Pre- and postoperative quality of life and emotional/behavioural problems in children with PFAPA.

OBJECTIVE: This study aimed to evaluate the effects of surgical intervention on quality of life, emotional/behavioural problems and school absenteeism in children with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA.) METHOD: A total of 56 children aged between 4 and 12 years, diagnosed with PFAPA and undergoing tonsillectomy with/without adenoidectomy at a tertiary hospital were included in the study. The Questionnaire for Quality of Life Assessment for Children and Adolescents Parent Form (Kid-KINDL) and the Strengths and Difficulties Questionnaires (SDQ) were used to evaluate quality of life and emotional/behavioural problems, respectively. The cases were assessed before and three months after surgery. RESULTS: The mean (SD) age of the children was 6.64 (3.03) years, and 58.9% (n = 33) were boys. The numbers of pre- and post-operative periodic fever episodes were 3.0 (1.7) and 0.6 (0.9) (p < 0.001), those for school absenteeism were 10.28 (5.53) and 2.85 (2.95) days (p < 0.001) and those for hospital presentations were 3.8 (2.5) and 1.1 (1.1) (p < 0.001), respectively, all of which were significantly lower in children with PFAPA at three months after the operation. The surgical procedures were effective in improving quality of life and emotional/behavioural problems, as evidenced by the significant differences between the pre- and post-treatment scores in outcome measures, including SDQ and Kid-KINDL (p < 0.001). CONCLUSIONS: This study demonstrated that the surgical approach exhibited positive effects in terms of improving quality of life and reducing emotional/behavioural problems and school absenteeism in children with PFAPA.

Presencia de lesiones orales en pacientes con afecciones psicológicas, atendidos en una institución de salud / Presence of oral lesions in a group of patients with psychological disorders attending a health institution

Introducción: El liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente constituyen entidades patológicas bucales que presentan relación con afecciones psicológicas. Objetivo: Describir la presencia de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca urente en pacientes con afecciones psicológicas atendidos en una institución de salud. Métodos: Se realizó un estudio descriptivo de corte transversal, obteniéndose una población de 35 pacientes seleccionados mediante un muestreo no probabilístico por criterio de 26 pacientes aquellos que fueron remitidos del área de psicología (bajo un test de diagnóstico psicológico) al servicio de estomatología, con lesiones orales antes descritas. Bajo la firma de un consentimiento informado fueron tratadas y evolucionadas en un periodo de 16 meses. Se tuvieron en cuenta las consideraciones éticas basadas en la resolución 008430 de 1993, tratado de Helsinki. Resultados: En cuanto a la frecuencia, la lesión bucal que más se presentó fue la estomatitis aftosa recurrente en un 65,3 por ciento, las aftas mayores en un 38,4 por ciento, seguido de un tipo aftas menores en un 26,9 por ciento, entre otras lesiones en menor frecuencia. Los diagnósticos psicológicos evidenciados fueron estrés, depresión y ansiedad, en diferentes proporciones, mostrándose como lesión más frecuente dentro de estas entidades psicológicas, la estomatitis aftosa recurrente. No existió asociación estadística entre las variables orales y las psicológicas por mostrar valores de p >0,005. Conclusiones: Existió la presencia de liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente en alteraciones psicológicas como estrés, ansiedad y depresión, con mayor frecuencia la estomatitis aftosa recurrente(AU)

Introduction: Oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome are oral conditions related to psychological disorders. Objective: Describe the presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome in patients with psychological disorders attending a health institution. Methods: A descriptive cross-sectional study was conducted of a population of 35 patients, of whom 26 were selected by criterion nonprobability sampling and referred from the psychology service (based on a psychological diagnosis test) to the dental care service due to the presence of the aforementioned oral lesions. Upon granting their informed consent, the patients were treated and followed up for 16 months. Ethical provisions from Resolution 008430 of 1993, the Helsinki Declaration, were complied with. Results: In terms of frequency, the most common oral lesion was recurrent aphthous stomatitis with 65.3 percent. Major aphthas represented 38.4 percent. and aphthas of a minor type 26.9 percent.; other lesions had a lower frequency. The psychological diagnoses achieved were stress, depression and anxiety to various degrees, and the most common lesion for these psychological disorders was recurrent aphthous stomatitis. No statistical association was found between oral and psychological variables, for they showed values of p >0.005. Conclusions: The presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome was determined in psychological disorders such as stress, anxiety and depression. Of these oral lesions, recurrent aphthous stomatitis was the most common(AU)

The role of anxiety, depression, and psychological stress on the clinical status of recurrent aphthous stomatitis and oral lichen planus.

