Porcelain Veneers in Vital vs. Non-Vital Teeth: A Retrospective Clinical Evaluation.

Nowadays, the ceramic veneer approach can be considered more predictable than direct composite veneer. To date, there is a lack of studies comparing the clinical performance of anterior veneers cemented on vital teeth (VT) and non-vital teeth (NVT). This longitudinal clinical study investigated the performance of ceramic veneers in VT or anterior NVT. A total of 55 patients were evaluated in the study. Two groups were defined based on the vitality status of the teeth (93 teeth-vital and 61 teeth-non-vital). The United States Public Health Service (USPHS) criteria were used to assess the clinical status. The data were evaluated statistically with the Mann-Whitney U test. All restorations were considered acceptable, and only one veneer in VT failed for the criteria of secondary caries. There were no statistically significant differences in any of the criteria evaluated (p ≤ 0.671). The ceramic veneers evaluated showed a satisfactory clinical performance both in VT and NVT.

Effect of Composite Core Materials on Fracture Resistance of Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies.

Various material properties are involved in the success of endodontically treated restorations. At present, restorative composites are commonly employed as core build-up materials. This study aimed to systematically review the literature to assess the effect of using composite core materials on the in vitro fracture of endodontically treated teeth. Two different reviewers screened the literature, up to June 2021, in five distinct electronic databases: PubMed (MedLine), Scopus, Scielo, ISI Web of Science, and EMBASE. Only in vitro studies reporting the effect of the use of composite core materials on the fracture resistance of endodontically treated teeth were included. A meta-analysis was carried out using a software program (Review Manager v5.4.1; The Cochrane Collaboration, Copenhagen, Denmark). The risk of bias in each study was assessed following the parameters of another systematic review. A total of 5016 relevant papers were retrieved from all databases. After assessing the title and abstract, five publications remained for qualitative analysis. From these, only three studies remained for meta-analysis. The fracture strength of endodontically treated teeth where a core build-up composite was used was statistically significantly higher than the control (p = 0.04). Most of the analyses showed a high heterogenicity. The in vitro evidence suggests that the composite core build-up with higher filler content tended to improve the fracture resistance of the endodontically treated teeth, in comparison with conventional composite resins. This research received no external funding. Considering that this systematic review was only carried out on in vitro papers, registration was not performed. Furthermore, there were no identified clinical studies assessing core build-up materials; therefore, more well-designed research on these materials is needed.

Oral non-specific lesions in patient with Crohn's disease - a case report.

Crohn's disease (CD) is a chronic and granulomatous inflammatory disease of the entire gastrointestinal tract. The etiopathogenesis is not fully elucidated. The most common symptoms in the active phase of the disease include abdominal pain, prolonged diarrhea, fever, fatigue, malaise and weight loss. Oral manifestations of CD are classified into specific for CD with granulomatous changes and non-specific ones. This rare extraintestinal manifestation of CD in adults may precede gastrointestinal tract involvement, occur together or appear after years of its duration. Oral lesions can be initiated by malnourishment, poor absorption of nutrients or side-effect of medications. A CASE REPORT: We describe a 28-year-old female with a 9-years CD history, who presented in the active disease with oral lesions. They were classified as non-specific ones, and included oral candidiasis, irregular erythematous patches on the cheek mucosa, exfoliative lip inflammation, and angular cheilitis. The patient was treated with azathioprine, and since the last exacerbation of symptoms, induction therapy with adalimumab, (anti-TNF-alpha), has been prescribed. Nystatin was applied to treat the oral lesions, based on the microbiological assessment of the Candida albicans susceptibility, and symptomatic treatment. After a two-week treatment the oral mucosa was healed and angular cheilitis showed marked improvement compared to the initial presentation. CONCLUSIONS: The young female with active CD presented the nonspecific lesions in the oral cavity. The lesions coexisted with the active inflammatory process in the intestinal tract with characteristic clinical symptoms, and were associated with sideropenic anemia. The implementation of the local therapy, systemic CD treatment and supplementation of micronutrient deficiencies have led to a healing of the oral lesions. We emphasize a personalized approach to treatment and close cooperation between the dentist and the gastroenterologist.

Effect of Fiber Posts on Stress Distribution of Endodontically Treated Upper Premolars: Finite Element Analysis.

