Common Oral Conditions: A Review.

Importance: Dry mouth, oral candidiasis, and recurrent aphthous ulcers are 3 of the most common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. Observations: In a meta-analysis of 26 population-based cohort and cross-sectional studies, the global prevalence of dry mouth symptoms was 23% (95% CI, 18% to 28%), placing individuals at risk of oral candidiasis, dental caries, dysgeusia, masticatory/speech impairment, and oropharyngeal dysphagia. Dry mouth is associated with using more than 3 oral medications per day (odds ratio [OR], 2.9 [95% CI, 1.4 to 6.2]), head and neck radiation, and Sjögren disease. Symptoms may include difficulty swallowing and speaking, thirst, and halitosis. Dry mouth is associated with an 11.5% (95% CI, 3.6% to 27%) higher risk of oral candidiasis, based on a meta-analysis of 6 observational cohorts. Management of dry mouth includes mechanical salivary stimulants, oral moisturizers, and/or systemic sialagogues. Oral candidiasis is an opportunistic fungal infection caused by overgrowth of the Candida genus with C albicans, which accounts for 76.8% of infections. The prevalence of oral candidiasis is higher in patients who are immunosuppressed, for example, those with HIV (35% [95% CI, 28% to 42%]) and those with salivary gland hypofunction (OR, 3.02 [95% CI, 1.73 to 5.28]). Common risk factors associated with oral candidiasis include use of antibiotics (P = .04) and oral mucosal disorders such as lichen planus. Oral burning and dysgeusia are common symptoms of oral candidiasis. Treatment includes addressing risk factors and use of topical and/or systemic antifungal medications. Recurrent aphthous stomatitis is characterized by symptomatic round or oval oral ulcers, which are covered by a gray-white fibrin layer and encircled by an erythematous ring. A meta-analysis of 10 case-controlled studies revealed an increased risk of recurrent aphthous stomatitis associated with polymorphism of IL-1ß (+3954C/T) (OR, 1.52 [95% CI, 1.07 to 2.17]) and IL-1ß (-511C/T) (OR, 1.35 [95% CI, 1.09 to 1.67]). Another meta-analysis of 9 case-control studies reported that patients with recurrent aphthous stomatitis had a higher frequency of nutritional deficiencies, including vitamin B12 (OR, 3.75 [95% CI, 2.38 to 5.94]), folic acid (OR, 7.55 [95% CI, 3.91 to 14.60]), and ferritin (OR, 2.62 [95% CI, 1.69 to 4.06]). Recurrent aphthous stomatitis can be associated with systemic diseases. A meta-analysis of 21 case-control studies revealed that celiac disease is associated with a higher incidence of recurrent aphthous stomatitis (25% vs 11%; OR, 3.79 [95% CI, 2.67 to 5.39]; P <.001). Topical corticosteroids are first-line agents to manage recurrent aphthous stomatitis; however, systemic medications may be necessary in more severe cases. Conclusions and Relevance: Dry mouth, oral candidiasis, and recurrent aphthous ulcers are common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. First-line treatment includes over-the-counter sialagogues for dry mouth, topical antifungals for oral candidiasis, and topical corticosteroids for aphthous ulcers. Oral conditions that do not improve with first-line treatment may require treatment with systemic medications.

Common Oral Manifestations of Select Systemic Diseases: Anemia, Diabetes Mellitus and HIV.

In this article, we discuss several common abnormal signs and symptoms that may be present in the oral cavity initially with or without any systemic symptoms at a typical dental practice. The purpose of this discussion is to increase clinical awareness for establishing differential diagnoses so that patients may obtain appropriate referrals for appropriate medical treatment.

Oral manifestations of anti-neutrophil cytoplasmic antibody-associated vasculitis: an update and narrative review of the literature.

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a multisystem disorder of small blood vessels subdivided into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Oral manifestations (OMs) have been reported to include mucosal ulceration, gingival enlargement, alveolar bone necrosis, tooth loss, oro-antral communication, palatal perforation, parotitis, and candidal infection mainly in GPA. They may appear during the course of the disease, as a disease flare-up, or as the presenting sign. These OMs are often nonspecific and can mimic an array of conditions, therefore formulating a differential diagnosis can be challenging. This review updates the OMs of GPA, and, for the first, time includes OMs of other AAVs. It provides recommendations for the overall assessment and the diagnosis and management of all AAV OMs with considerations for treatment coordination. The role of oral health care providers in multidisciplinary care is highlighted.

Gastroesophageal reflux disease and oral health: A narrative review.

