Dentist Involvement in the Treatment of Radiation-Induced Oral Mucositis-A Pilot Cross-Sectional Study.

Objectives: Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area. This paper aims to determine the occurrence and characteristics of OM in patients with head and neck cancer (HNC), as well as the involvement of dentists/oral medicine specialists in treating such patients. Methods: This study was conducted at the Department of Otorhinolaryngology and Department of Oral Medicine, University Hospital Center Zagreb, from April to August 2022, on patients irradiated in the head and neck area. A unique OM questionnaire was created on the incidence, characteristics, oral care, and involvement of dentists in the overall care. Results: Thirty patients filled out the questionnaire. Of the 22 patients who had developed OM, 14 had grade-three OM. Ten patients were treated for OM in line with the instructions of an oral medicine specialist, eight based on the instructions of a specialist responsible for monitoring of the underlying disease, and four were not treated at all. Sixteen patients had not been referred to a dentist before the start of RT. Conclusions: These results showed insufficient care and treatment of OM, as well as insufficient involvement of dentists in the oncology team.

Different Treatment Modalities of Oral Lichen Planus-A Narrative Review.

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology which affects the oral mucosa. OLP varies in its clinical features from a reticular form that is, in most cases, asymptomatic, to atrophic-erosive, and is accompanied by symptoms of burning sensation and pain followed by difficulty in eating. Given the fact that OLP is a disease of unknown etiology, the treatment is symptomatic and involves suppressing the signs and symptoms of the disease using various topical and systemic drugs. The first line of therapy for treating symptomatic OLP is topical corticosteroids, whereas systemic corticosteroids are used for treating persistent lesions that do not respond to local treatment. However, the lack of convincing evidence on the efficacy of previous therapies, including topical corticosteroids, and numerous side effects that have appeared over recent years has resulted in the emergence and development of new therapeutic options. Some of the therapies mentioned are tacrolimus, efalizumab, dapson, interferon, retinoic acid, photochemotherapy with psoralen and ultraviolet A rays (PUVA), aloe vera, antimalarials, antibiotics and others. These therapies only partially meet the properties of efficacy and safety of use, thus justifying the continuous search and testing of new treatment methods.

Live Intraoral Dirofilaria repens of Lower Lip Mimicking Mucocele-First Reported Case from Croatia.

Dirofilariasis is an endemic infestation in tropical and subtropical countries caused by about 40 different species. It rarely occurs in the oral cavity and is mostly presented as mucosal and submucosal nodules. Differential diagnoses include lipoma, mucocele, and pleomorphic adenoma. We report a rare case of oral dirofilariasis mimicking mucocele in a 41-year-old male patient from Croatia without an epidemiological history of travelling outside the country. He came in because of non-painful lower lip swelling that had lasted for two months. The parasite was surgically removed from the lesion. This is the first reported case of oral dirofilariasis in Croatia. It is important to point out this rare diagnosis in order to make dentists aware of the possibility of the presence of such an infestation in common lesions of the oral mucosa.

Corrigendum to "Oral Adverse Reactions Caused by Over-the-Counter Oral Agents".

[This corrects the article DOI: 10.1155/2015/196292.].

DRUG-INDUCED ORAL ULCERATIONS: CASE REPORT.

A 70-year-old patient was admitted to the Department of Oral Medicine for multiple oral ulcerations on the left buccal mucosa, around 0.5 cm in diameter, as well as on the gingiva. Otherwise, the patient suffered from chronic lymphocytic leukemia, hypogammaglobulinemia, chronic renal insufficiency, with complete afunction of the right kidney, asthma, hypertension, gastritis and prostate hyperplasia. Differential diagnosis of oral ulcerations included drug induced oral ulcerations, paraneoplastic pemphigus, viral ulcerations (cytomegalovirus, herpes simplex viruses), fungal ulcerations (candidiasis, aspergillosis, histoplasmosis, cryptococcosis) and bacterial ulcerations, as well as neutropenic ulcers. One of the possible explanations was that the lesions were due to the use of drugs, the more so as oral lesions evolved when the doses of allopurinol and chlorambucil were increased, and subsided when the doses of both drugs were decreased. However, we could not establish for sure whether the lesions were due to allopurinol or chlorambucil. According to literature data, allopurinol is one of the most frequent drugs known to induce skin adverse reactions, therefore we assumed that it was the culprit drug. Unfortunately, several weeks later the patient died from sepsis, pneumonia with respiratory insufficiency and multiorgan failure.

OROFACIAL GRANULOMATOSIS: CASE REPORT.