By means of a finite element method (FEM), the present study evaluated the effect of fiber post (FP) placement on the stress distribution occurring in endodontically treated upper first premolars (UFPs) with mesial-occlusal-distal (MOD) nanohybrid composite restorations under subcritical static load. FEM models were created to simulate four different clinical situations involving endodontically treated UFPs with MOD cavities restored with one of the following: composite resin; composite and one FP in the palatal root; composite and one FP in the buccal root; or composite and two FPs. As control, the model of an intact UFP was included. A simulated load of 150 N was applied. Stress distribution was observed on each model surface, on the mid buccal-palatal plane, and on two horizontal planes (at cervical and root-furcation levels); the maximum Von Mises stress values were calculated. All analyses were replicated three times, using the mechanical parameters from three different nanohybrid resin composite restorative materials. In the presence of FPs, the maximum stress values recorded on dentin (in cervical and root-furcation areas) appeared slightly reduced, compared to the endodontically treated tooth restored with no post; in the same areas, the overall Von Mises maps revealed more favorable stress distributions. FPs in maxillary premolars with MOD cavities can lead to a positive redistribution of potentially dangerous stress concentrations away from the cervical and the root-furcation dentin.

Serum concentration of selected biochemical markers of endothelial dysfunction and inflammation in patients with the varying activity of inflammatory bowel disease.

INTRODUCTION: Endothelial dysfunction leads to an increased expression of cell adhesion molecules, leukocyte diapedesis, vascular smooth­muscle tone, excessive permeability of vascular walls, and increased procoagulant activity. OBJECTIVES: We investigated whether serum levels of several endothelial and platelet activation markers correlated with disease activity in patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS: This study included 56 patients with ulcerative colitis, 66 with Crohn disease, and 40 healthy controls. We measured the complete blood count and levels of fibrinogen, C­reactive protein, albumin, interleukin 6, tumor necrosis factor α, E­selectin, P­selectin, monocyte chemoattractant protein 1 (MCP­1), soluble CD40 ligand (sCD40L), and microparticles. RESULTS: There were no significant differences in the median levels of E­selectin, P­selectin, MCP­1, sCD40L, and microparticles between patients with active IBD, those with inactive IBD, and healthy controls. The clinical disease activity assessed with the Mayo scale in the ulcerative­colitis group was weakly, positively correlated with sCD40L (R = 0.32, P = 0.02), P­selectin (R = 0.32, P = 0.02), and inflammatory marker levels. The clinical disease activity index in the Crohn disease group was positively correlated with the markers of inflammation yet not with the markers of endothelial activity. CONCLUSIONS: E­selectin, P­selectin, sCD40L, MCP­1, and microparticle levels do not significantly differ between patients with the varying activity of IBD. However, due to the observed correlations, further studies of a larger patient group should be conducted to confirm our observations.

Awareness of oral health prophylaxis in pregnant women.

I n t r o d u c t i o n: During pregnancy, changes in the oral cavity occur due to fluctuations in hormone levels and changes in eating habits and hygiene. O b j e c t i v e s: To evaluate pregnant women's awareness of oral health prophylaxis. Material and Methods: An anonymous questionnaire was completed by 341 pregnant women from Malopolskie Voivodeship. The statistical analysis was carried out in the R program (v. 3.4.3); a p-value <0.05 was considered significant. R e s u l t s: Over half of the respondents did not receive oral hygiene instruction and did not take part in any prophylactic program. The main sources of oral health knowledge were the internet (66.3%), dentist (43.1%) and gynaecologist (17.9%). Respondents willingly followed the advice of healthcare workers. Approximately 32% of the surveyed women were aware of the most appropriate period for dental treatment (second trimester). Over half of the women admitted that they would receive dental care more often if more procedures were reimbursed. Approximately 71% of the women were aware of the increased susceptibility to tooth decay during pregnancy. The relationship between the presence of caries in parents and that in children was known by 42.1% of respondents, but 45% admitted they did not know how to take care of their child's teeth properly. C o n c l u s i o n s: Women with a higher education level had better knowledge in the area of oral health. However, most of the respondents need to increase their knowledge in this area. Prophylactic programs should be broadly propagated, and healthcare workers should deliver essential information in daily practice.

