Oral Medicine Experience and Attitudes Toward Oral Cancer: An Evaluation of Dentists Working in Primary Health Care.

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Cytological Screening Model of Normal Oral Mucosa Exposed to Carcinogens: A Pilot Study.

INTRODUCTION: Oral cytopathology is able to detect incipient cellular alterations, but it is not routinely applied to this purpose. We aimed to establish a model to screen individuals with no oral lesion exposed to smoking/alcohol, by means of the nuclear area, cell proliferation rate, and analysis of genetic damage. METHODS: In this cross-sectional pilot study, 90 patients were allocated into 3 groups: oral cancer group (patients with oral squamous cell carcinoma), tobacco/alcohol group (patients without oral lesions and exposed to these risk factors), and control group (individuals with no lesion and not exposed to tobacco and alcohol). The cytological smears performed in these individuals were stained with Papanicolaou, a silver-staining and a Feulgen reaction. The nuclei of cells were measured, and AgNORs/nucleus and micronuclei (MN) were quantified. The cutoff values were stipulated evaluating the healthy mucosa (control group) and the cancerization field mucosa (oral cancer group). RESULTS: Cutoff values for the screening of individuals exposed to carcinogens were ≥8% of nuclei larger than 100 µm2, ≥3.38 AgNOR/nucleus, and ≥3 MN per 1,000 cells. CONCLUSIONS: Nuclear area measurement and AgNORs/nucleus and MN quantification identified the incipient phase of oral carcinogenesis. A screening model for individuals without oral lesion exposed to smoking/alcohol was proposed.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview.

INTRODUCTION: We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations. MATERIALS AND METHODS: The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis. RESULTS: Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease. CONCLUSION: Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

Morphological and immunohistochemical features of tooth extraction sites in rats treated with alendronate, raloxifene, or strontium ranelate.

OBJECTIVE: The aim of this study was to evaluate morphological and immunohistochemical features of tooth extraction sites in rats subjected to different antiresorptive drugs. MATERIALS AND METHODS: Wistar rats were allocated into 4 groups according to the treatment: (1) alendronate, (2) raloxifene, (3) strontium ranelate, and (4) control. The animals underwent tooth extraction (60th day of treatment) and afterwards were euthanized (90th day of treatment). Tooth extraction sites were analyzed by means of scanning electron microscopy (SEM), hematoxylin-eosin staining (H&E), and immunohistochemical staining (RANKL and OPG). RESULTS: On H&E analysis, the alendronate group showed greater amounts of non-vital bone, biofilm, inflammatory infiltrate and root fragment, and smaller amount of vital bone. The strontium ranelate group showed great amount of non-vital bone. This group also had lower levels of OPG, while the alendronate group showed lower OPG and RANKL than the other groups. On SEM analysis, the alendronate group showed a considerable number of microcracks on the alveolar bone surface and few Howship lacunae and lack of bone cells as well. The raloxifene, strontium ranelate, and control groups showed a large number of bone cells and Howship lacunae on the bone surface and few microcracks. CONCLUSION: Alendronate therapy is associated with macro- and microscopic features of medication-related osteonecrosis of the jaw at tooth extraction sites, whereas raloxifene therapy is not, and strontium ranelate therapy is associated with non-vital bone. CLINICAL RELEVANCE: Osteonecrosis of the jaws is a serious side effect of alendronate therapy, where tooth extraction is a major risk factor. Considering the significant number of patients undergoing antiresorptive therapies worldwide, the present study investigated whether raloxifene and strontium ranelate interfere with bone repair after tooth extraction in a similar way to bisphosphonates.

Does laser photobiomodulation prevent hyposalivation in patients undergoing head and neck radiotherapy? A systematic review and meta-analysis of controlled trials.

