Mixed Heterotopic Gastrointestinal/Respiratory Oral Cysts in Newborns: From Prenatal Diagnosis to Histopathological and Therapeutic Management: A Case Report and Literature Review.

Fetal lingual tumors are very rare, and their early prenatal diagnosis is important for defining the subsequent therapeutic strategy. In this study, we aimed to describe a case of a congenital septate lingual cyst and perform an extensive literature review on two main databases (PubMed, Web of Science), analyzing the clinical manifestations, the imaging appearance, the differential diagnosis, and particularities regarding the treatment of these tumors. The electronic search revealed 17 articles with 18 cases of mixed heterotopic gastrointestinal/respiratory oral epithelial cysts that met the eligibility criteria and were included in this review. The clinical case was diagnosed prenatally during second-trimester screening. On the eighth day of life, the fetus underwent an MRI of the head, which revealed an expansive cystic process on the ventral side of the tongue with the greatest diameter of 21.7 mm, containing a septum of 1 mm inside. On the 13th day of life, surgery was performed under general anesthesia, and the lingual cystic formation was completely excised. The postoperative evolution was favorable. The histopathological examination revealed a heterotopic gastric/respiratory-mixed epithelial cyst with non-keratinized respiratory, gastric squamous, and foveolar epithelium. The lingual cyst diagnosed prenatally is an accidental discovery, the differential diagnosis of which can include several pathologies with different degrees of severity but with a generally good prognosis.

Gingival Manifestations in Oral Chronic Autoimmune Bullous Diseases: A Retrospective Study.

Background and Objectives: Desquamative gingivitis (DG) is a clinical term indicating "peeling gums" and is associated with different oral manifestations. In this study, we aimed to assess the association between DG and autoimmune blistering mucocutaneous diseases (ABMD) with oral manifestations. Materials and Methods: A retrospective study including 88 patients diagnosed between 1998 and 2019 with ABMD (intraepithelial and subepithelial autoimmune blistering diseases) was performed at the Oral Medicine Department, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest. For each patient, the sociodemographic and anamnestic data, as well as clinical features of oral lesions (location), histological evaluation, and direct immunofluorescence data were collected. Results: Most of the patients involved in the study were female (78.4%). In total, 34 patients (38.63%) were diagnosed with subepithelial autoimmune diseases (SAD) and 54 (61.36%) had intraepithelial autoimmune diseases (IAD). Differences in the anatomic distribution of oral involvement were found between SAD and IAD. The presence of DG was significantly more common in patients with SAD compared to those with a diagnosis of IAD. Conclusions: Specific anatomical locations of the oral lesions are significantly associated with different subtypes of ABMD, with gingiva and hard palate mucosa being more involved in SAD and the soft palate and buccal mucosa in IAD. Desquamative gingivitis is a clinical sign that raises diagnostic challenges for several conditions in oral medicine.

Gingival overgrowth approached using recent mechanical and laser technologies: A case report.

Gingival enlargement is a side effect of different drug classes, with calcium channel blockers being among the most often cited examples. Most often accompanied by a disruption in the oral biofilm, this form of gingival overgrowth, with histological signs of hyperplasia and hypertrophy, becomes a chronic inflammatory condition with the oral biofilm a primary cause. This periodontal disease is now classified as 'dental biofilm-induced gingivitis', and its preferred name is drug-influenced gingival expansion. The present study presented the case of a patient with gingival enlargement while being treated with nifedipine for cardiac disease. This patient had factors that contributed to the retention of bacteria, ranging from poor oral hygiene practices to poorly adapted prosthodontics. After reducing these factors, a multimodal treatment was conducted, including bacterial mechanical decontamination through guided biofilm therapy protocol, laser bacterial decontamination, and surgical laser gingivectomy. The patient was referred to their cardiologist for substituting the calcium channel blocker medication. Clinical evaluations followed each treatment step. At 12 months, the patient presented positive, stable results, with an improvement in gingival status (no gingival overgrowth in the area where all risk factors were eliminated and minimal overgrowth in the area where old poorly marginally adapted prosthodontics were kept in place and no/minimal signs of gingival inflammation).

Non-Communicable Diseases and Associated Risk Factors in Burning Mouth Syndrome Patients.