Relative homogeneity of oral bacterial oral in Crohn's disease compared to ulcerative colitis and its connections with antioxidant defense - preliminary report.

INTRODUCTION: Interactions between oral microbiota and systemic diseases have been suggested. We aimed to examine the composition of oral microbiota with reference to antioxidative defense and its correlation with clinical state in Crohn's disease (CD) in comparison to ulcerative colitis (UC). MATERIALS AND METHODS: Smears were taken from the buccal and tongue mucosa of patients with CD, UC and controls, and cultured with classical microbiology methods. Bacterial colonies were identified using matrix-assisted laser desorption/ionization (MALDI) with a time-of-flight analyzer (TOF). Blood morphology and C-reactive protein (CRP) were analyzed in the hospital laboratory. Antioxidative defense potential (FRAP) was determined using spectrophotometry in saliva and serum. RESULTS: Oral microbiota in CD patients were characterized by lower diversity in terms of the isolated bacteria species compared to UC and this correlated with reduced FRAP in the oral cavity and intensified systemic inflammation. Oral microbiota composition in CD did not depend on the applied treatment. In CD patients, a negative correlation was observed between the FRAP value in saliva and serum and the CRP value in serum. Individual differences in the composition of oral microbiota suggest that different bacteria species may be involved in the induction of oxidative stress associated with a weakening of antioxidative defense in the oral cavity, manifested by ongoing systemic inflammation. CONCLUSIONS: Analysis of both the state of the microbiota and antioxidative defense of the oral cavity, as well as their referencing to systemic inflammation may potentially prove helpful in routine diagnostic applications and in aiding a better understanding of CD and UC pathogenesis associated with oral microbiota.

Levels of tissue factor pathway inhibitor in patients with inflammatory bowel disease.

INTRODUCTION Endothelial dysfunction has been reported to be involved in the pathogenesis of inflammatory bowel disease (IBD) and concomitant thromboembolic complications. Inflammation stimulates the expression of tissue factor and tissue factor pathway inhibitor (TFPI) by endothelial cells. OBJECTIVES This study assessed the relationship between TFPI levels and disease activity in patients with IBD. PATIENTS AND METHODS A total of 50 consecutive adult patients with ulcerative colitis (UC), 50 patients with Crohn disease (CD), and 50 healthy controls were enrolled to the study. Plasma levels of total TFPI, free TFPI, and von Willebrand factor were measured. Associations among these levels, disease activity, and inflammatory marker levels were assessed. RESULTS Total TFPI levels were higher in patients with IBD (median, 68.5 [IQR, 60.2-80.1] ng/ml) than in controls (median, 61.1 ng/ml [IQR, 54.3-74.2]; P = 0.01). Free TFPI levels were higher in patients with active UC (median, 12.8 ng/ml [IQR, 11.1-15.4]), inactive UC (median, 9.9 ng/ml [IQR, 7.3-11.5]), active CD (median, 11.7 [IQR, 9.7-14.4] ng/ml), and inactive CD (median, 9.7 ng/ml [IQR, 8.6-11.6]) than in controls (median, 5.5 ng/ml [IQR, 4.3-7.2]; P <0.001). In the CD and UC groups, free TFPI levels correlated with the levels of inflammatory markers and disease activity. The von Willebrand factor level was higher in patients with UC (median, 143.4 IU/dl [IQR, 115.5-170.4]) and those with CD (median, 151.8 IU/dl [IQR, 112.8-189.4]) than in controls (85.1 IU/dl [IQR, 77.1-101.5]; P <0.001 for both comparisons). CONCLUSIONS The anticoagulant TFPI pathway is activated during remissions and flares in patients with IBD. The free TFPI level correlates with biochemical markers of inflammation and disease activity.

Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment.