INTRODUCTION: Head and neck radiotherapy can cause hypofunction of the salivary glands. Many studies report that laser photobiomodulation (PBM) is able to minimize radiation-induced hyposalivation, yet there is no consensus about its effects. OBJECTIVE: To carry out a meta-analysis of controlled clinical trials that used PBM to prevent radiation-induced hyposalivation. METHODS: A systematic search was performed through Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, LILACS and Web of Science databases. The strategy included comparisons of the effect of PBM with placebo/clinical follow-up on unstimulated and/or stimulated salivary flow in patients undergoing head and neck radiotherapy. RESULTS: Six clinical trials were included, five of which were used for meta-analysis. Evidence was observed between the use of PBM and increased unstimulated salivary flow (MD 0.20 mL/min, 95 % Cl 0.10-0.30, I² = 96 %, p < 0.00001) and in stimulated salivary flow (MD 0.27 mL/min, 95 % CI 0.08-0.46, I² = 95 %, p < 0.00001). CONCLUSION: PBM appears to minimize radiation-induced hyposalivation.

Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects, and complications.

BACKGROUND: Deoxycholic acid (DCA) was developed by the pharmaceutical industry for aesthetical use in submental fat reduction. It represents the first lipolytic substance approved by the Food and Drug Administration (FDA) for fat reduction in that area. AIMS: This study presents an update of properties and the use of DCA, as well as adverse events and possible complications. METHODS: A search in MEDLINE/PubMed, Cochrane, and Bireme/LILACS databases was performed using the terms: "deoxycholic acid" OR "ATX-101" AND "injection" NOT "amphotericin" NOT "biliary" NOT "bile." Experimental studies developed in animals, clinical trials, literature reviews, case reports, and letters to the editor that included the DCA mechanism of action, dose, manner of use, adverse effects, and complications were selected. RESULTS: The most frequent adverse events are edema, local pain, bruise, and numbness, which usually spontaneously regress. However, complications, including, skin necrosis, nerve injury, alopecia, and vascular events, can occur, demanding complex management without specific protocols. CONCLUSION: Although DCA is beneficial for lysis of adipose tissue, clinicians should be aware about the adverse effects and risks involved with the use of this substance. The knowledge of local anatomy, properties, and adverse effects are fundamental to treatment with DCA.

Effect of photobiomodulation on salivary flow and composition, xerostomia and quality of life of patients during head and neck radiotherapy in short term follow-up: A randomized controlled clinical trial.

Xerostomia and hyposalivation are frequent conditions in patients undergoing head and neck radiotherapy, which usually lead to a worsening of quality of life. This study aimed to assess whether photobiomodulation (PBM) can minimize hyposalivation, xerostomia and qualitative changes on saliva and improve quality of life in patients undergoing radiotherapy in short-term follow-up. Twenty-one patients were randomly divided into two groups: sham group (SG) and laser group (LG). A diode laser was used for intra- (660 nm, 10 J/cm2, 0.28 J per point, 40 mW) and extra-oral (810 nm, 25 J/cm2, 0.7 J per point, 40 mW) applications over the salivary glands, three times a week, during the entire radiotherapy period. In SG, the tip of the instrument was sealed with blue rubber to prevent the passage of light. Xerostomia and pH were evaluated and unstimulated and stimulated salivary flow was determined before the start of radiotherapy (T1), after the 15th session (T2), after the end of radiotherapy (T3) and 60 days after radiotherapy (T4). Concentrations of calcium, total proteins, chloride, sodium, potassium and amylase and catalase activities were evaluated in stimulated saliva samples. Quality of life was assessed at times T1 and T4. Generalized estimating equations were used to assess differences in the outcome between times and groups. All patients showed worsening in unstimulated (p = .003) and stimulated (p < .001) salivary flow, xerostomia (p < .05) and quality of life during radiotherapy (p = .001). An increase in chloride concentrations was observed at times T3 and T4 (p < 0,05), and a reduction in amylase activity at T3 (p < .05). Unstimulated saliva pH was higher in LG than SG at T3 (p = .037). No difference between groups was noted in relation to salivary flow and composition, xerostomia or quality of life. Our results suggest that PBM may help in preserving salivary pH during radiotherapy.