Background and Objectives: Noncommunicable diseases (NCDs) are a group of non-transmissible conditions that tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioral factors. Although an association between oral disorders and NCDs has been suggested, the relationship between Burning Mouth Syndrome (BMS) and NCDs and their associated risk factors has not been deeply investigated. In this study, we aim to identify associations between BMS and NCDs in the Romanian population. Materials and Methods: Ninety-nine BMS patients and 88 age-matched controls (aged 50 and over) were clinically evaluated for the presence of eight noncommunicable diseases (NCDs) and their most common risk factors, including hypertension, dyslipidemia, smoking, and obesity. Results: The results of our study showed that the BMS in the Romanian population seems to be significantly associated with cardiovascular diseases (CVDs) (p < 0.001) and two of their risk factors, hypertension (p < 0.001) and dyslipidemia (p < 0.001). Moreover, evaluating the Framingham Risk Score (FRS) in the individuals not affected by CVDs (73 CTRL and 38 BMS), we found that 13.2% of BMS patients reported a moderate risk of developing CVDs in ten years, compared to the controls, all of whom presented a low risk (p = 0.002). Conclusions: Our findings suggest that a multidisciplinary clinical approach, which also includes a cardiovascular evaluation, is essential for the successful management of BMS. Moreover, these data highlighted the importance of introducing an integrated strategy for the prevention and care of NCDs in BMS patients.

Impact of Altered Lipid Profile in Oral Lichen Planus.

Background:Oral lichen planus (OLP) is a chronic inflammatory disease that affects the oral mucosa. This disorder has been suggested to be related to an impairment of lipid metabolism and profile. A number of studies indicate a higher incidence of dyslipidemia in OLP patients compared to not-affected individuals. Objectives: The aim of this study was to investigate the correlations between lipid profile alterations and clinical features of oral lichen planus. Patients and methods:A total of 52 patients diagnosed with OLP were enrolled in this study. Data regarding the demography, symptoms, severity of lesions assesed by Thongprasom score and lipid profile status were collected from the medical charts. The study group was divided into two sub-cohorts: Group 1, which included OLP patients with lipid profile within the normal range, and Group 2 comprising OLP patients with alterations of the lipid status. Results:The comparative analysis between the two groups found a statistically significant association between the lipid profile and OLP symptoms. Thus, the most frequent symptom was pain, in OLP patients with normal lipid status (Group 1), and burning, in those with altered lipid status (Group 2) (p=0.050). Moreover, the presence of symptoms was reported by a higher percentage of patients from Group 2 (75%) than Group 1 (68.25%). Patients reporting burning symptomatology showed higher triglyceride levels than those who reported pain (p=0.032). Furthermore, we found that male OLP patients have higher levels of LDL compared with female subjects (p=0.021). Conclusion:Lipid profile changes are not associated with an increased severity of OLP lesions. A statistically significant association was found between burning sensation and higher lipid profile parameters.

Applications for oral research in microgravity - lessons learned from burning mouth syndrome and ageing studies.

The negative consequences of microgravity for the human body are central aspects of space travel that raise health problems. Altered functions of the same systems and treatment options are common points of spaceflight physiology, age-related diseases, and oral medicine. This work emphasizes the convergence of knowledge between pathophysiological changes brought on by aging, physiological reactions to microgravity exposure, and non-pharmacological and non-invasive treatment methods that can be used in spaceflight. Sarcopenia, peripheral nerves alterations, neuromotor plaque in the masticatory muscles, lingual, labial, and buccal weakness, nociplastic pain in oral mucosal diseases, and microgravity, as well as soft tissue changes and pathologies related to chewing and swallowing, corticomotor neuroplasticity of tongue, and swallowing biomechanics, are of particular interest to us. Neurologic disease and other pathologies such as recovery from post-stroke dysphagia, nociplastic pain in glossodynia, sleep bruxism, and obstructive sleep apnea have been studied and, in some cases, successfully treated with non-invasive direct and transcranial magnetic stimulation (TMS) methods in recent decades. An interdisciplinary team from medical specialties, engineering, and biophysics propose an exploratory study based on the parallelism of ageing and space physiology, along with experiment scenarios considering TMS and non-invasive direct methods.

Neuropsychological assessment of Romanian burning mouth syndrome patients: stress, depression, sleep disturbance, and verbal fluency impairments.