BACKGROUND/PURPOSE: Granulomatosis with polyangiitis (GPA) is a type of primary systemic vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). GPA mainly affects medium and small vessels and may manifest in different organs, most commonly upper respiratory tract. Oral lesions occur in 6-13% of GPA patients and might be the first symptom observed by the patient. This study presents the evaluation of orofacial manifestations of patients with GPA. MATERIALS AND METHODS: Prospective study was conducted between June 2014 and November 2017 in Department of Allergy and Immunology at University Hospital in Krakow. Patients diagnosed with GPA, after medical assessment, were examined including precise dental inspection, bacterial and fungal flora of oral cavity evaluation and Cone Beam Computed Tomography (CBCT) imaging. RESULTS: Nine patients were enrolled in the study. Characteristic for GPA strawberry gingivitis was observed in one patient. Bone destruction and inflammatory lesions in paranasal sinuses was confirmed by CBCT in 55.6% of patients. Fungal infection was revealed in 66.7% of patients. CONCLUSION: These findings oblige dentists to consult patient with laryngologist or internal medicine physician to establish further diagnostic approach, because early diagnosis of GPA is crucial for implementing appropriate treatment and preventing chronic organ damage.

Evaluation of plasma concentrations of selected antioxidant parameters in patients with active Crohn's disease.

Oxidative stress (OxS) has been implicated in the pathogenesis of Crohn's disease (CD). The aim of this study was to examine whether nonenzymatic antioxidants are associated with active CD, by using the FRAP and GSH assay in plasma. Additionally, we measured bilirubin and albumin levels as two individual components of the plasma antioxidant system. A total of 55 patients with established CD, 30 with active CD and 25 with inactive disease, and 25 healthy individuals were prospectively enrolled in this study. We evaluated CD activity index, BMI and blood morphology, platelet count, serum CRP level, and bochemical parameters of OxS: ferric reducing ability of plasma (FRAP), reduced glutathione (GSH) in plasma and bilirubin and albumin levels in serum. Plasma FRAP and GSH concentrations were decreased in both CD groups compared to controls and negatively correlated with CDAI values (FRAP: r = -0.572, p = 0.003; GSH: r = -0.761, p = 0.001), CRP and platelet count. Bilirubin and albumin levels were lower in the serum of active CD patients than inactive CD patients and controls and negatively correlated with the CD activity index (r = -0328, p = 0.036, r = -0.518, p = 0.002) and CRP (r = -0.433, p = 0.002). e decreased FRAP and GSH levels in plasma and bilirubin and albumin levels in serum of patients with active CD compared to inactive CD and controls underlines the importance of OxS in the pathophysiology and activity of CD.

Correlation of Paraoxonase-1 with the Severity of Crohn's Disease.

Diagnostics of Crohn's disease (CD) requires noninvasive biomarkers facilitating early detection and differentiation of the disease. Therefore, in this study, we aimed to determine the relationship between paraoxonase-1 (PON-1), the severity of CD, oxidative stress, and inflammation in CD. The CD activity index was based on the current classification. Plasma PON-1 was measured in 47 patients with CD, and in 23 control volunteers. Using quantitative variables such as receiver operating characteristics (ROC) (area under the curve (AUC)), the diagnostic utility of PON-1 in differentiating the severity of CD was assessed. Circulating PON-1 was found to be decreased in the CD group compared to the control group (269.89 vs. 402.56 U/L, respectively), and it correlated well with the disease activity. PON-1 correlated positively with hemoglobin (Hb) (r = 0.539, p < 0.001), hematocrit (Ht) (r = 0.48, p < 0.001), total cholesterol (TC) (r = 0.343, p < 0.001), high density lipoprotein (HDL) (r = 0.536, p < 0.001), low density lipoprotein (LDL) (r = 0.54, p < 0.001), and triglyceride (TG) (r = 0.561, p < 0.001) and correlated negatively with white blood cell count (WBC) (r = -0.262, p = 0.029), platelet count (PLT) (r = -0.326, p = 0.006), C-reactive protein (CRP) (r = -0.61, p < 0.001), and malondialdehyde (MDA) (r = -0.924, p < 0.001). PON-1 as a marker for CD differentiation possessed a sensitivity and specificity of 93.62% and 91.30%, respectively. CD was found to be associated with the decrease in the levels of PON-1, which correlates well with activity of the disease and reflects the intensification of inflammation, as well as intensified lipid peroxidation. High sensitivity and specificity of PON-1 determines its selection as a good screening test for CD severity.

Markers of lipid peroxidation and antioxidant status in the serum and saliva of patients with active Crohn disease.