BACKGROUND: In spite of all the efforts, recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) still have unexplained etiology. The role of anxiety, depression, and psychological stress in occurrence and intensity of symptoms in RAS and OLP patients has been investigated in this study. METHODS: A total of 110 patients with RAS in the acute phase and 112 patients with OLP also in acute phase participated in this study. All patients filled out questionnaires related to the primary disease (RAS/OLP) after which they took the following psychological tests: Beck Depression Inventory (BDI), The State-Trait Anxiety Inventory (STAI), and Ways of Coping Questionnaire (WCQ). RESULTS: According to multiple regression analysis, in patients with RAS, the highest correlation was found between results of the pain intensity and STAI test (ß= 0.66; p < 0.000). In the patients with OLP, the highest correlation was found between the level of hyperkeratosis and WCQ test (ß = 0.53; P < 0.000), inflammation and results of BDI test (ß = 0.33; P < 0.002), and results of dynia test and STAI test (ß = 0.31; P < 0.004). CONCLUSIONS: In this study, a high correlation between anxiety, depression, and psychological stress with symptoms of RAS and OLP has been observed.

Reliability and validity of the Chinese version of the chronic oral mucosal diseases questionnaire.

INTRODUCTION: The aim of this study was to evaluate the reliability and validity of the Chinese version of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ). METHODS: A consecutive sample of 200 patients with chronic oral mucosal diseases was enrolled to complete the questionnaire after its translation and cross-cultural adaptation. The reliability of the Chinese version of COMDQ was determined through internal consistency and test-retest methods. The construct validity of COMDQ was analysed by exploratory factor analysis (EFA). RESULTS: Cronbach's alpha value for the total COMDQ score was 0.894, and the test-retest intraclass correlation coefficient value for the total COMDQ score was 0.83. The EFA extracted four factors, which accounted for 67.89% of the variance. All items showed adequate factor loadings, ranging from 0.487 to 0.947. CONCLUSION: The results suggest that the Chinese version of the COMDQ has satisfactory psychometric properties and is applicable to patients with chronic oral mucosal diseases in China.

Psychological profiles in patients with recurrent aphthous ulcers.

The aim of this study was to investigate the psychological profiles of patients with recurrent aphthous ulcers (RAUs). 50 patients (27 men and 23 women, mean age 31.44±9.95 years) with diagnosed RAUs participated in this study. 50 controls who matched the patients in age and gender were also recruited. The participants' personality and psychological profiles were assessed using the Hospital Anxiety and Depression Scale (HAD) and the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI). Data analysis showed that females had higher HAD anxiety scores than males in both patients and controls. Patients' age, intensity of pain and number, position, duration, and frequency of ulcers had no relation to HAD and NEO-FFI scores. Patients reported higher levels of anxiety in comparison to controls, but both reported comparable depression scores. Patients' NEO-FFI scores were not different from those reported by controls and the psychological profiles of patients and controls were similar. In conclusion; stressful situations and conditions (i.e. anxiety) rather than personality profiles and stable psychological traits were related to the occurrence of recurrent aphthous ulcers.

Further reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire.

OBJECTIVE: To test the reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), in measuring the quality of life (QofL) in patients with chronic oral mucosal conditions. METHODS: A random sample of 160 patients with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis received a copy of the COMDQ. A subset of 100 patients received the questionnaire on two further occasions, 2 weeks and 3 months later. Statistical tests were carried out to evaluate the test-retest reliability and responsiveness of this instrument. RESULTS: This study has demonstrated that the COMDQ has good test-retest reliability with an intraclass correlation coefficient of 0.81 and is responsive to changes in the patients' overall conditions. CONCLUSION: In conclusion, this study has further demonstrated the reliability and responsiveness of the COMDQ in assessing QofL in patients with chronic oral mucosal diseases.

