Unveiling denture-induced oral lesions: A comprehensive study on classification and pain assessment.

BACKGROUND: Denture-induced oral Lesions (DIOLs) often manifests shortly after the placement or adjustment of new or realigned dentures, frequently resulting in severe pain and discomfort. OBJECTIVES: This study aimed to classify DIOLs placing a particular emphasis on assessing the associated pain. METHODS: A prospective case study was conducted involving 126 patients who were fitted with a total of 193 dentures of various types at the Hadassah School of Dental Medicine. All patients underwent comprehensive intra-oral examinations within 1-8 weeks following denture delivery, completed symptom questionnaires and had their medical records reviewed. Key variables documented included age, gender, overall health status, denture type, and a detailed description of the DIOLs. The description encompassed factors such as lesion location, shape, colour, size, border characteristics, ulcerative appearance, membrane coverage, 3D morphology (elevated, immersed and flat) and patient-reported Verbal Pain Score (VPS) when touching the DIOLs, when wearing the denture, and when not wearing the denture. RESULTS: Notably, 25.4% of denture wearers required no adjustments, while 14.4% necessitated more than three revisions. A majority (71.8%) of DIOLs cases were associated with mandibular complete dentures, primarily situated on the alveolar ridge. The mean VPS indicated a pain intensity of 7 ± 2.1, with temporary dentures in both jaws causing the most discomfort. Implant-supported overdentures were particularly painful when placed in the mandible. Additionally, VPS scores were higher among older individuals and those with prior prosthetic experiences. A significant correlation was observed between pain intensity and presence of chronic health condition (0.036). CONCLUSIONS: This study revealed distinct characteristics of DIOLs and highlighted the multifactorial nature of pain experienced following the development of DIOLs. Insights into the influence of patient and denture characteristics on DIOLs and pain intensity can guide healthcare professionals in optimising patient comfort and satisfaction.

Possible proteomic biomarkers for the detection of pancreatic cancer in oral fluids.

The 80% mortality rate of pancreatic-cancer (PC) makes early diagnosis a challenge. Oral fluids (OF) may be considered the ultimate body fluid for non-invasive examinations. We have developed techniques to improve visualization of minor OF proteins thereby overcoming major barriers to using OF as a diagnostic fluid. The aim of this study was to establish a short discriminative panel of OF biomarkers for the detection of PC. Unstimulated OF were collected from PC patients and controls (n = 30). High-abundance-proteins were depleted and the remaining proteins were analyzed by two-dimensional-gel-electrophoresis and quantitative dimethylation-liquid-chromatography-tandem mass-spectrometry. Label-free quantitative-mass-spectrometry analysis (qMS) was performed on 20 individual samples (n = 20). More than 100 biomarker candidates were identified in OF samples, and 21 had a highly differential expression profile. qMS analysis yielded a ROC-plot AUC value of 0.91 with 90.0% sensitivity and specificity for a combination of five biomarker candidates. We found a combination of five biomarkers for PC. Most of these proteins are known to be related to PC or other gastric cancers, but have never been detected in OF. This study demonstrates the importance of novel OF depletion methodologies for increased protein visibility and highlights the clinical applicability of OF as a diagnostic fluid.

[Medicaments and oral healthcare. Systematic review of the -literature assessing the effect of drugs on the salivary glands]. / Serie: Medicamenten en mondzorg.Systematisch literatuuronderzoek naar effect van medicatie op de speekselklieren.

Evidence-based reviews of drugs causing medication-induced salivary gland dysfunction, such as xerostomia (sensation of oral dryness) and subjective sialorrhea are lacking. To compile a list of medicaments that influence salivary gland function, electronic databases were searched for relevant articles published up to June 2013. A total of 269 papers out of 3,867 records located satisfied the inclusion criteria (relevance, quality of methodology, strength of evidence). A total of 56 active substances with a higher level of evidence and 50 active substances with a moderate level of evidence of causing salivary gland dysfunction are described in this article. While xerostomia was a commonly reported outcome, the objective effect on salivary secretion was rarely measured. Xerostomia was, moreover, mostly reported as a negative side effect instead of the intended effect of that drug. A comprehensive list of medications having documented effects on salivary gland function or symptoms was compiled, which may assist practitioners in assessing patients who complain of dry mouth while taking medications.

Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea.

OBJECTIVE: Oral appliances (OA) are recommended for patients with severe obstructive sleep apnea who fail to comply with continuous positive airway pressure (CPAP) therapy. This mixed-methods study aimed to quantify adherence to OA therapy and evaluate subjective reasons associated with non-adherence. MATERIALS AND METHODS: The medical records of 52 patients with an apnea-hypopnea index (AHI) ≥ 40, treated with OA after discontinuation of CPAP treatment, were examined for OA adherence. Patients were divided according to usage at the time of a phone interview. The USER group included all forms of usage, whereas those who completely ceased using the OA were in the NUSE group. The timing of the phone interview was from five months to six years (average 44.63 ± 17.17 months) after OA delivery. RESULTS: The overall adherence rate was 57.7% (30/52 patients). The mean usage times were 10.07 ± 8.96 and 44.30 ± 17.3 months in the NUSE and NUSE groups, respectively. The main factors associated with non-adherence were concerns about the effects of the OA on teeth (22%) and insufficient efficacy (22%). Other factors were discomfort (15%) and improved well-being following weight loss (15%). The overall number of interfering and discontinuity factors was significantly higher in the NUSE group than in the USER group (P = 0.041). Nine (17.3%) of 52 patients resumed CPAP use. Subjective and objective outcomes, determined by using a second sleep test with OA in 69.2% of patients, were related to the continuation of treatment. CONCLUSIONS: On-adherence to OA is strongly associated with patient reservations regarding the effects of the device on teeth, possible lack of efficacy, and discomfort. Clinicians should closely monitor adherence patterns and assess potential interfering factors during their diagnostic workup. Patients should be reassured regarding device safety, particularly following dental work that may interfere with the insertion of the OA.

[Oral medicine in Israel: Current status and future directions].

The oral cavity-body relationships are bi-directional: oral diseases affect the welfare and health of the individual, while diseases and conditions of organs and tissues in the human body affect oral health. The global policy of the World Health Organization is to improve oral health in the 21st century as an integral part of promoting our general health. During the recent years the knowledge of the dental profession has grown exponentially and widened its fields of interest and this has led to impressive advances at both clinical and research levels. Oral medicine, which is a recognized, licensed specialty in Israel, is a definite example that reflects this process. In the last decade residency programs in oral medicine are in the process of constant increased demand. The authors discuss this trend and comment on the need to maintain excellence in this specialty.

World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction.

The aim of this paper was to perform a systematic review of the pathogenesis of medication-induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α-and ß-adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology.

The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI.

This narrative review of the functions of saliva was conducted in the PubMed, Embase and Web of Science databases. Additional references relevant to the topic were used, as our key words did not generate references which covered all known functions of saliva. These functions include maintaining a moist oral mucosa which is less susceptible to abrasion, and removal of micro-organisms, desquamated epithelial cells, leucocytes and food debris by swallowing. The mucins form a slimy coating on all surfaces in the mouth and act as a lubricant during such processes as mastication, formation of a food bolus, swallowing and speaking. Saliva provides the fluid in which solid tastants may dissolve and distributes tastants around the mouth to the locations of the taste buds. The hypotonic unstimulated saliva facilitates taste recognition. Salivary amylase is involved in digestion of starches. Saliva acts as a buffer to protect oral, pharyngeal and oesophageal mucosae from orally ingested acid or acid regurgitated from the stomach. Saliva protects the teeth against acid by contributing to the acquired enamel pellicle, which forms a renewable lubricant between opposing tooth surfaces, by being supersaturated with respect to tooth mineral, by containing bicarbonate as a buffer and urea and by facilitating clearance of acidic materials from the mouth. Saliva contains many antibacterial, antiviral and antifungal agents which modulate the oral microbial flora in different ways. Saliva also facilitates the healing of oral wounds. Clearly, saliva has many functions which are needed for proper protection and functioning of the human body.

Lifestyle and dental attendance as predictors of oral health-related quality of life.