Introduction Increased oxidative stress has been implicated in the pathogenesis of Crohn disease (CD). Except for C­reactive protein (CRP), good biological markers of CD activity are lacking. Objectives We aimed to investigate the diagnostic usefulness of selected markers of oxidative stress in the serum and saliva of patients with active and inactive CD. Patients and methods A total of 58 patients with confirmed CD (32 with active CD, 26 with inactive CD, and 26 healthy controls) were prospectively enrolled to the study. The markers examined were malondialdehyde (MDA), ferric reducing ability of plasma (FRAP), reduced glutathione (GSH), and catalase (CAT). Results MDA levels were higher in the serum and saliva of patients with active CD than in those with inactive CD and controls and were positively correlated with the Crohn's Disease Activity Index (r = 0.8, P <0.001) and CRP (P <0.001). Serum and saliva antioxidant indicators (FRAP and GSH) were decreased in both CD groups compared with controls and were negatively correlated with clinical activity and inflammation (FRAP, r = -0.5, P <0.001; GSH, r = -0.5, P <0.001; and CAT, r = -0.5, P <0.001). Conclusions The increased lipid peroxidation and decreased antioxidant activity in serum and saliva confirm that CD patients are under oxidative stress. The positive correlations of MDA with the clinical activity and inflammation, as well as the comparison of the receiver operating characteristic curves for MDA and CRP, suggest that MDA could be a good diagnostic marker of CD.

Insulin­like growth factor system in remission and flare of inflammatory bowel diseases.

INTRODUCTION    Insulin­like growth factor 1 (IGF­1) is involved in the modulation of immunity and inflammation. It also plays a role in regulating the migration of endothelial cells and production of vasoactive agents. OBJECTIVES    This study assessed the concentrations of IGF­1 and insulin­like growth factor-binding protein 3 (IGFBP­3) and their relationships to disease activity in patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS    A total of 129 adult patients with IBD (69 with Crohn disease [CD] and 60 with ulcerative colitis [UC]) were involved in the study. The control group consisted of 31 healthy volunteers. Biochemical serum analyses were performed and the associations of IGF­1 and IGFBP­3 with inflammatory markers and disease activity were assessed. RESULTS    IGF­1 levels were decreased in patients with active UC compared with those with nonactive UC (mean [SD], 78.3 [22.7] ng/ml and 96.2 [24.5] ng/ml, respectively; P = 0.02) and controls (94.5 [26.5] ng/ml; P = 0.03). The IGF­1 level was lower in patients with active CD compared with those with nonactive CD (mean [SD], 79.2 [24.9] ng/ml and 110.1 [43.4] ng/ml, respectively; P <0.001). The IGFBP­3 level was lower in patients with active UC compared with those with nonactive UC (P = 0.04) and controls (P = 0.04). IGF­1 correlated negatively with C­reactive protein (CRP) levels (P <0.01), disease activity (P <0.05), and disease duration (P <0.05). IGFBP­3 levels correlated negatively with CRP levels (P <0.05). CONCLUSIONS    The IGF system is disrupted in patients with IBD. Systemic levels of the IGF axis components are related to disease activity and duration.

Skewing toward Treg and Th2 responses is a characteristic feature of sustained remission in ANCA-positive granulomatosis with polyangiitis.

The objective of our study was to evaluate the T-helper (Th) and regulatory T (Treg) cell profile in ANCA-positive granulomatosis with polyangiitis (GPA) and its relation to disease activity. In a prospective study, we studied two groups of GPA patients: (i) disease flare (active-GPA, BVAS>6, n = 19), (ii) sustained remission (≥ 1-year prior enrollment, inactive-GPA, BVAS = 0, n = 18). 24 age-sex matched healthy subjects served as controls. Active-GPA patients were followed for 6 months and reevaluated during remission (early remission; n = 13). We analyzed subsets of Th-cells (flow cytometry), production of signature cytokines by in vitro stimulated lymphocytes, and broad spectrum of serum cytokines (Luminex). In all GPA patients we observed expansion of effector Th17 cells, and increased production of IL-17A by in vitro stimulated T cells, as compared to controls. Disease flare was characterized by marked reduction in Treg cells, whereas in sustained remission we showed expansion of both Treg and Th2 subset. Finally, analyzing the cytokine profile, we identified CCL23 and LIGHT, as potential biomarkers of active disease. We conclude that in GPA, expansion of Treg and Th2 lymphocytes in parallel to increased Th17 response is a characteristic feature of sustained remission. In contrast, Treg cells are markedly decreased in disease flare.