A patient-centered approach to developing a quality-of-life questionnaire for chronic oral mucosal diseases.

OBJECTIVE: The objective of this study was to develop a self-completion questionnaire measuring quality of life in patients with chronic oral mucosal diseases. STUDY DESIGN: The stages of development involved the use of both clinical expert input, via a modified Delphi technique, and patient input, via qualitative interviews, in the generation of items. Item reduction was carried out using a judgment method. RESULTS: Expert input was derived from 5 professors or consultants in oral medicine. Qualitative interviews were conducted with 24 patients during the item-generation phase of development. An initial item pool of 28 items was generated from the clinician and patient input. Importance ratings ranged from 4.0 to 0.44. Items with importance ratings below 1 were reviewed and considered for exclusion. Three items were subsequently excluded and 1 item added resulting in a final 26-item instrument. CONCLUSIONS: This is the first discipline-specific quality-of-life measure developed in the field of oral medicine.

Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.

OBJECTIVE: To explore the experience of daily life of persons with chronic oral mucosal conditions. METHODS: Purposive sampling was used to recruit patients from the Oral Medicine Unit of Cork University Dental School and Hospital. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non clinical setting. Focus groups were mixed with regard to gender, age, chronic oral mucosal condition, time since diagnosis and severity. A total of 24 patients took part, including patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, recurrent aphthous stomatitis and orofacial granulomatosis. RESULTS: Analysis of the interviews revealed that patient views could be divided into the following themes - biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation and issues for the healthcare professionals. CONCLUSION: Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.

[Sick or made sick? Recurrent episodes of cutaneous and subcutaneous ulcers, colitis, arthralgia and hair loss... a systemic disease or iatrogenic?]. / Krank oder krank gemacht? Rezidivierende Episoden kutaner Ulzera, Aphten, Kolitis, Arthralgien, Haarausfall... eine systemische Erkrankung oder iatrogen?

Recurrent episodes of cutaneous and subcutaneous ulcers, especially in the oral cavity, represent a high psychological and painful burden for the patient. If there in addition are symptoms of arthralgia and/or colitis, an autoimmune disease with vasculitis, particularly a Morbus Behçet has to be considered as a possible differential diagnosis. The therapy therefore would be an immunosuppressive one. Also a wide immunologic diagnostic process has to be started. Furthermore, a chronic inflammatory bowel disease has to be excluded by colonoscopic biopsy. An infectious etiology of the symptoms (viral/bacterial/parasitic) should be investigated by microbiological and laboratory tests. A thrush or a herpes-infection caused by immunosuppression (toxic or due to illness) has to be considered as a further differential diagnosis. Also a precise medical and drug history is very important because of possible toxic adverse effects. Until confirmation of a final diagnosis, only a symptomatic analgetic or antifungal or antiviral therapy in case of a positive thrush or herpes culture respectively should be initiated with respect to the very different kinds of treatment of the diseases included in the differential diagnosis.

Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients.

Dental treatment procedures frequently involve blood and saliva that may be contaminated with HIV. The purpose of this cross-sectional survey was to assess Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. In 2008, a fifty-three-item self-administered questionnaire was conducted on all 750 dental students who participated in the 10(th) Dental Student Congress in Isfahan, Iran. The overall response rate to the questionnaire was 60.7 percent. The total mean knowledge and attitudes scores were 82.1 percent (excellent) and 57.4 percent (negative), respectively. There were no significant differences in the knowledge or attitude scores between male and female students. A majority of the students were aware of the association between HIV and oral candidiasis (98.1 percent), major aphthous (95.8 percent), and Kaposi's sarcoma (93.8 percent). Although a majority of the students had excellent knowledge (78.4 percent), only 1 percent had professional attitudes about treating patients with HIV/AIDS. Therefore, it is important that dental students, as future dentists, develop not only the necessary practical skills but also attitudes that will prepare them to treat HIV/AIDS patients.

Psychological stress and recurrent aphthous stomatitis

INTRODUCTION AND OBJECTIVES: Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS. METHOD: Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist. RESULTS: There was a higher level of psychological stress among RAS group patients when compared to the control group (P < 0.05). CONCLUSION: Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.