Diagnosis and treatment strategies for patients with refractory recurrent aphthous ulcer and systemic diseases / 口腔疾病防治

@#Recurrent aphthous ulcer (RAU) is one of the most common diseases of the oral mucosa. At present, no effective method is available for RAU treatment, especially for refractory RAU, which significantly affects patients’ oral health and quality of life. Research shows that combination with systemic diseases greatly increases the difficulty of curing refractory RAU, making conventional oral ulcer treatment harder to perform effectively. This is probably because dentists commonly only focus on handling oral ulcers but neglect to think about the etiology of oral ulcers from a holistic perspective. Thus, we summarized some conditions of refractory RAU accompanied by systemic diseases, including inflammatory bowel disease, iron deficiency anemia, diabetes mellitus, Behçet’s disease, Reiter’s syndrome, sprue syndrome, Sutton syndrome, and acquired immunodeficiency syndrome. We also outlined the treatment principles of these patients. To be specific, on the one hand, dentists should cooperate with the relevant specialists to treat the systemic diseases, while on the other hand they should take measures including topical/general use of medicine, local physical therapy, Traditional Chinese medicine treatment, and psychotherapy for RAU management. This paper aims to provide clinicians with a more comprehensive understanding of the diagnosis and treatment of refractory RAU, in order to make personalized treatment plans for patients and improve the clinical efficacy of refractory RAU.

The Validation of Beck's Depression Inventory in Patients With Systemic Diseases: A Psychometric Study at a Dental Institute.

Background Depression seriously threatens the world's public health, manifesting symptoms like loss of interest, fatigue, guilt, and impaired focus. Major depressive disorder is a common problem for those with chronic systemic illnesses. Since this illness has an impact on psychosocial well-being and interacts with anxiety and stress, it is crucial to assess psychological functioning. Depression-related issue has a negative impact on oral health and can cause cognitive dysfunction, social interaction problems, and low self-esteem. For the purpose of identifying and effectively managing depression in patients with systemic illnesses undergoing dental procedures, screening tools like the Beck's Depression Inventory (BDI) were used. The BDI's benefits include its strong internal consistency, sensitivity to change, broad concept validity, adaptable criteria validity for separating depressed and nondepressed people, and global dissemination. Materials and methods A cross-sectional prospective study was carried out after receiving the necessary institutional ethical approvals, and the participant's agreement was also obtained. The questionnaire was explained to the patients. The entire participation was voluntary. Results In the current study patient's ages ranged from 34 years to maximum age of 83 years with a mean age of 59.70±13.16 years, with 40% of the population falling into the 51-65 years age group. According to the results, participants who had multiple systemic disorders were more likely to experience depression than people who had one systemic illness. The chi-square test showed no statistically significant results between the depression scores and the number of systemic diseases (p-0.574). Seventy-five per cent of individuals with depression required tooth extractions. Conclusion Those with systemic disorders who were receiving dental care in the current study showed elevated levels of depression. An important finding was the correlation between depression and tooth extraction, highlighting the need for proactive mental health assessments in dental care. Tailored interventions can mitigate the impact, enhancing the holistic well-being of patients suffering from systemic diseases and depression.

The oral microbiota: a literature review for updating profesional s in dentistry-Part II / La microbiota oral: una revisión de literatura para la actualización de profesionales en odontología-Parte II

ABSTRACT: In the first part of this literature review, published in October 2019 in this journal, we summarized the conceptual background of the oral microbiota, and the main methods used in microbiology to characterize oral organisms. We also presented the most studied bacteria species in the oral microbiota. In this second part, we will discuss the evidence regarding the biological plausibility linking the oral microbiota dysbiosis and systemic diseases, as well as the main factors and mechanisms suspected in this association.

RESUMEN: En la primera parte de esta revisión de literatura, publicada en esta revista en octubre de 2019, se resumieron los antecedentes conceptuales de la microbiota oral y describieron los principales métodos utilizados en microbiología para caracterizar los microorganismos orales. Asimismo, se presentaron las especies bacterianas mejor estudiadas de la microbiota oral. En esta segunda parte, se explorará la plausibilidad biológica que vincularía la disbiosis de la microbiota oral y las enfermedades sistémicas, así como las características que podrían influenciar la composición de la microbiota oral.