Oral mucosa lesions in patients with active Crohn's disease - a prospective study.

Introduction: Crohn's disease (CD) is a chronic inflammatory disease, which may involve any part of the gastrointestinal tract, including the oral cavity. Mucosal lesions in the oral cavity are described in various populations, but observations in active disease with severe clinical symptoms are quite rare. Objectives: To evaluate the prevalence and nature of oral mucosa lesions in adult patients with active CD and their correlation with clinical and laboratory indicators of disease activity. Material and Methods: Prospective study was performed in 62 patients (29 women, 33 men, age 18-49 years) admitted between December 2010 and February 2013 to the gastroenterology department with a confirmed diagnosis of CD and exacerbations of symptoms, and 40 sex- and gender-matched healthy volunteers. CD activity was classified according to clinical and blood parameters, and the CD activity index (CDAI). We examined: blood morphology, hemoglobin and CRP levels, BMI. Examination of the oral cavity included a detailed interview and physical examination, based on the WHO recommendations. Results: In patients with active CD we found: increased CDAI score (258.4±21.5), higher CRP levels (24.6±1.3 mg/l) and platelet count, anemia with significantly reduced RBC and hemoglobin level, and reduced BMI, in comparison to controls. The specific for CD symptoms were found in the mouth: indurated tag polypoid lesions on vestibular retromolar region in 12.9% of patients, cobblestoning of the mucosa in 9.7%, diffuse asymptomatic buccal swelling in 16.2%, mucogingivitis in 19.4% of patients. Oral nonspecific lesions were more frequent: angular cheilitis in 29.1%, atrophic glossitis in 14.5% of patients. Oral lesions correlated with hemoglobin and CRP concentrations (r=-0.431 and r=0.437; respectively; p<0.001), platelet count (r=0.45; p<0.003), CDAI (r=0.421; p<0.001) and BMI (r=0.307; p<0.006). No correlation has been found between specific or non-specific lesions and location of inflammatory changes in the gastrointestinal tract. Conclusions: Changes in the oral mucosa in adult patients with active CD are frequent. They should be correlated with other clinical symptoms of gastrointestinal tract and biochemical parameters in patients with CD. The nature of these changes may have an impact on the further therapeutic approach.

Gastrointestinal tract as a side-effect target of medications.

World Health Organization (WHO) defines adverse drug reaction (ADR) as "a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function". ADRs are a serious problem of contemporary pharmacotherapy. Expenditures for treatment of ADRs in the United States may cost up to 30.1 billion dollars annually. Factors affecting the development of ADRs are: age, gender, body weight, polypharmacy. About 10% of ADRs is associated with gastrointestinal tract (GIT). ADR can affect every part of GIT. Xerostomia is the most common ADR occurring in oral cavity. ADRs affecting esophagus include irritation and inflammation of the mucosa. Approximately one-third of all cases of esophageal inflammation results from administration of non-steroid anti-inflammatory drugs (NSAIDs). The main cause of ulcerations involving stomach and small intestine are NSAIDs. Drug-induced diarrheas are the most common adverse effect accounting for approximately 7% of all observed cases of ADRs. They may be triggered by antibiotics, magnesium salts, laxatives and others. On the other hand, some groups of medications may induce constipation. These drugs comprise opioids, diuretics, calcium channel blockers, cholinolytics and others. Proton pump inhibitors, metformin, orlistat and colesevelam may lead to restricted absorption of certain vitamins and minerals. Physicians' knowledge about most popular and well documented ADRs can improve patients' safety and make pharmacotherapy more comfortable for them.

