Observational Molecular Case-Control Study of Genetic Polymorphisms 1 in Programmed Cell Death Protein-1 in Patients with Oral Lichen Planus

Background: The association between programmed cell death protein 1 (PD-1) variations and susceptibility to autoimmune diseases has been recurrently reported. However, there is no report about its relationship with oral lichen planus (OLP) as one of autoimmune diseases. Methods: We investigated the association between genetic predisposition to OLP and two single nucleotide polymorphisms in PD-1. Results: GG, GA, and AA genotypes at position +7146 were found in 59 (80.8 %), 10 (13.7 %), and 4 (5.5 %) patients, and in 132 (77 %), 34 (20 %), and 5 (3 %) healthy participants. CC, CT, and TT genotypes at position +7785 were found in 32 (43.8 %), 35 (47.9 %), and 6 (8.2 %) patients and in 99 (58 %), 66 (39 %), and 6 (3 %) controls. Analysis indicated that patients' genotypes were not statistically different from controls' genotypes at both positions +7146 (P = 0.35 and P = 0.98) and +7785 (P = 0.07 and P = 0.06). Conclusion: The findings indicated that PD-1 SNPs at +7146 [PD-1.3] G/A and +7785 [PD-1.5] C/T was not associated with susceptibility to OLP. However, further research with higher sample size and in different geographical regions is needed in order to achieve the generalizability of the findings.

Prevalence of Chronic Orofacial Pain in Elderly Patients Referred to Shiraz Dental School From 2005 to 2017.

BACKGROUND: Orofacial pain is presented mainly as a pain in the front part of the head, including the oral cavity. Adult and elderly patients are important target groups affected by this chronic pain, which may cause several problems. METHODS: In this cross-sectional study, the characteristics of patients who suffered from orofacial pain were evaluated. The data such as patients' gender, age, pain diagnoses, treatments, responses to treatments, duration and severity of pain, and disability were collected from their records. The diagnoses were provided based on the characteristics of pain, X-ray findings, physiological findings, lab tests, nerve block injection, and a drug challenge test. RESULTS: Among all the 5,221 patients referred to Oral and Maxillofacial Medicine and Prosthodontics Department, 583 (11.16%) reported orofacial pain as the chief complaint. The frequency of orofacial pain was more prevalent among women than men. Burning mouth syndrome was the most prevalent cause of orofacial pain in the elderly, followed by temporomandibular disorder and trigeminal neuralgia. CONCLUSIONS: Most cases of orofacial pain in elderly patients were burning mouth syndrome, temporomandibular disorder, and neuralgia. It was more observed in females than males with the mean age of 55.3 ± 10.7 years old.

Evaluation of the serum levels of galectin-3 in patients with oral lichen planus disease.

OBJECTIVES: Galectin-3, a member of beta-galactoside-binding proteins, can be found in cytoplasm and nucleus as well as extracellularly in various tissues and involved in many physiological and pathological processes. We aimed to measure the serum levels of galectin-3 in oral lichen planus (OLP) disease and compare the result with that observed in healthy ones. MATERIALS AND METHODS: In this cross-sectional study, the serum levels of galectin-3 were measured in 56 healthy individuals and 53 pathologically proven OLP patients including those with atrophic/erosive (33 cases) or reticular (20 cases) lesions, using enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared with healthy individuals (1.1 ± 0.4 ng/ml), galectin-3 serum levels in patients with OLP (3.1 ± 1.1 ng/ml) were significantly elevated (p < 0.0001). Serum galectin-3 levels were elevated significantly in patients with atrophic/erosive lesions compared to those of reticular (3.9 ± 2.1 ng/ml vs. 1.9 ± 1.4 ng/ml, p = 0.001), but it has not associated with age and gender. CONCLUSIONS: The elevation of galectin-3 in OLP is a future tool to increase the knowledge about the possible etiology of the disease and may be helpful to differentiate atrophic/erosive lesions from reticular ones. To the best of our knowledge, this is the first study evaluated the serum galectin-3 levels in OLP.

Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients.

INTRODUCTION: Patients with chronic liver failure (CLF) are faced with many complications, because this organ is involved in various metabolic activities. Hepatic osteodystrophy is one of the major health issues encountered by this group of patients. The current study evaluated osteoporosis and bone changes in oral panoramic radiographies of cirrhotic patients. MATERIALS AND METHODS: In this study, 138 panoramic views of CLF patients, candidates for liver transplant (65 females, 73 males, aged 19-68 years) referred to Shiraz University Dental Clinic (Shiraz, Iran) for pretransplant oral examination, were evaluated. Also 138 healthy individuals (69 females, 69 males, aged 18-70 years) referred to the same clinic were examined. Abnormalities such as osteoporosis, pathologic radiolucencies, pathologic calcifications, tonsilloliths, condylar degeneration, and other findings in the alveolar bones were recorded. RESULTS: Osteoporosis was a common finding in CLF patients (p<0.001), and the probability of detecting low bone density in the panoramic view was 20.37 times higher among patients than healthy subjects. The probability of detecting pathologic jaw radiolucencies was 8.92 times higher in the case group than in the controls (p<0.001). Other bone abnormalities such as condylar degeneration and idiopathic osteosclerosis were also more prevalent in CLF patients compared to healthy subjects (p<0.001). CONCLUSION: Cirrhotic patients are prone to osteoporosis of the alveolar bones. Also, pathologic jaw radiolucencies as a result of oral infections are more prevalent in this group of patients. Routine oral panoramic views are acceptable and cost-effective radiographies for use in detecting such abnormalities in the alveolar bones as well as overall dental health. These findings also support the importance of dental health examinations prior to liver transplantation to reduce the risk of organ rejection.