Cannabidiol on 5-FU-induced oral mucositis in mice.

PURPOSE: The aim of this study was to evaluate the clinical, histological, hematological, and oxidative stress effects of cannabidiol (CBD) in mice with induced oral mucositis. METHODS: We used 90 mice of the CF-1 strain in which oral mucositis was induced using a protocol with 5-fluorouracil (5-FU) chemotherapy. The animals were divided randomly into 10 study groups. Three groups were treated with different doses of CBD (3, 10, and 30 mg/kg), while 2 were control groups (positive control: 5-FU + mechanical trauma + placebo; and negative control: mechanical trauma + placebo), and 2 experimental times were studied (4 and 7 days). All treatments were by intraperitoneal administration. RESULTS: In the clinical evaluation, the groups treated with CBD showed less severity of oral lesions compared with the positive control at both experimental times. The intensity of the inflammatory response was also lower in the groups treated with this drug, but there was no statistically significant difference when compared with the positive control. With regard to erythrocyte, leukocyte, and platelet counts and anti-oxidant enzyme activity, the groups treated with CBD showed better results, but only some of these variables showed statistically significant differences. CONCLUSIONS: CBD seems to exert an anti-inflammatory and anti-oxidant activity favoring a faster resolution of oral mucositis in this animal model.

The topical effect of chlorhexidine and povidone-iodine in the repair of oral wounds. A review.

PURPOSE: The aim of this paper was to review the current literature with regard to the use of chlorhexidine and povidone-iodine in the treatment of oral wounds. BACKGROUND: Oral mucosa is continuously subjected to physical or chemical injuries, where it becomes a common site for the occurrence of ulcerated lesions. These lesions are susceptible to infections that may delay healing. MATERIALS AND METHODS: A search of the medical and dental literature was conducted in Medline/Pubmed and Scielo using a combination of the terms oral ulcer, oral wound, wound healing, povidone-iodine and chlorhexidine, to review their mechanism of action and their use in the healing of oral wounds. RESULTS AND CONCLUSION: The use of chlorhexidine and povidone-iodine is effective in the control of local infection in a concentration-dependent manner, exerting a positive influence on the tissue repair process. Oral antiseptics appear be a good alternative in the management of these lesions, since there is a low risk of systemic toxicity and allergies, and less clinical evidence of bacterial resistance.

Effects of cannabidiol, a Cannabis sativa constituent, on oral wound healing process in rats: Clinical and histological evaluation.

The effects of cannabidiol (CBD), the main non-psychotropic component of Cannabis sativa, were assessed on oral wound healing in an in vivo model. Standardized ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received intraperitoneal injections of CBD at doses of 0 (control), 5, and 10 mg/kg daily. Animals were weighed daily, and wound healing was clinically and histologically evaluated after 3 and 7 days of treatment. CBD treatment did not influence the wound area of ulcerative lesions at either observation time. Conversely, microscopic findings revealed that at Day 3 postwounding, CBD-treated lesions exhibited significantly lower inflammatory scores than those in the control group. However, this difference was not observed at Day 7. Collectively, these findings indicate that CBD exert an antiinflammatory effect in early phase of wound healing process although it was not sufficient promote clinical improvement of oral traumatic ulcerative lesions.

Oral yeast colonization in patients with primary and secondary Sjögren's syndrome.