Curso optativo de riesgo quirúrgico para estudiantes de pregrado de la carrera de estomatología / Elective course on surgical risk for undergraduate dental medicine students

Introducción: Los pacientes de riesgo quirúrgico presentan enfermedades asociadas que deben considerarse durante el tratamiento estomatológico. Investigaciones realizadas revelan la existencia de deficiencias durante la atención estomatológica a este tipo de paciente y que el tema debe ser reforzado durante el pregrado. Objetivos: Exponer las generalidades del curso optativo de atención estomatológica integral al paciente de riesgo quirúrgico y los criterios emitidos por sus participantes. Métodos: Se realizó una investigación descriptiva de corte pedagógico para exponer las características más importantes del curso. Se tuvieron en cuenta las siguientes variables: temas, objetivos, sistema de conocimientos y de habilidades. Se aplicó la técnica de Positivo, Negativo, Interesante a todos los participantes del curso. Resultados: El curso implementado contó con cinco temas: el primero dedicado a las generalidades y las características particulares en la confección de historia clínica; el segundo y tercero, a las enfermedades de riesgo quirúrgico y los tratamientos estomatológicos; el cuarto, al uso de medicamentos para la enfermedad sistémica y las posibles interacciones; y el quinto, a experiencias clínicas. Los estudiantes aportaron criterios positivos, negativos e interesantes. Conclusiones: El curso diseñado ofrece conocimientos y habilidades al estudiante que no se proporcionan en las asignaturas de pregrado, lo cual permite una mejor atención estomatológica integral a los pacientes de riesgo quirúrgico. Los estudiantes participantes del curso optativo aportaron criterios favorables sobre su estructura, pertinencia y valor científico(AU)

Introduction: Surgical risk patients have associated diseases that must be considered during dental treatment. Some research carried out have revealed the existence of deficiencies during dental care for this type of patients, a reason why the issue must be strengthened during undergraduate studies. Objective: To present the generalities of an elective course of comprehensive dental care for patients at surgical risk and the criteria issued by its participants. Methods: A descriptive research with a pedagogical nature was carried out to expose the most important characteristics of the course. The following variables were taken into account: topics, objectives, knowledge system and skills system. The positive-negative-interesting technique was applied to all the course participants. Results: The implemented course had five topics: the first was dedicated to generalities and particular characteristics in the preparation of a clinical record; the second and third courses, to surgical risk diseases and dental treatments; the fourth course, to the use of drugs for systemic diseases and possible interactions; and the fifth, to clinical experiences. The students provided positive, negative and interesting criteria. Conclusions: The designed course offers knowledge and skills to the student that are not provided in undergraduate subjects, which allows better comprehensive dental care to patients at surgical risk. The students participating in the elective course provided favorable criteria about the course's structure, relevance and scientific value(AU)

Multiorgan-on-a-Chip: A Systemic Approach To Model and Decipher Inter-Organ Communication.

Multiorgan-on-a-chip (multi-OoC) platforms have great potential to redefine the way in which human health research is conducted. After briefly reviewing the need for comprehensive multiorgan models with a systemic dimension, we highlight scenarios in which multiorgan models are advantageous. We next overview existing multi-OoC platforms, including integrated body-on-a-chip devices and modular approaches involving interconnected organ-specific modules. We highlight how multi-OoC models can provide unique information that is not accessible using single-OoC models. Finally, we discuss remaining challenges for the realization of multi-OoC platforms and their worldwide adoption. We anticipate that multi-OoC technology will metamorphose research in biology and medicine by providing holistic and personalized models for understanding and treating multisystem diseases.

Association between oral lichen planus and systemic conditions and medications: Case-control study.

OBJECTIVE: The aim of this study is to investigate the association between oral lichen planus (OLP) and a variety of systemic conditions, medication, and supplement usage. MATERIALS AND METHOD: A total of 156 patients diagnosed with OLP and 156 controls at Columbia University Irving Medical Center from 2000 to 2013 were selected as part of the matched (1:1) case-control study. Demographics, systemic conditions, prescription medications and supplements were extracted from the patients' medical records. A univariable conditional logistic regression (CLR) analysis was performed to calculate unadjusted odds ratio, to identify significant variables associated with OLP (p < .10). Significant variables were further tested using multivariable CLR analysis with both forward and backward selection to calculate adjusted odds ratio (aOR) and further distinguish variables associated with OLP (p < .05). RESULTS: This analysis identified six significant variables: thyroid disorder (aOR:5.1,95%CI:2.3-11.2), any form of cancer (aOR:3.4,95%CI:1.4-8.4), type 2 diabetes (aOR:2.8,95%CI:1.2-6.3), hyperlipidemia (aOR:2.3,95%CI:1.3-4.1), oral sedative usage (aOR:6.3,95%CI:1.8-22.5), and vitamin D supplementation (aOR:2.7,95%Cl:1.3-6.0). CONCLUSION: Thyroid disorders, cancer, type 2 diabetes, hyperlipidemia, sedatives, and vitamin D supplementation were found to be associated with OLP. Additional investigation is required to explore these associations, which could shed light on the potential mechanism of OLP and reinforce the idea that oral lesions could be predicative of previously undetected systemic conditions.

Oral lichen planus and associated comorbidities: An approach to holistic health.

Lichen planus (LP) is a chronic inflammatory disorder with involvement of skin, oral and genital mucosa, scalp, and nail appendages. Oral lichen planus (OLP) lesions demonstrate a number of morphologic presentations, persist for a long time with rare self-resolution, and undergo malignant changes. OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The oral health physician should be aware of these systemic associations and should work in close connect with the primary healthcare physicians to rule out the predisposing factors for the associated comorbidities. This article aims to highlight the various systemic associations of OLP and warrants the screening of these ailments in OLP for prevention and effective management.