The relation of preoperative stress and anxiety on patients' satisfaction after implant placement.

BACKGROUND: There are some factors which can affect preoperative patient anxiety such as the necessity of procedure, postoperative pain, and patient's conception of his body image. The aim of this study was to assess the relation of patients' preoperative anxiety and postoperative patients' satisfaction in dental implant surgery. MATERIALS AND METHODS: Dental implants were placed in 40 patients (19 male and 21 female) who were referred to Dental Implant Surgery Department in Imam Reza clinic, during March-December of 2014 in Shiraz. The procedures were performed with or without bone regeneration. Preoperative anxiety was evaluated using Corah Dental Anxiety Scale, and postoperative satisfaction was determined on the basis of pain intensity, bleeding tendency, inability to eating, and overall satisfaction by filling a questionnaire in the 2nd or 3rd week after surgery. Data were collected and analyzed using Mann-Whitney test. RESULTS: Preoperative anxiety was detected as high in 10%, mild in 85%, and moderate in 5% of patients. Anxiety and depression score did not differ in both genders. There was no statistical difference between neither level of anxiety nor depression in both high and low educated patients. Postoperative bleeding, difficulty in eating, and overall satisfaction was nearly the same in both genders. Statistical analysis demonstrated a lower pain level and higher pain threshold in men than women (P = 0.007). Patients' age was not related to anxiety, depression, amount of bleeding, pain, and difficulty in eating. Overall dental care satisfaction was similar in both men and women. CONCLUSION: The results of the study indicated that while anxiety does play a role in the perception of pain by patients undergoing implant surgery, overall patient satisfaction and post surgical outcomes did not significantly differ.

Cone Beam Computed Tomographic Analysis of the Course and Position of Mandibular Canal.

PURPOSE: Estimation of the relative position of infra alveolar nerve (IAN) canal and its relation to the mandibular anatomical landmarks can be clinically useful in minimizing the risk of surgery complications such as neurosensory disturbances that may occur after invasive mandibular surgical procedures. The purpose of the present study was to investigate the anatomic location and radiographic course of the mandibular canal compared to anatomic landmarks on CBCT and to discuss its clinical significance and also to determine the possible correlations between the mandibular position and the age of the patients. METHODS: This cross sectional study was conducted on 242 CBCT of patients (99 males and 143 females). The location of canal was evaluated in 4 different regions. The first section in trans-axial view after mental foramen, in which the loop of mandibular canal is formed, was selected as point 1 for measurement and intervals of 10 mm, respectively, points 2, 3, 4 were selected for measurement. On these sections, the shortest linear distances (mm) from the most buccal and lingual aspects of the canal to the corresponding cortical plates of the mandible and also the minimum linear distance between the inferior aspect of canal and inferior border of mandible in these regions were calculated. RESULTS: There was statistically significant correlation between the anatomic course of the canal and the patients' gender. The mean vertical position of the canal, as measured from the lower border of the IAN canal to the inferior border of the mandible, was 8.50 mm, ranging from 4.80 to 14.50 mm. On average, the mandibular canal was situated more lingually at all sites to the point it reached the mental foramen. However, at the mental foramen region (Point 1), it was located closer to the buccal cortical plate. CONCLUSION: Assessment of the exact course of the IAN preoperatively along the body of the mandible by using CBCT might contribute to efficient and accurate surgical planning and therefore positively influence the surgical results. The results of this study confirm the necessity of using CBCT before invasive surgical procedures to determine the variations in the relative position and course of IAN canal.

Clinical Evaluation of High and Low-Level Laser Treatment (CO2vsInGaAlP Diode Laser) for Recurrent Aphthous Stomatitis.

STATEMENT OF THE PROBLEM: Recurrent aphthous stomatitis (RAS) is one of the most common lesions in the oral cavity. Due to its multifactorial nature, there is no definitive treatment for RAS. Laser therapy is one of the suggested treatments to reduce patient's discomfort. PURPOSE: The purpose of the present clinical trial is to assess the effect of low and high level laser therapy on pain control and wound healing of RAS. MATERIALS AND METHOD: Thirty six patients with minor RAS were divided into three groups. Group 1 (n=14) received CO2 laser, group 2 (n=12) were treated with InGaAlP Diode laser and group 3 (n=10) received sham laser as placebo. All patients were evaluated daily up to 15 days after receiving one session of laser therapy. Pain severity before and after treatment, wound healing, patient's satisfaction, and functional disturbance before and after treatment were recorded for each patient. RESULTS: According to statistical analysis, pain reduction after treatment in group 1 was 7.00±2.41, in group 2 was 2.08±2.31, and in group 3 was 1.40±1.77. In addition, a significant difference was observed in the reduction of functional complications in CO2 laser treated patients compared to the other two groups. CONCLUSION: High-level laser treatment showed analgesic effects on RAS, but no healing was observed. Low-level laser therapy demonstrated no positive effect on recurrent aphthous ulcers.