Gastroesophageal reflux disease (GERD) is a clinical condition in which stomach contents leak backward into the esophagus. It affects millions of people worldwide and has a detrimental effect on quality of life. Heartburn and acid regurgitation are typical GERD symptoms, while atypical manifestations include noncardiac chest pain, cough and laryngitis. The oral and maxillofacial manifestations of GERD may include dental erosion, xerostomia, mucositis, aphthous like ulcerations, sour taste, burning mouth, hyperesthesia, bruxism, and/or temporomandibular disorder (TMD). This narrative review provides oral health care professionals with an update to medical aspects of GERD, recognition and management of oral and maxillofacial manifestations of the condition and provision of appropriate dental care for this patient population.

Orofacial Granulomatosis Treated With Combination of Intralesional Steroids and Hydroxychloroquine.

This article presents a case of a 39-year-old woman with spontaneous lip swelling with gingival erythema. The case report discusses orofacial granulomatosis, a condition that often poses diagnostic and management challenges. Additionally, the article emphasizes the importance of establishing a definitive diagnosis of this disease, which has similar clinical and histological features to other oral and systemic conditions. Finally, a successful management approach is discussed that uses combination therapy consisting of intralesional steroid injections and oral hydroxychloroquine.

Dental management of a pediatric patient with Kohlschutter-Tonz syndrome: A case report.

INTRODUCTION: Kohlschutter-Tonz syndrome (KTS) is a rare, genetic condition, which typically manifests as a triad of symptoms: 1) amelogenesis imperfecta, 2) infantile onset epilepsy, and 3) intellectual disability. The condition poses dental treatment challenges given the manifestation of amelogenesis imperfecta. Additional considerations are needed to medically manage these patients who present with epilepsy and intellectual disability. CASE REPORT: Our patient presented with multiple restorative needs, was treated under general anesthesia, and maintained good oral outcomes with close follow-up. DISCUSSION: To the best of our knowledge, this is the first case report which documents comprehensive dental management of a pediatric patient with KTS.

Introduction to dental medicine: Analysis of a massive open online course in dentistry.

OBJECTIVES: This study aims to: (1) assess learner demographics of Introduction to Dental Medicine (IDM), an early Massive Open Online Course (MOOC) developed for the Coursera platform and (2) analyze course enrollment to determine worldwide interest in accessible, high-quality dental education. METHODS: The authors review the development and organization of IDM and present learner statistics to critically evaluate learner traits and course engagement for IDM. RESULTS: IDM has been available since June 15, 2015, and as of March 1, 2020, gained 90,374 visitors, of whom 16,739 have enrolled and demonstrate continued monthly and daily engagement. Learners represent all age groups and genders and include participants of all educational and employment backgrounds, reflecting broad interest in dental knowledge. They originate from 6 continents with the largest percentages of learners from countries including the United States, Egypt, India, and the United Kingdom. IDM learners have provided positive feedback, rating the course 4.8/5 stars and often providing individual accounts of the benefit of their experiences. CONCLUSIONS: IDM presented an opportunity to learn general dental concepts. The course served to increase familiarity in the field for all learners, including health professionals, patients, and anyone with an interest in the subject. It also served as preparation for or to expand education in dental, medical, and allied health professions. High learner engagement with wide global distribution demonstrated interest in dental education worldwide.

Participation in an existing massive open online course in dentistry during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges and interruptions to education at all levels. As many across the world were required to stay at home, virtual educational resources were developed and relied upon to provide all levels and subjects of instruction. Introduction to Dental Medicine, a massive open online course in dentistry, experienced an increase in enrollment during the start of the pandemic and learners displayed a positive reception to the information provided. Introduction to Dental Medicine was particularly well positioned as a resource during the pandemic given its availability, established nature, and the wide accessibility of course material. As disruptions to normal activities continue, this and other virtual educational methods may continue to play a central role in education and exposure to dentistry.

Implications of Tattoos That Oral Healthcare Providers Should Consider.

Occasionally, a patient may present with an intraoral tattoo, such as the patient in this instance who presented with one on the lower orolabial mucosa. Both extraoral and intraoral tattooing could be considered a potential indicator of risk-taking behaviors and possible increased risk of mental health or sleep disorders in this patient population. This article discusses risks of ornamental tattooing and the role oral healthcare providers can play in early identification of possible systemic diseases.

Oral Hypersensitivity Reactions.