An 18-year-old girl was referred to the Department of Oral Medicine with upper lip swelling. She was in good general health and laboratory tests were within the normal range. Histopathologic diagnosis did not reveal the presence of granulomas. This is consistent with the finding that 30% of patients with orofacial granulomatosis do not have granulomas on their biopsies. The patient was treated with intralesional steroids once a week for three weeks. The lesion subsided, but not completely, and recurred partially after ketchup intake. This case report highlights the fact that in every patient with non-odontogenic facial or oral swelling, systemic diseases such as sarcoidosis, Crohn's disease, tuberculosis, etc. must be excluded. Furthermore, it is not unusual that in patients with orofacial granulomatosis, noncaseating granulomas are absent in the histopathologic finding.

Dental infection and dermatological diseases: analysis of ninety-two patients and review of the literature.

Dental disease has long been proposed as a potential causative agent in certain dermatological diseases. However, literature data on this association are scarce. The aim of this retrospective study was to evaluate dental status in 92 patients with various dermatological diseases who were referred to our Department for elimination of dental disease and to assess the relationship between dental infection and dermatological diseases. Dermatological conditions due to which patients were referred were alopecia, urticaria, eczematoid dermatitis, psoriasis, edema, etc. Out of 92 patients, 42 (45.7%) patients were referred for further dental treatment, while the remaining 50 (54.3%) patients had no observable dental pathology. None of the patients reported improvement following dental treatment. Based on the results of this study, we might conclude that dental infection does not play any role in the development of dermatological disease.

The influence of psychological state on oral lichen planus.

Oral lichen planus (OLP) is a T-cell mediated disease directed to a still unknown antigen, which may affect oral mucosa. The aim of this study was to determine whether differences in anxiety, depression and stress could be seen in patients with OLP in acute stage and in remission, as well as in comparison with healthy control subjects. The study included 50 OLP patients aged 22-79 (mean age 61.04) years and 50 control subjects who had healthy oral mucosa aged 38-80 (mean age 58.70) years. Patients with OLP filled out the State-Trait Anxiety Inventory for Adults and Beck Depression Inventory II test in acute stage and in remission. Control subjects also filled out the same tests. On detailed medical history, study subjects were asked about the possible stressors, which might have happened in the previous year. Statistical analysis was performed by use of descriptive statistics and t-test. There were no differences in the level of anxiety, depression and stress between the two stages of OLP disease (acute vs. remission period). Patients with OLP were significantly more anxious, depressed and stressed in both OLP stages as compared with healthy controls. It might be that psychological disturbances precede OLP development rather than worsening the disease process itself.

[Analysis of oral mucosal lesions in patients referred to oral medicine specialists]. / Analiza oralnih lezija u pacijenata upucenih u specijalisticku praksu oralne medicine.

The need for studies on prevalence of lesions in the field of oral medicine increases as more patients suffer from oral mucosal diseases. Data on prevalence of oral mucosal diseases throughout the world are scarce. Therefore, we have made a retrospective study of patients referred to the Department of Oral Medicine, University of Zagreb, during a period of one year, i.e. 2010. Data on patient age, gender and diagnosis were recorded. Out of 1118 analyzed clinical records of the patients, 756 (67.6%) were women and 362 (32.4%) were men. The age range of female patients was 54 +/- 19 years (mean age 62.17 years) and the male age range was 49+/-21 (mean age 64.17 years). The most common diagnosis was burning mouth syndrome (23.4%), followed by xerostomia (10.6%), traumatic ulceration (8.7%), geographic tongue (6.6%) and denture stomatitis (5.7%). Other diagnoses were found in a smaller percentage. Our results point out an increased need for oral medicine services.

New developments and opportunities in oral mucosal drug delivery for local and systemic disease.

The oral mucosa's accessibility, excellent blood supply, by-pass of hepatic first-pass metabolism, rapid repair and permeability profile make it an attractive site for local and systemic drug delivery. Technological advances in mucoadhesives, sustained drug release, permeability enhancers and drug delivery vectors are increasing the efficient delivery of drugs to treat oral and systemic diseases. When treating oral diseases, these advances result in enhanced therapeutic efficacy, reduced drug wastage and the prospect of using biological agents such as genes, peptides and antibodies. These technologies are also increasing the repertoire of drugs that can be delivered across the oral mucosa to treat systemic diseases. Trans-mucosal delivery is now a favoured route for non-parenteral administration of emergency drugs and agents where a rapid onset of action is required. Furthermore, advances in drug delivery technology are bringing forward the likelihood of transmucosal systemic delivery of biological agents.