Susceptibility of Candida albicans and Candida dubliniensis to Photodynamic Therapy Using Four Dyes as the Photosensitizer.

STATEMENT OF THE PROBLEM: Oral candidiasis is the most common opportunistic infection affecting the human oral cavity. Photodynamic therapy, as one of its proposed treatment modalities, needs a distinct dye for achieving the best effect. PURPOSE: The purpose of this study was to evaluate photosensitization effects of four distinct dyes on standard suspension of Candida albicans (C. albicans) and Candida dubliniensis (C. dubliniensis) and biofilm of C. albicans considering the obtained optimum dye concentration and duration of laser irradiation. MATERIALS AND METHOD: In this in vitro study, colony forming units (CFU) of two sets of four groups of Laser plus Dye (L+D+), Dye (L-D+), Laser (L+D-) and No Laser, No Dye (L-D-) were assessed individually with different methylene blue concentrations and laser irradiation period. The photodynamic therapy effect on standard suspension of Candida species (using methylene blue, aniline blue, malachite green and crystal violet) were studied based on the obtained results. Similar investigation was performed on biofilm of C. albicans using the spectral absorbance. Data were imported to SPSS and assessed by statistical tests of analysis of variance (ANOVA) and Tukey test (α= 0.05). RESULTS: CFU among the different dye concentration and irradiation time decrease in dose- and time-dependent manner (p> 0.05), all of which were significantly lower than the control groups (p< 0.05). Among the examined photosensitizers, there was no statistically significant difference, (p> 0.05) though all of them were significantly decrease CFU compared with the control groups (p< 0.05). In L+D- and L+D+ groups, biofilm was significantly destroyed more than that of L-D- (p< 0.05). CONCLUSION: Photodynamic therapy might be used as an effective procedure to treat Candida associated mucocutaneous diseases and killing biofilm in the infected surfaces such as dentures.

Oral manifestations of asthmatic patients.

The effect of asthma on oral health is the subject of debate among dental practitioners. The current study was planned to investigate the oral manifestations of asthmatics compared to healthy subjects. The study group composed of 100 asthmatics and 100 age-matched healthy controls. The caries status based on Decayed/Missing/Filled Teeth (DMFT) criteria and oral lesion were evaluated in all subjects. The mean age of the asthmatics group was 47.5±3.5 years and in the control group it was 43.5±3.0 years. Asthmatics included 45(45%) males and 55(55%) females. There was no statistical difference between caries prevalence in both groups. The most prevalent oral lesions in asthmatics group were geographic tongue 10(10%), fissured tongue 13(13%), chronic atrophic candidiasis13(13%), and in the control group were fissured tongue(11%) and lichenoid reaction(2%). The dental professional must be familiar with all signs and symptoms of this disease in order to offer effective and safe treatment.

The antibacterial effect of four mouthwashes against streptococcus mutans and escherichia coli.

OBJECTIVE: To evaluate the antimicrobial properties of several mouthwash concentrations on oral Streptococcus mutans and Escherichia coli. METHODS: The study was conducted at Shiraz Medicine School in 2011. Serial dilutions of Chlorohexidin, Oral B and Persica and Irsha (2,4,8,16,64,128) were prepared in Muller-Hinton media. Minimum inhibitory concentration was visually determined and defined as the lowest concentration of each oral washing which inhibited > 95% growth reduction compared to the growth control well. RESULTS: Chlorhexidine, Oral B and Irsha mouthwash inhibited Streptococcus mutans even with diluted concentrations. Also, Chlorhexidine and Oral B prohibited Escherichia coli with different potencies. But Persica had no antimicrobial activity against either Escherichia coli or Streptococcus mutans. CONCLUSIONS: Chlorhexidine, Irsha, and Oral B mouthwashes can be used for antimicrobial effects, especially on Streptococcus mutans. This chemical activity of mouthwashes is an adjuvant for mechanical removing of plaque. However, the antimicrobial effect of Persicaremains controversial.

Lack of association between Helicobacter pylori infection and oral lichen planus.

Oral lichen planus is a premalignant chronic inflammatory mucosal disorder with unknown etiology. It is a multifactorial disease and in addition to genetic background, infections, stress, drug reactions are suggested as risk factors. Helicobacter pylori which is involved in development of many gastrointestinal lesions may also be implicated in oral lichen planus induction. This is of clear importance for cancer prevention and the present study was performed to determine any association between H. pylori infection and oral lichen planus in southwestern Iran. Anti H. pylori IgG levels were determined in 41 patients and 82 sex-age matched controls. The results showed no association between H. pylori infection and oral lichen planus (51% in patients vs. 66% in control). or any of its clinical presentations.