Allergic contact hypersensitivity reactions of the oral mucosa pose a significant medical concern for some patients. Oral hypersensitivity reactions can result from a vast number of allergenic chemicals, but occur commonly from dental materials, flavorings, and preservatives. Clinical presentation is varied and often overlaps with other oral conditions, complicating their diagnosis and management. The most common clinical entities associated with oral hypersensitivity reactions are oral lichenoid reactions and allergic contact cheilitis. In addition to reviewing these conditions and their most common corresponding allergens, this article summarizes the pathogenesis of oral hypersensitivity reactions and addresses patch testing pearls.

Analysis of clinical oral medicine practices at the University of Pennsylvania: a 5-year retrospective study.

OBJECTIVE: The aim of this study was to characterize oral medicine (OM) clinical practices at the University of Pennsylvania (Penn), determine the importance of OM clinical services, and emphasize aspects of training for OM specialists. STUDY DESIGN: Nonprobability sampling of OM resident patient logs for patients receiving clinical care from 2008 to 2013 was conducted. OM resident patient logs included clinical diagnosis, International Classification of Diseases, ninth edition code, medical history, clinical procedure, Current Procedural Terminology code, attending physician, and resident participation notes. RESULTS: Outpatients in OM medical practices (n = 6024) averaged 1.56 diagnoses from OM specialists. Orofacial pain (45.02%) and oral mucosal diseases (34.28%) comprised the majority of OM diagnoses. The most common procedures were tissue biopsies (59.34%) and treatments for temporomandibular disorders (29.9%). Inpatients (n = 313) comprised 3.46% of Penn OM hospital services, and cardiovascular disorders (38.99%) were the most common admitting diagnoses in this group. In the OM dental practice (n = 1648), 42.05% of patients had a median of 3 medical comorbidities (range = 2-11), of which cardiovascular disorders (27.13%) were most prevalent. CONCLUSIONS: Analysis of Penn OM clinical practices emphasizes the breadth and multidisciplinary nature of OM services and importance of comprehensive postdoctoral training in all domains of OM.

Analysis of The Oral Cavity: Portal to Health and Disease, a massive open online course in oral medicine.

OBJECTIVE: The aims of this study were to (1) analyze the demographic characteristics of learners participating in The Oral Cavity: Portal to Health and Disease (TOC), the first massive open online course in oral medicine, and (2) assess worldwide interest in accessible, high-quality oral medicine education. STUDY DESIGN: TOC development and design was reviewed in detail to provide background for course organization and content. Learner demographic characteristics were gathered and analyzed to identify course participation and engagement. RESULTS: TOC premiered on September 17, 2017 as a novel source for oral medicine-based information. By March 1, 2020, TOC had 18,122 learners, of whom 4,641 enrolled. This sample included all age groups and genders, people of varied educational and employment backgrounds, and participants from 6 continents. Learners rated the course 4.9 out of 5 stars and submitted many positive reviews. CONCLUSIONS: TOC provided oral medicine-based education to individuals with interests in dental, medical, and allied health professions. Interest in oral medicine-related education was supported by high learner engagement in this course with wide global distribution.

Persistent orofacial pain associated with nasopharyngeal extramedullary plasmacytoma.

Orofacial pain (OFP) disorders affect the maxillofacial complex and typically involve other locations in the head and neck. Common etiologies of OFP disorders include odontogenic sources, temporomandibular disorders, neuropathic pain, chemosensory disorders, and headaches. Less commonly, benign and malignant neoplasms can be associated with OFP complaints. Patients with OFP symptoms require a thorough evaluation and are often referred to additional healthcare providers for interprofessional management. In those OFP patients whose symptoms do not respond to conventional treatment(s), whose symptoms change over time, or who report positive responses to review of systems questions that suggest more extensive involvement, further investigation is warranted. To the best of our knowledge, this is the first case report of nasopharyngeal extramedullary plasmacytoma, a localized malignant neoplasm, associated with persistent OFP.

Considerations in the evaluation and management of oral potentially malignant disorders during the COVID-19 pandemic.

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. CONCLUSIONS: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs.

Recalcitrant Gingival Lesions in a Patient Previously Diagnosed With Behçet's Disease.

Oral mucosal lesions are frequently encountered in a variety of healthcare settings and often present as a diagnostic and management challenge. Several immune-mediated disorders present with overlapping oral and/or cutaneous manifestations. Healthcare providers must establish a specific diagnosis to guide effective disease management. This article describes the case of a patient previously diagnosed with Behçet's disease who presented with recalcitrant gingival lesions. The case report underscores the need for healthcare providers to have a fundamental knowledge of mucocutaneous disorders.