OBJECTIVES: To evaluate the impact of health-related behaviors and dental attendance on oral health-related quality of life (OHRQoL). METHODS: One hundred and ninety-two individuals presenting for dental treatment were included in a cross-sectional survey using a self-administered questionnaire that assessed demographics, smoking and alcohol consumption, physical activity habits, dental attendance, and dental pain utilizing a numeric rating scale (NRS). Results of the Oral Health Impact Profile (OHIP)-14 questionnaire were considered as the dependent variable. A conceptual hierarchical data analysis model from distal to proximal determinants of the median OHIP-14 total score was adopted. RESULTS: Analysis of the OHIP-14 domains and total score revealed several significant protector characteristics: younger age, academic education, no alcohol consumption, regular physical activity, fewer smoking pack years, routine dental attendance, and lower NRS scores. Routine dental attendance was related to lower NRS scores (P < 0.001) which in turn were associated with lower OHIP-14 scores (P = 0.018). Better health-related behaviors (P = 0.039) and routine dental attendance (P = 0.029) also correlated directly with lower OHIP-14 scores. CONCLUSIONS: Better health-related behaviors and routine dental attendance have a protective effect on OHRQoL. Clinicians should assess these behaviors during routine diagnostic workups. Global health authorities need to integrate oral and general health care and improve both OHrQoL and HrQoL.

Oral and maxillofacial pathologies in young- and middle-aged adults.

OBJECTIVE: To evaluate the distribution of oral and maxillofacial pathologies (OMFPs) and its association with patient age in young- and middle-aged adults. METHODS: Distribution of histopathologically diagnosed OMFPs (n = 385) treated during 2007-2010 was recorded and the association with patient age was retrospectively analyzed. RESULTS: The main diagnostic categories included benign exophytic lesions (45.3%), white benign lesions (13.5%), potentially malignant lesions/disorders (10.1%), intrabony lesions (9.8%), mucosal discoloration (7.8%), benign pigmented lesions (7.3%), chronic trauma/inflammation (3.9%), and oral malignancy (2.1%). Potentially malignant lesions/disorders as a diagnostic category were positively associated with age (OR = 1.07 for 1 year; P < 0.001) and specifically the diagnoses of oral lichen planus (OR = 1.04 for 1 year; P = 0.037) and dysplastic changes (OR = 1.08 for 1 year; P = 0.013) that comprised this category. Pigmented melanocytic lesions were negatively associated with age (OR = 0.94 for 1 year; P = 0.039) as well as benign/reactive exophytic lesions (OR = 0.98 for 1 year; P = 0.038), the latter included the histopathological diagnosis of benign salivary gland pathologies (OR = 0.90 for 1 year; P < 0.001). CONCLUSION: This study provided baseline information regarding the distribution OMFPs among young- and middle-aged adults. It is important to highlight the high frequency of potentially malignant lesions/disorders and oral malignancy in young- and middle-aged adults, as these lesions require lifelong follow-up.

A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study.

OBJECTIVE: Oral appliances for treating severe obstructive sleep apnea (OSA) are recommended for patients who failed to comply with continuous positive airway pressure (CPAP) treatment. The objective of this study was to evaluate medium long-term outcome and success rates of oral appliances in patients with severe OSA. METHODS: In a retrospective study, 52 OSA patients with an apnea-hypopnea index (AHI) ≥40, who did not tolerate CPAP treatment, were enrolled and fitted with a modified Herbst oral appliance. A 2-year mean follow-up including a second somnography was conducted in 36 of the patients. RESULTS: A significant reduction (P < 0.0001) in the AHI was demonstrated between the initial somnography (55.25 ± 10.79,) and the followed one (17.74 ± 11.0, n = 36). Overall, 57.7% of total study subjects (n = 52) and 63.9% (n = 36) that had sequential sonmogarphy continued using the device. The reduction in AHI in the user group was 42.4 ± 3.1 (n = 23), which was significantly higher (P = 0.013) than in the non-user group (28.9 ± 17.2; n = 13). Moreover, 53% (n = 19) reached AHI of <15. CONCLUSIONS: Oral appliances were found to be successful for treating for severe OSA after first-line treatment had failed.

Elevated serum IgE in recurrent aphthous stomatitis and associations with disease characteristics.