Burning Mouth Syndrome (BMS) is a chronic condition characterized by a burning sensation in the oral mucosa, lasting more than 2 hours daily for more than 3 months, without clinical and/or laboratory evidence. BMS is often comorbid with mood, and psychiatric disorders, and a complex pathophysiology and interaction between impairments in nociceptive processing and psychologic function is occurring. In this work, we aimed to define the neuropsychological profile specific for BMS patients for a better management of this complex disease. We conducted a case-control study comparing 120 BMS patients and 110 non-BMS individuals (CTRL). Sociodemographic data and lifestyle habits, were collected, along with data regarding quality of life (SF-36 scale), stress (PSS), depression and anxiety (MADRS and HADS scales), sleep quality (PSQI scale), and cognitive functions (MoCA, SVF and PVF tests). The statistical analysis revealed a lower general quality of life (p < 0.001), worse sleep quality (p < 0.001) in BMS patients than CTRL. The BMS patients also displayed a higher prevalence of mild depressive symptoms than CTRL applying the MADRS (p < 0.001) and HADS-Depression scales (p = 0.001), whereas no differences in anxiety symptoms were found between the two groups (p = 0.174). Moreover, reduced scores semantic and phonemic verbal fluency tests (p < 0.05) were found, but no change in cognition was observed through MoCA (p = 0.551). Our results highlight that synergy between dentistry and neuropsychiatric assessment is essential for a successful management of BMS.

Oral leukoplakia: A clinicopathological study and malignant transformation.

OBJECTIVES: To assess the clinicopathological characteristics of a cohort of patients with oral leukoplakia (OL) managed in a Romanian dental hospital and to evaluate the risk of malignant transformation (MT). MATERIALS AND METHODS: We conducted a hospital-based retrospective study using the clinical charts of patients diagnosed with OL that had complete clinical and histopathological evaluation followed up for 1-16 years. RESULTS: From 120 included patients, 68 (56.7%) were females, and 71 (59.2%) were current smokers. The homogeneous form was present in 60% of cases; the buccal mucosa was the most frequently involved site. MT was observed in 9 cases, which was more common in females and in those with dysplastic leukoplakia. A significant statistical association was found between MT and dysplasia grade (χ2 test: p = 0.007). MT occurred during a mean interval of time 75 months in both treated and non-treated patients. CONCLUSIONS: In this leukoplakia cohort, most of the lesions encountered were in smokers, clinically homogeneous and 62.5% proved histologically benign. But despite the clinically benign appearance of leukoplakia, tissue diagnosis of some cases was carcinoma. The results of the current study advocate the necessity for biopsy even in apparently homogeneous, clinically benign lesions. The malignization rate was 7.5%; two-thirds were nonhomogeneous lesions.

Oral Leukoplakia. A Five-Year Follow-Up Study.

Background: Oral leukoplakia (OLK) is the most studied oral potentially malignant disorders in the scientific literature. Its malignant transformation (MT) rate varies between 1.1% and 40.8%, depending on the type of study and population group studied. There is no universal agreement to treat or manage these lesions, so it is up to each clinician's experience and expertise in how he/she manages these patients. Objective:The aim of this retrospective study was to assess the clinical aspects and pattern of evolution of OLK in 30 patients five years or more after the initial diagnosis. Material and methods:We selected 30 OLK patients from our database. Demographic, clinical and evolutive data was retrieved from the medical files. The following variables were analysed: age and sex, smoking habits, clinical features (form, dimension, site of the lesion), result of mycological examination, treatment and outcomes of the lesions over a follow-up of more than five years. Results:For a follow-up of 119.63 months, we detected a value of 0.2% MT rate per year. Outcomes varied from the complete disappearance of the lesion to recurrence and malignant transformation with a variety of treatment methods applied. Conclusion:Despite the low MT rate for a long follow-up, it is hard to say which treatment method is the best, due to the heterogeneity of the clinical aspects of the lesions and because there is no standardised test method, either genetic testing or immunohistochemical testing. We recommend a varied approach, suitable for each patient's needs and medical context, always when possible histopathological confirmation for grading epithelial dysplasia, which remains the most reliable method of checking the process of malignant transformation.

Validity and Reliability of the Dental Neglect Scale among Romanian Adults.

The Dental Neglect Scale (DNS) is a well-known measure for assessing behaviours and attitudes related to oral health. However, the factor inconsistency revealed by the literature involves further investigations. The study focuses on the validation of the DNS in the case of a sample of the adult population from Romania. In this regard, data were collected online from 872 adults (616 females and 256 males). DNS reliability was examined from the perspective of internal consistency. Convergent validity was performed by associating DNS with different scales from the oral health field. In order to examine and confirm the factorial structure, the sample was broken down into two subsamples which made the subject of the exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA), respectively. DNS-RO is positively associated with the scale which measures the values related to oral health (OHVS) and negatively with those that assess the impact of the oral health on life quality (OHIP-14), the distrust of the benefits of oral health services (R-DBS), and reduced need for oral care (DIS). The Cronbach's α = 0.70, McDonald's ω = 0.70 and CR = 0.77 are acceptable. Both EFA and CFA (χ2/df = 1.13; CFI = 0.99; RMSEA = 0.017; SRMR = 0.059) support the unifactorial structure of the scale. The gender differences show that females evince greater care for oral health than male subjects. The study shows that the DNS-RO can be used to assess the behaviours and attitudes towards oral health in the case of the Romanian adult population in epidemiological studies and health promotion programs through health education.