Medicamentos en pacientes con riesgo quirúrgico y su repercusión en Estomatología / Medicine use in surgery risk patients and repercussion in Dentistry

RESUMEN • Introducción: Con el envejecimiento creciente de la población, la práctica estomatológica exige la utilización del conocimiento para identificar y tratar pacientes con enfermedades sistémicas cada vez más frecuentes, lo cual puede requerir el uso de medicamentos capaces de interactuar con el tratamiento farmacológico de su enfermedad de base. La literatura refleja esta relación de manera fragmentada y carente de un enfoque sistémico. Objetivo: Identificar en la literatura el uso de medicamentos en pacientes con riesgo quirúrgico y describir su repercusión durante el tratamiento estomatológico. Material y Métodos: Se realizó una revisión bibliográfica y se consultaron artículos científicos, tesis de titulación de especialistas, maestrías y doctorales entre otras referencias principalmente de los últimos 5 años mediante Google. Desarrollo: Se abordan las generalidades, manejo estomatológico y las interacciones medicamentosas de cada una de las enfermedades a estudiar (Diabetes Mellitus, hipertensión arterial y cardiopatía), así como las situaciones que requieren profilaxis antibiótica. Conclusiones: Los pacientes con riesgo quirúrgico utilizan medicamentos que producen interacciones importantes con fármacos como AINES, anestésicos locales y glucocorticoides que habitualmente se emplean en los tratamientos estomatológicos; existen además enfermedades sistémicas en las cuales hay que tener en cuenta la profilaxis antibiótica antes de realizar determinados procederes estomatológicos.

ABSTRACT • Introduction: With the growing of population aging, the dental practice requires the adequate knowledge to identify and treat patients with increasingly frequent systemic diseases, which may require the use of drugs capable of interacting with the pharmacological treatment of their underlying diseases. The literature reflects this relationship in a fragmented manner and lacking a systemic approach. Objective: To identify the drugs used in risk patients undergoing surgery and describe their repercussion during dental treatment. Material and Method: A bibliographic review was carried out. Scientific articles, specialists´ theses, Master´s and PhD degrees among other references were consulted, mainly the ones obtained from the search carried out in Google during the last 5 years. Results: The generalities, dental management and drug interactions between the diseases studied (diabetes mellitus, arterial hypertension and heart disease) were addressed, as well as the situations that require antibiotic prophylaxis. Conclusions: The surgical risk patients studied use drugs that produce important interactions with drugs such as NSAIDs, local anesthetics and glucocorticoids that are usually used in dental treatments. There are also systemic diseases in which antibiotic prophylaxis must be taken into account before performing certain dental procedures.

[Importance of phototherapy in the treatment of chronic pruritus]. / Stellenwert der Phototherapie in der Behandlung des chronischen Pruritus.

Phototherapy and photochemotherapy (PUVA) are important treatment modalities in inflammatory skin diseases such as psoriasis and atopic dermatitis as well as in cutaneous T­cell lymphoma (e.g., mycosis fungoides/Sezary syndrome). Many of these skin diseases are accompanied by distracting pruritus. In addition, patients may suffer from intense pruritus in systemic diseases of the kidney and liver as well as of the endocrine and hematopoietic system. UV-light during phototherapy is capable of not only improving the inflammatory skin lesions but also of reducing the pruritus in skin and systemic diseases. The significant antipruritic effect, the usually low rate of well-known side effects, as well as the possibility to treat adults of any age, pregnant and lactating women, and under certain circumstances also children, make phototherapy a valuable treatment option for pruritus of various origin. Thus, the use of phototherapy should be considered early in the course of antipruritic therapy, when topical treatment modalities are insufficient to significantly improve pruritus.

Protective effects of resveratrol against streptozotocin-induced diabetes in rats by modulation of visfatin/sirtuin-1 pathway and glucose transporters.

This experiment was aimed at elucidating the protective effect of resveratrol against diabetes. Forty male Wistar albino rats were allocated into four groups: the control and streptozotocin (STZ)-induced diabetes groups were treated either with placebo (1 ml/kg, i.p.) or resveratrol (20 mg/kg, i.p.) for 8 weeks. Body weight, blood glucose and serum malondialdehyde (MDA) concentrations were monitored. At the end of the experimental period, expression levels of visfatin, sirtuin-1 (SIRT1) and glucose transporters (GLUTs, 2 and 4) were measured in skeletal muscle and pancreas by Western blotting. The resveratrol treatment partially compensated for body weight loss and alleviated hyperglycaemia and returned serum MDA concentrations to the control group levels. Data suggest that supplementation may reduce the severity of diabetes and its complications through suppressing oxidative stress and increasing potential to internalise glucose by extrahepatic tissues.