OBJECTIVES: To characterize demographic, clinical and serological parameters in recurrent aphthous stomatitis (RAS) patients and analyse their association with serum immunoglobulin E (IgE) levels. SUBJECTS AND METHODS: Forty-nine patients with RAS responded to a questionnaire that included demographic background, stress status, smoking habits, history and course of RAS episodes. They were also subjected to relevant laboratory tests, including determination of serum IgE levels. RESULTS: A familial history of RAS was reported by 47.9% of the patients, stress in the previous year by 51.1% and smoking by 18.4%. Non-Caucasian origin, familial history of RAS, stress and smoking were associated with increased severity of RAS episodes. Haematological deficiencies were observed in 18.7% of RAS patients. Average IgE levels were increased and were significantly associated with younger age, ≤12 years of schooling, female gender, RAS episode frequency of every 2 weeks , early onset of RAS episodes and elevated C reactive protein levels. CONCLUSION: Immunoglobulin E levels may be considered as part of the RAS patient's work-up. Further research is needed to identify biological mechanisms that account for the observed associations.

Morphometrical study of minor salivary gland in xerostomic patients with altered lipid metabolism.

OBJECTIVE: To evaluate the correlation between dyslipidemia in patients with oral dryness and the development of non-specific histopathological findings in their labial salivary gland biopsies. METHODS: Thirty seven patients suffering from oral dryness (18 patients with dyslipidemia and 19 age-matched patients with normal lipid blood levels) underwent labial salivary gland biopsy. Total acinar area (TAA), acinar cell number, acinar lumen area (ALA), duct lumen area (DLA), area occupied by cells in acinus (AoCA), and area of one acinar cell (OAC) were calculated. RESULTS: A significantly (P < 0.05) increased AoCA, OAC, and DLA in labial glands from patients with impaired lipid metabolism, compared to controls, were found. CONCLUSION: A positive relationship between dyslipidemia and morphological changes in labial salivary glands was obtained.

[Screening saliva].

Oral Fluids (OF) are a complex mixture including components deriving from, salivary glands, blood, nasal and bronchial secretions, mucosal lining cells and microbiota. Therefore, OF as a mirror of the body, were suggested as an important diagnostic fluid for the detection of both, oral and systemic diseases. OF as diagnostic fluids have several advantages; their collection is easy, inexpensive and noninvasive, they are suitable for home use and for epidemiology researches, they are easy to store and ship, do not clot and enable fast detection. OF based diagnostics research accomplished a great advance during the last decade. This is mainly due to biotechnology improvements such as 2-D Fluorescence Difference Gel Electrophoresis, quantitative Mass Spectrometry and bioinformatics systems. These technologies enabled the detection of more than 3000 proteins in oral fluids, as well as the establishment of a panel of biomarkers to different human pathological conditions (i.e. periodontitis, Sjögren's Syndrome, oral cancer, pancreatic cancer etc). However, this diagnostic field has several drawbacks, mainly due to oral fluids variance composition, blood contamination as a result of gingivitis or mucosal injuries, the lack of a single established collection protocol and the presence of high abundant components in OF. This article summarizes the current research, and provides an outlook toward the foundation of this unique body fluid as a major player in the diagnostic field.

Urban legends series: Sjögren's syndrome.

Sjögren's syndrome (SjS) is one of the most common autoimmune rheumatic diseases, clinically characterized by xerostomia and keratoconjunctivitis sicca. We investigated the following controversial topics: (i) Do we have reliable ways of assessing saliva production? (ii) How important are the quantity and quality of saliva? (iii) Are only anti-SSA/Ro and anti-SSB/La relevant for the diagnosis of SjS? (iv) Are the American-European Consensus criteria (AECC) the best way to diagnose SjS? Results from literature searches suggested the following: (i) Despite the fact that numerous tests are available to assess salivation rates, direct comparisons among them are scarce with little evidence to suggest one best test. (ii) Recent developments highlight the importance of investigating the composition of saliva. However, more research is needed to standardize the methods of analysis and collection and refine the quality of the accumulating data. (iii) In addition to anti-Ro/La autoantibodies, anti α-fodrin IgA and anti-MR3 autoantibodies seem to be promising diagnostic markers of SjS, but more studies are warranted to test their sensitivity and specificity. (iv) AECC are classification, not diagnostic criteria. Moreover, recent innovations have not been incorporated into these criteria. Consequently, treatment directed to patients diagnosed using the AECC might exclude a significant proportion of patients with SjS.