New psychometric evidences on the Dental Environment Stress questionnaire among Romanian students.

BACKGROUND: The academic environment is a challenge for dental students due to the multiple sources of stress they face. For this reason, the present study analyzes the psychometric properties of the Dental Environment Stress (DES) questionnaire. The secondary objective was to identify the specific sources of stress perceived by dental students related to gender and years of study. MATERIALS AND METHODS: A cross-sectional study was conducted among dental students (n = 340; Mage= 22.45) from the Romanian University of Medicine and Pharmacy in October- December 2019. The factorial structure of the questionnaire was performed by means of the confirmatory factor analysis (CFA) and the multi group-CFA. The convergent and divergent validities were measured by associating DES with scales that measure depression, anxiety, and tension/stress (Depression Anxiety Stress Scale-21-R), perceived stress (Perceived Stress Scale-14), and life satisfaction (Satisfaction with Life Scale). RESULTS: New measure obtained supported a five-factor and thirty-item structure, which is gender invariant. All the factors within DES have a significant positive correlation with depression, anxiety, tension/stress, and perceived stress and a negative correlation with life satisfaction. The Cronbach's α coefficients are acceptable (range: 0.67-0.89). The female students perceive aspects related to performance, the relations with the faculty, clinical responsibilities, and personal life to be more stressful than males. Senior students perceive more stressed aspects related to personal life, while freshmen have higher scores on stress associated with clinical responsibilities. CONCLUSIONS: The present results show that DES has psychometric properties which are adequate for the assessment of dental stress in the case of Romanian students; nevertheless, it is necessary to extend the use of DES to students attending other universities and to dental practitioners.

The Implication of Candida Infection in Oral Lichen Planus Lesions.

Objectives: The purpose of this study is to determine if superimposed infection with Candida species in oral lichen planus exacerbates the clinical symptoms and lesions. Methodology:We conducted a retrospective study on the medical charts of oral lichen planus (OLP) patients diagnosed by clinical and histopathological criteria. A baseline demographic, anamnestic, clinical data, results of the oral candida investigations were analyzed and recorded for all patients. Results:From a total number of 203 OLP patients, oral candidiasis was diagnosed in 75 (36.94%) cases. There was no statistical significance between the clinical forms of lichen planus and the presence of Candida infection. Of all encountered Candida species, Candida albicans was most commonly detected, followed by Candida krusei, Candida lusitaniae, and Candida tropicalis. Conclusion:Although our study is limited regarding the sample size and no statistically significant difference has been found between clinical features of OLP and oral candidiasis, a routine screening of OLP patients for oral candidiasis and a preventive antifungal strategy in the OLP treatment schedule is needed.

High-risk human papillomavirus in patients with oral leukoplakia and oral squamous cell carcinoma-A multi-centre study in Sweden, Brazil and Romania.

OBJECTIVES: Although causal associations between oral leukoplakia (OL), oral squamous cell carcinoma (OSCC) and high-risk human papillomavirus (HR-HPV) have been speculated upon in several reports, conclusive evidence has not been presented. This study investigates whether the number of cases of HR-HPV in OL has increased over time and whether the prevalence of HR-HPV-positive OL differs in various parts of the world. PATIENTS AND METHODS: A total of 432 patients with OL from Sweden, Brazil and Romania were analysed. Patients were divided into historical (1992-2002) and contemporary (2011-2017) cohorts from the respective countries. Seventeen patients with OL developed oral squamous cell carcinoma (OSCC). A real-time PCR assay, targeting HPV sub-types 6,11,16,18,31,33,35,39,45,52,56,58 and 59, was performed to detect HR-HPV in patients with OL. RESULTS: In the Swedish and Romanian cohorts, none of the investigated HPV sub-types were detected. In the Brazilian cohorts, five patients with OL (3%) were positive for HR-HPV, including four patients from the contemporary cohort (HPV 16, 31, 33) and one from the historical cohort (HPV 11). All the cases of OL that transformed into OSCC were HR-HPV-negative, as were the corresponding tumours. CONCLUSIONS: In summary, the prevalence of HR-HPV in OL is low in all the tested countries, and the incidence has not changed over time. HR-HPV in OL does not seem to be a driver of oncogenesis.

Oral health-related quality of life in different clinical forms of oral lichen planus.