OBJECTIVE: The study aimed to investigate the pattern of oral yeast colonization of Sjögren's syndrome patients and its correlation to salivary flow rates, age, and time of the disease progression. MATERIALS AND METHODS: Saliva and swab specimens were obtained from 45 patients (primary Sjögren's syndrome = 15/ secondary Sjögren's syndrome = 15/ healthy controls = 15). Yeast species were identified using culture method through chromogenic medium followed by polymerase chain reaction and Sanger sequencing. RESULTS: Eleven species from six different genera were detected. The most prevalent species found was Candida albicans followed by Candida tropicalis, Candida glabrata, Candida parapsilosis, and Candida krusei. Both groups of Sjögren's syndrome showed higher counts of C. albicans (Total and CFU counts) when compared to control group. In contrast, a greater variety of yeast species was identified on samples of the control group. CONCLUSIONS: This study showed that C. albicans is the most prevalent yeast, but also that a variety of other yeast species can colonize the oral cavity of Sjogren's syndrome patients. The identification of most of the colonies was not obtained by culturing-PCR methods combined.

Topical chlorhexidine, povidone-iodine and erythromycin in the repair of traumatic ulcers on the rat tongue: Clinical, histological and microbiological evaluation.

OBJECTIVE: This study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats. DESIGN: Forty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed. RESULTS: The experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p < 0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p > 0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p < 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p < 0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p < 0.05 at 3 days and p < 0.01 at 7 days). CONCLUSIONS: All drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.

Salivary Alpha-Amylase Enzyme, Psychological Disorders, and Life Quality in Patients with Recurrent Aphthous Stomatitis.

Objective. The aim of this study was to evaluate stress, anxiety, and salivary alpha-amylase (SAA) activity in patients with recurrent aphthous stomatitis (RAS). The impact of this disease on the life quality was also evaluated. Design. Twenty-two patients with RAS and controls, matched by sex and age, were selected. Stress and anxiety were assessed using Lipp's Inventory of Stress Symptoms and Beck Anxiety Inventory. Life quality was assessed through the World Health Organization Quality of Life-bref (WHOQOL-BREF) and the Oral Health Impact Profile-14 (OHIP-14). Saliva samples were collected in the morning and afternoon and the SAA activity was analyzed by enzymatic kinetic method. Results. No significant difference was observed between the groups regarding the SAA activity (p = 0.306). Patients with RAS had higher scores of anxiety (p = 0.016). The scores of WHOQOL-BREF were significantly lower in patients with RAS. The values obtained through OHIP-14 were significantly higher in these patients (p = 0.002). Conclusion. RAS negatively affects the life quality. Patients with the disease have higher levels of anxiety, suggesting its association with the etiopathogenesis of RAS.

Role of tumour-associated macrophages in oral squamous cells carcinoma progression: an update on current knowledge.

BACKGROUND: Oral squamous cell carcinoma (OSCC) accounts over 90% of malignant neoplasms of the oral cavity. This pathological entity is associated to a high mortality rate that has remained unchanged over the past decades. Tumour-associated macrophages (TAMs) are believed to have potential involvement in OSCC progression. However, the molecular networks involved in communication between stroma and cancer cells have not yet been fully elucidated. MAIN BODY: The role of M2 polarized cells in oral carcinogenesis is supported by a correlation between TAMs accumulation into OSCC stroma and poor clinical outcome. Signalling pathways such as the NF-κB and cytokines released in the tumour microenvironment promote a bidirectional cross-talk between M2 and OSCC cells. These interactions consequently result in an increased proliferation of malignant cells and enhances aggressiveness, thus reducing patients' survival time. CONCLUSIONS: Here, we present a comprehensive review of the role of interleukin (IL)-1, IL-4, IL-6, IL-8, IL-10 and the receptor tyrosine kinase Axl in macrophage polarization to an M2 phenotype and OSCC progression. Understanding the molecular basis of oral carcinogenesis and metastatic spread of OSCC would promote the development of targeted treatment contributing to a more favourable prognosis.

Effect of low-level laser therapy on irradiated parotid glands--study in mice.