The impact of current health-related quality of life on future health outlook in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, autoimmune small and medium vessel vasculitis. EGPA is accompanied by asthma and involves mainly the blood vessels of the lungs, gastrointestinal system, and peripheral nerves; however, the skin, kidneys, and heart may be also affected. To investigate if patients with EGPA experience reduced health-related quality of life (HRQOL), and the effect of this parameter on their own perception of future health outlook. Twenty-six EGPA patients are in disease remission and completed a custom-designed questionnaire and the Medical Outcomes Study Short Form 36 (SF-36). Using the RAND method, eight HRQOL dimensions were calculated: general health, physical functioning, emotional role limitations, physical role limitations, social functioning, mental health, bodily pain, and vitality. Using norm-based scores, the HRQOL of patients was compared with that of the general population. EGPA patients had decreased HRQOL across all eight dimensions of the SF-36. Patients with higher mental component score felt more positive about their future health, while patients with low physical component score were likely not to feel negatively about their future health. Also, 36 % of older patients (>50 years) had a positive outlook compared to 47 % of younger patients (<50 years) and patients with a longer disease course were much less likely to have a positive outlook (30 % positive) than those with a shorter course (50 % positive). Although not statistically significant, these correlations warrant further investigation with a larger patient population. Despite being in disease remission, EGPA patients had decreased quality of life, which in turn influenced their perception of their future health outlook.

Proinflammatory cytokines in the saliva of patients with active and non-active Crohn's disease.

INTRODUCTION:  Crohn's disease (CD) involves the entire gastrointestinal tract, including the mouth. Numerous cytokines play a role in the regulation of inflammatory process in CD. OBJECTIVES:  The aim of the study was to examine the prevalence of oral lesions in adult patients with CD and to investigate whether salivary concentrations of interleukin 1ß (IL-1ß), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) are associated with the activity and oral manifestations of CD. PATIENTS AND METHODS:  A prospective study included 95 adult patients: 52 with active CD and 43 with inactive CD. The control group involved 45 subjects without CD. We performed blood tests, careful oral examination, and measurement of IL-1ß, IL-6, and TNF-α in unstimulated whole saliva by enzyme-linked immunosorbent assays. RESULTS:  IL-1ß, IL-6, and TNF-α were significantly elevated in patients with active CD. IL-1ß levels were 289.8 ±52.7 in patients with active CD vs. 196.7 ±42.9 pg/ml in patients with inactive CD (P <0.039), and 196.7 ±42.9 pg/ml (P <0.01) in controls. IL-6 levels were 13.8 ±4.2 vs. 7.2 ±3.1 pg/ml (P <0.041), respectively, and 6.3 ±1.4 pg/ml (P <0.001) in controls. TNF-α levels were 32.5 ±8.7 vs. 10.2 ±6.3 pg/ml (P <0.002), respectively, and 6.8 ±2.8 pg/ml (P <0.001) in controls. We observed CD-specific oral lesions: diffuse asymptomatic buccal swelling in 12 patients (23%) and cobblestoning in 5 patients (11.3%). CD-nonspecific lesions were observed in 17 patients (32.7%) with active CD, in 11 patients (25.6%) with inactive CD, and in 6 controls (13.3%). In active CD, higher salivary IL-6 and TNF-α and serum C-reactive protein levels correlated with specific oral lesions. CONCLUSIONS:  In patients with active CD, salivary IL-1ß, IL-6, and TNF-α levels are higher than in patients with inactive disease and controls. Elevated salivary IL-6 and TNF-α levels correlate with specific oral lesions. These cytokines may be used as markers of active CD, but the finding should be confirmed in a larger group of patients.

[Inflammatory changes of oral cavity proceeding appearance of clinical symptoms of Crohn's disease]. / Zmiany zapalne w jamie ustnej wyprzedzajace wystapienie objawów choroby Lesniowskiego-Crohna. Opis przypadku.

Crohn's disease belongs to the inflammatory bowel diseases. Inflammatory changes can be located in any part of the gastrointestinal tract including rarely oral cavity. We present a case of a 21 years old woman with unhealed by the local treatment, and verified by histological examination, inflammatory changes of oral cavity. These changes had proceed the diagnosis of typical changes in gastrointestinal tract for 6 months. Changes were located in terminal ileum and colon and were confirmed by colonoscopic, histologic and radiologic studies. Standard therapy of Crohn's disease with antiinflammatory and immunosuppressive drugs led to the healing of oral changes. We point out on the necessity of proper differential diagnosis of problematic unhealing changes, particularly with ulcerations of oral mucosa in young patients. Dental examination with histological confirmation of mucosal changes may be helpful in proper diagnosis of Crohn's disease in the young group of patients.