OBJECTIVES: The aim of the study was to determine the prevalence of clinical forms in a group of oral lichen planus (OLP) patients and to investigate whether the oral health-related quality of life (OHRQoL) of patients with common clinical OLP forms differs significantly from that of other clinical forms of OLP and healthy patients, respectively. METHODS: OHRQoL was assessed using the Romanian version of the short form of the Oral Health Impact Profile (OHIP-14). OLP patients rated the pain they were currently experiencing on a visual analog scale (VAS). Statistics was performed using parametric and non-parametric tests and multiple linear regression. RESULTS: Eighty OLP patients and 80 healthy controls were enrolled. The most prevalent OLP clinical form was keratotic form (n = 39, 48.75%, group 1), followed by atrophic (31.25%), erosive-ulcerative (17.5%), and bullous (2.5%) forms, which were included in group 2 (n = 41). The OHRQoL did not differ significantly between group 1 and the other two groups. A negative social impact was reported on psychological discomfort domain for both OLP groups, as compared with healthy controls. VAS scores were significantly associated with OHIP total scores in group 1 (rho = 0.41, n = 39, p = 0.009, Spearman's correlation coefficient). Within the same group, significantly higher OHIP total scores were recorded in patients lacking academic education (p = 0.0086, Mann-Whitney U test). CONCLUSIONS: Overall, the most common clinical OLP form did not impact significantly the OHRQoL of OLP patients. CLINICAL RELEVANCE: Psychological therapy and meeting the educational needs might improve the OHRQoL of patients with common clinical forms of OLP.

Oral leukoplakia - an update.

ABSTRACT: The main purpose of this paper was to assess the current state of science on oral leukoplakia. Although it is considered a potentially malignant disorder the overall malignant progression of oral leukoplakia is of the order of 5% and even more. Nowadays there are no currently accepted markers to distinguish those that may progress to cancer from those that may not. The current golden standard is considered the presence of epithelial dysplasia on the tissue biopsy of the lesion. Proliferative verrucous leukoplakia is a rare form of OL which has multiple recurrences, is refractory to treatment and has malignant transformation in a short period. It is considered a true premalignant lesion. The management of oral leukoplakia varies from a "wait and see" attitude and topical chemopreventive agents to complete surgical removal.

Association of oral lichen planus with chronic C hepatitis. Review of the data in literature.

ABSTRACT: The relationship between chronic hepatitis C virus infection (HCV) and oral lichen planus (OLP) is a current topic in the field of oral medicine. Many studies of this association have been made over time. The geographic variation of the hepatitis C prevalence proved to be an important factor influencing the statistical results of the studies analyzing the association of the oral plan lichen with the hepatitis C virus. Approaching this issue is not to be neglected. Treatment outcomes in patients with oral lichen planus associated with chronic hepatitis C virus are often unsatisfactory compared to patients suffering from idiopathic oral lichen planus. Also, the evolution of oral lesions is often fluctuating, with repeated periods of relapse according to the degree of liver function decompensation. Background therapy for liver disease itself may influence lichen planus lesions. Thus, during therapy with interferon and ribavirin oral lesions may appear or become acute.

Oral lichen planus: A retrospective study of 633 patients from Bucharest, Romania

Objective: In this retrospective study, patients’ medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. Material and Methods: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. Results: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. Conclusions: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients (AU)

Oral lichen planus: a retrospective study of 633 patients from Bucharest, Romania.

OBJECTIVE: In this retrospective study, patients' medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. MATERIAL AND METHODS: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. RESULTS: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. CONCLUSIONS: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients.

Recurrent intraoral HSV-1 infection: A retrospective study of 58immunocompetent patients from Eastern Europe

Objectives. To revise the clinical features of the recurrent intraoral herpetic infection (RIOH) with respect to precipitatingfactors, demographic, clinical features and outcome.Study design. Fifty-eight, unrelated Caucasian, immunocompetent patients with positive laboratory test for intraoralHerpes simplex virus infection were studied.Results. The mean age in the women’s group (n=42) was 41.23 years (± 21.73) and in the men’s group was 32.25years (± 15.68). Possible trigger factors were identified in 9 cases (15.5%). General symptoms were noted in 20cases (34.48%). Most of patients in this study presented multiple lesions. 14 patients had vermillion lesions associatedwith intraoral lesions. In most of the cases both fixed and mobile mucosa was concomitantly involved. Treatmentwas prescribed in order to control the symptoms and to shorten the evolution with minimal side effects.Conclusions. Intraoral secondary herpetic infection could be polymorphous and sometimes associated with generalsymptoms. The recognition of its atypical features may prevent unnecessary and costly investigations andtreatments for unrelated though clinically similar-appearing disorders (AU)