The objective of this study was to evaluate the effect of low-level laser therapy (LLLT) on radiotherapy-induced morphological changes and caspase-3 immunodetection in parotids of mice. Forty-one Swiss mice were divided into control, radiotherapy, 2- and 4-J laser groups. The experimental groups were exposed to ionizing radiation in a single session of 10 Gy. In the laser groups, a GaAlAs laser (830 nm, 100 mW, 0.028 cm2, 3.57 W/cm2) was used on the region corresponding to the parotid glands, with 2-J energy (20 s, 71 J/cm2) or 4 J (40 s, 135 J/cm2) per point. LLLT was performed immediately before and 24 h after radiotherapy. One point was applied in each parotid gland. The animals were euthanized 48 h or 7 days after radiotherapy and parotid glands were dissected for morphological analysis and immunodetection of caspase-3. There was no significant difference between groups in the immunodetection of caspase-3, but the laser groups had a lower percentage compared to the radiotherapy group. LLLT promoted the preservation of acinar structure, reduced the occurrence of vacuolation, and stimulated parotid gland vascularization. Of the two LLLT protocols, the one using 4 J of energy showed better results.

Efficacy of low-level laser therapy for the treatment of burning mouth syndrome: a randomized, controlled trial.

The aim of the present study was to assess the effect of low-level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS). A diode laser was used in 78 BMS patients who were randomly assigned into four groups: IR1W, n = 20 (830 nm, 100 mW, 5 J, 176 J/cm2, 50 s, LLLT weekly sessions, 10 sessions); IR3W, n = 20 (830 nm, 100 mW, 5 J, 176 J/cm2, 50 s, three LLLT weekly sessions, 9 sessions); red laser, n = 19 (685 nm, 35 mW, 2 J, 72 J/cm2, 58 s, three LLLT weekly sessions, 9 sessions); and control-group (CG), n = 19. Symptoms were assessed at the end of the treatment and eight weeks later; quality of life related to oral health was assessed using the Oral Health Impact Profile (OHIP-14). Statistical analysis was carried out using repeated measures analysis of variance followed by the posthoc Tukey test. There was significant reduction of the symptoms in all groups at the end of the treatment, which was maintained in the follow-up. The scores of the IR1W and IR3W laser groups differed significantly from those of the CG. There was also a decrease in the OHIP-14 scores in the four groups. The IR3W laser group scores differed significantly from those of the CG. LLLT reduces the symptoms of BMS and may be an alternative therapeutic strategy for the relief of symptoms in patients with BMS.

Contribution of Ultrasonography to the Diagnosis of Submucosal and Subcutaneous Nodular Lesions of the Oral and Maxillofacial Region: Analysis of Cases.

OBJECTIVE: The aim of this study was to evaluate the contribution of ultrasonography in the establishment of the diagnosis of nonspecific nodular lesions of the oral soft tissues. We determined the indication of use and reliability of ultrasonography in the field of dentistry, considering whether it was of value in the conclusive diagnosis of these pathologies. MATERIALS AND METHODS: We recruited 65 patients from the Oral Medicine Unit of São Lucas Hospital, who had submucosal and subcutaneous nodules, without established diagnosis. They were subjected to ultrasonography of the lesion, carried out with standardization of the protocol and equipment, utilizing a Doppler system. The ultrasonographic report was prepared by an experienced professional, noting the imaging characteristics as well as the possibility of diagnosis. Two calibrated examiners analyzed the data, comparing the ultrasonographic report with the final diagnosis. Accordingly, we used established scoring, where zero corresponded to no contribution to the final diagnosis, 1 helped in the management of the case, and 2 when imaging determined the diagnosis. RESULTS: A zero score was obtained for 12.3 % of the examinations performed, and 1 and 2 accounted for respectively 41.5 and 46.1 %, totaling a contribution of about 88 %. Ultrasonography was of value in the diagnosis of vascular lesions in 93.3 % and of neoplasms in 87.5 %. In the salivary gland diseases, it contributed to the final diagnosis in 75 %. CONCLUSION: The results demonstrated that ultrasonography is an effective tool in the determination of the definitive diagnosis of nonspecific nodular lesions of the soft tissues of the oral and maxillofacial region.

