail tracks" appearance. Two cases of PV associated with IBD--one with Crohn's disease (CD) and the other with ulcerative colitis (UC) are reported. In the first case, adalimumab therapy brought the oral and gastrointestinal manifestations to complete remission. In the second case, the remission was achieved with systemic steroid therapy, but the disease relapsed after therapy discontinuation. Azathioprine was added leading to sustained remission of PV. Because of persistent active intestinal manifestation of UC, in spite of immunosuppressive therapy, infliximab was introduced. With the therapy remission of intestinal manifestation of UC was achieved as well. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of oral lesions.

Inflammatory bowel disease.

Inflammatory bowel diseases (IBDs) encompass ulcerative colitis, Crohn's disease, and indeterminate colitis, all of which are characterized by remission and exacerbation of gastrointestinal symptoms, and a variety of extraintestinal manifestations including those affecting the oral cavity. Although not particularly a cause for mortality, inflammatory bowel diseases are associated with significant morbidity and impact on the quality of life. This article reviews clinical presentation, diagnostic criteria, and therapeutic modalities for the 2 main types of inflammatory bowel disease and discusses manifestations of these conditions in the oral cavity. The role of the oral health care provider in timely recognition and referral for medical work-up as well as management of oral complaints is also emphasized.

Glossitis with linear lesions: an early sign of vitamin B12 deficiency.

The classic oral manifestations of vitamin B(12) deficiency are considered nonspecific. We describe 4 patients with oral linear lesions associated with vitamin B(12) deficiency. Patients were free of neurologic symptoms and anemia at diagnosis. We believe that glossitis with linear lesions is an early clinical sign of vitamin B(12) deficiency. We recommend the determination of vitamin B(12) in such patients, even in the absence of anemia.