Sialochemistry and cortisol levels in patients with Sjogren's syndrome.

OBJECTIVES: (i) To determine whether salivary cortisol and electrolyte levels differ between patients with Sjogren's syndrome (SjS) and healthy individuals. (ii) To assess correlations between whole-saliva cortisol and some clinical manifestations in patients with SjS. METHODS: A total of 24 healthy women (mean age 49.3±9.8) served as controls (C) vis-à-vis 17 patients with SjS (mean age 55.5±15.7). Salivary cortisol concentration was determined, and sialochemistry analysis was performed. RESULTS: Significantly lower saliva flow rates and higher salivary chloride (Cl(-) ), potassium (K(+) ), and Ca(2+) levels were found in the SjS group. No significant differences or correlations were found in other parameters, including sodium (Na(+) ), magnesium (Mg(2+) ), phosphate ((-) ), urea (U), and salivary cortisol levels. CONCLUSION: Increased whole-salivary output of Cl(-) and K(+) in SjS may reflect release from apoptotic rests of acinar cells after secondary necrosis. Normal levels of salivary Na(+) , Mg(2+) , and (-) argue against concentration effect, deranged tubular function or cortisol (mineralocorticosteroid) effect as the cause for these findings. Increased salivary Ca(2+) levels probably reflect leakage of plasma Ca(2+) through the injured oral mucosa in SjS. In spite of disease-associated stress, salivary cortisol, a stress biomarker, was not increased, suggesting insufficient hypothalamus-pituitary-adrenal (HPA) axis response and/or local consumption of cortisol by lymphocyte infiltrates.

Improved visualization of low abundance oral fluid proteins after triple depletion of alpha amylase, albumin and IgG.

OBJECTIVES: The aim of this study was to examine whether triple depletion of salivary-α-amylase (sAA), albumin (Alb) and immunoglobulins G (IgGs) may improve the visualization capability of proteins in two-dimensional gel electrophoresis (2-DE) of oral fluids (OF). SUBJECTS AND METHODS: Oral fluids from healthy volunteers were subjected sequentially to sAA removing device followed by application to an Alb and IgG immunoaffinity column (triple depletion). The depleted OF samples were analyzed using SDS-PAGE followed by 2-DE and protein identification using ion-trap mass spectrometry (MS). RESULTS: This specific triple depletion technique unmasked spots never visualized before. A total of 36 new spots were observed after depletion (348 vs 312 before depletion). Moreover, 58 spots showed more than twofold increase intensity after depletion. In the 60-69kDa area, the depletion procedure unmasked 14 proteins including HSP70, LTA4H, L-Plastin, Desmoplakin that are known to be involved in disease pathogenesis. CONCLUSION: The ability to selectively remove and elute the most abundant OF proteins visualized on the 2-DE represents an important step in the characterization of human OF. The better visualization and gel resolution achieved will improve quantification abilities in 2-DE and in tag-MS leading to better identification of disease-specific biomarkers. We further analyzed the eluted Alb and IgGs isoforms suggesting a new methodology venue for OF.

Comparison of oral mucosal pH values in bulimia nervosa, GERD, BMS patients and healthy population.

OBJECTIVES: The aim of this study was to compare the oral mucosal pH in healthy individuals to patients with gastroesophageal reflux disease (GERD), Bulimia nervosa (BN) and burning mouth syndrome (BMS). SUBJECTS AND METHODS: Using a flat pH meter sensor, pH levels were established in eight mucosal sites in 26 healthy individuals, 26 GERD patients, 22 BN patients and 29 BMS patients. RESULTS: A significantly lower pH was found in the BN and GERD groups (6.38 ± 00.45, 6.51 ± 0.32 respectively, P < 0.05) and a higher, but non-significant, pH level in the BMS group (7.01 ± 0.34, P > 0.05) compared with the control (C) group (6.82 ± 0.33). CONCLUSIONS: BMS patients showed no pH differences from C group. The mucosa of BN and GERD patients was significantly acidic relative with controls; thus this simple technique may serve as a diagnostic tool for identifying gastro-esophageal conditions.