Antioxidant agents: a future alternative approach in the prevention and treatment of radiation-induced oral mucositis?

Radiotherapy is a therapeutic modality frequently employed for patients with head and neck cancer (HNC). It destroys tumor cells, but it is not selective, also affecting healthy tissues and producing adverse effects. One that stands out is oral mucositis because of the morbidity that it is capable of causing. This lesion is characterized by the presence of erythema, ulcerations, pain, opportunistic infections, and weight loss. These side effects can lead to serious situations that require the interruption of the antineoplastic treatment and can result in hospitalization and even death. The complex mechanisms linked to the pathogenesis of oral mucositis were recently established, and since then, the control of oxidative stress (OS) has been tied to the prevention and management of this disease. The authors have carried out a review of the literature about the use of antioxidant agents in the prevention and treatment of radiation-induced oral mucositis, using the PubMed database. This review has shown that the research on use of antioxidants (AOX) has proved insufficient to justify suggesting the products in treatment protocols. Results are promising, however, and AOX may represent a future alternative in the prevention and treatment of oral mucositis.

Oral squamous cell carcinoma from users and nonusers of tobacco and alcohol: clinicopathologic features and immunoreactivity of VEGF, caspase-3, and p53.

OBJECTIVES: The objective of this study was to compare the clinicopathologic characteristics and immunoreactivity of vascular endothelial growth factor (VEGF), caspase-3, and p53 between oral squamous cell carcinomas from users and nonusers of tobacco and alcohol. DESIGN: We randomly selected 90 specimens of oral carcinomas, from patients diagnosed between 1991 and 2011 in Oral Medicine Division. The specimens were distributed into 3 groups according to exposure to risk factors: 30 specimens from smokers, 30 from smokers/alcohol drinkers, and 30 from individuals not exposed to these factors. The clinicopathologic characteristics of the lesions were evaluated and the proteins VEGF, caspase-3, and p53 were detected by immunohistochemistry. RESULTS: The group of nonsmokers/nonalcohol drinkers consisted mainly of women (P≤0.001), with a higher mean age (P=0.004). The group of smokers/alcohol drinkers exhibited larger tumors when compared with patients not exposed to smoking and alcohol (P=0.004). The histopathologic grading also differed between these groups (P=0.040), because a greater number of grade I lesions and fewer grade III lesions were found in patients who were nonsmokers/nonalcohol drinkers. No significant difference was observed in relation to immunoreactivity of VEGF (P=0.315), caspase-3 (P=0.860), and p53 (P=0.876) between the groups. CONCLUSIONS: There are substantial clinicopathologic differences between oral carcinomas in users and nonusers of tobacco and alcohol. Immunodetection of the proteins VEGF, caspase-3, and p53 is not influenced by smoking or alcohol consumption, suggesting that other molecular mechanisms are associated with the biological aggressiveness of oral carcinoma in patients exposed to these risk factors.

Effect of an herbal compound for treatment of burning mouth syndrome: randomized, controlled, double-blind clinical trial.

OBJECTIVE: This randomized, double-blind, placebo-controlled clinical study aimed at evaluating the effect of the systemic use of an herbal compound (Catuama) on the symptoms of burning mouth syndrome (BMS). STUDY DESIGN: Seventy-two patients with BMS were randomly allocated into test (n = 38) and control (n = 34) groups. Patients were instructed to take 2 capsules each day for 8 weeks. They were reassessed at 4, 8, and 12 weeks after treatment onset using a faces scale (FS) and a visual numeric scale (VNS). RESULTS: Although both groups demonstrated a reduction in symptoms, the improvement observed in the test group was significantly greater than in the control group after 4 (FS: P = .010) and 8 (VNS: P = .03; FS: P < .001) weeks of treatment. This significant reduction was maintained 12 weeks after treatment onset (FS, VNS: P = .001). CONCLUSIONS: The systemic administration of Catuama reduces the symptoms of BMS and may be a novel therapeutic strategy for the treatment of this disease.