Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma - what's the difference?

BACKGROUND: Oral erythroplakia (OE) is a rare oral potentially malignant disorder, that has a high rate of malignant transformation. The definition of OE still lacks uniformity. In particular, lesions that look clinically like erythroplakias, but are histopathologically diagnosed as squamous cell carcinomas are still sometimes called erythroplakias. The purpose of this study is to present demographic and clinicopathologic features of a series of OEs and clinically oral erythroplakia -like squamous cell carcinomas (OELSCC), to study their differences and to discuss the definition of OE. METHODS: A multicenter retrospective case series of OEs and OELSCCs. Descriptive statistics were used to analyze the data. RESULTS: 11 cases of OEs and 9 cases of OELSCCs were identified. The mean age of the OE patients was 71 years and 72.7% were female, while the mean age of the OELSCC patients was 69 years, and all were female. 9% of the OE and 22% of the OELSCC patients had smoked or were current smokers. 72.7% of the OEs and 55.5% of OELSCCs were uniformly red lesions. 63.6% of the OE and 22% of the OELSCC patients had a previous diagnosis of oral lichenoid disease (OLD). The malignant transformation rate of OE was 9% in a mean of 73 months. CONCLUSIONS: OE and OELSCC may arise de novo or in association with OLD. Tobacco and alcohol use were not prevalent in the present cases. The clinical features of OEs and OELSCC are similar, but symptoms, uneven surface and ulceration may be more common in OELSCCs than in OEs. Clinical recognition of OE is important since it may mimic other, more innocuous red lesions of the oral mucosa. The diagnosis of OE requires biopsy and preferably an excision. Clarification of the definition of OE would aid in clinical diagnostics.

The prevalence of bruxism and oral parafunction activities among Israeli juveniles with autism spectrum disorder: A preliminary study during the COVID-19 pandemic.

OBJECTIVE: To evaluate the prevalence of oral habits, bruxism, and Temporomandibular Disorders (TMD) injuvenileswithautisticspectrumdisorder(ASD). METHODS: Data included 165 juveniles diagnosed with ASD, allocated to younger group aged 6 21 (n=86) and older group aged 13-21 (n=79). RESULTS: Sleep bruxism was reported by 26.7% in the younger group and by 5% in the older group. Awake bruxism was reported by 22% and 17.7%, respectively. Oral habits were reported by 43% of all participants, with similar rate in both groups. TMD related p ain was low in both groups (6.3% and 7% respectively). The influence of the COVID 19 pandemic on oral parafunction was moderate in the younger group (17.4%) and mild in the older group (8.6%), influence on bruxism was mild in both groups (5.8% and 2.5%, respectively). CONCLUSION: The prevalence of bruxism and oral parafunctions was similar to the reported in the literature for the general population.

The effect of post-COVID-19 on gustatory and olfactory function: A preliminary case-controlled study.

AIMS: The aim of the study was to analyze objective and subjective olfactory/gustatory function in post-COVID-19 infection (PCI). MATERIALS AND METHODS: Patients with past PCR-confirmed COVID-19 infection and persistent olfactory/gustatory complaints were investigated. Olfactory threshold and identification, gustatory detection, identification, and magnitude scaling were tested. RESULTS: A total of 42 PCI subjects were compared to 41 age- and gender-matched controls with no COVID-19 history. All PCI tested had mild COVID-19 disease. Mean interval between COVID-19 confirmations to testing was 7.4 ± 3.1 months. PCI subjects complained of combined dysfunction in 85.7%, isolated olfactory or gustatory dysfunction in 7.1% each. Combined complaints were significantly higher in PCI (p < 0.001). Objective testing showed significantly higher prevalence of dysfunction in PCI versus controls for hyposmia (73.8%, 12.2%), anosmia (11.9%, 0%), odor identification (68.5%, 83.0%), hypogeusia (23% and 2.4%, respectively), and impaired magnitude scaling, (p < 0.05). All PCI subjects with hypogeusia had abnormal gustatory magnitude scaling. CONCLUSIONS: While most PCI subjects complained of combined gustatory and olfactory dysfunction, objective testing showed in the majority an isolated single sense dysfunction, with a low level of agreement between subjective and objective findings. Abnormal objective results for all olfactory and gustatory functions tested may suggest a central rather than peripheral mechanism, although concomitant mechanisms cannot be excluded.

Local myalgia compared to myofascial pain with referral according to the DC/TMD: Axis I and II results.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) categorized TMD muscle disorders into 3 subgroups: local myalgia, myofascial pain with spreading and myofascial pain with referral. However, the rationale for such division into subgroups and the pathogenesis and prognosis of muscle-related TMD are still poorly understood. The aim of this study was to explore the differences between local myalgia and myofascial pain with referral by means of a biopsychosocial model based on the DC/TMD. METHODS: This retrospective study included all consecutive TMD patients who were diagnosed according to the DC/TMD in our institution between 2015 and 2018. The Axis I and II findings of patients diagnosed with local myalgia were compared to those of patients with myofascial pain with referral. A p value < 0.05 was considered statistically significant. RESULTS: A total of 255 patients (61 men and 194 women, mean age 37.8 ± 15.34 years) were enrolled into the study, 114 in the local myalgia group and 83 in the myofascial pain with referral group. The levels of depression and nonspecific physical symptoms, headache attributed to TMD (HAattrTMD), and characteristic pain intensity (CPI) were significantly higher in the latter group. The significant differences for depression and nonspecific physical symptoms persisted after excluding patients diagnosed with HAattrTMD, however, the levels of significance were lower (p = 0.006 compared to p = 0.033 for depression total score, and p = 0.001 compared to p = 0.046 for nonspecific physical symptoms total score). CPI levels, extent of disability, and pain duration were similar for both groups when excluding for HAattrTMD. CONCLUSION: The current study findings highlight the importance of differentiating between subgroups of myalgia according to the DC/TMD. The diagnosis of myofascial pain with referral may point to a significant Axis II component.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients.

AIM: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. METHODS: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. RESULTS: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). CONCLUSIONS: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

Headache Attributed to Temporomandibular Disorders: Axis I and II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To analyze Axis I and II findings of patients diagnosed as having painful temporomandibular disorder (TMD) with headache attributed to TMD (HAattrTMD) in order to assess whether HAattrTMD is associated with a specific Axis I and II profile suggestive of the central sensitization process. METHODS: This retrospective study included 220 patients with painful TMD divided into those with (n = 60) and those without (n = 160) HAattrTMD, and the patients were compared for Axis I and II results according to the Diagnostic Criteria for TMD (DC/TMD). A P value < .05 was considered statistically significant. RESULTS: A total of 27.3% of the patients received a diagnosis of HAattrTMD. Myofascial pain with referral was significantly more common in the HAattrTMD group (P < .001), while local myalgia was significantly more common in the non-HAattrTMD group (P < .001). Characteristic pain intensity was significantly higher in the HAattrTMD group (P = .003), which also showed significantly higher levels of depression (P = .002), nonspecific physical symptoms (P = .004), graded chronic pain (P = .008), and pain catastrophizing (P = .013). Nonspecific physical symptoms were positively associated with HAattrTMD (odds ratio [OR] = 1.098, 95% CI = 1.006 to 1.200, P = .037). Local myalgia was negatively associated with HAattrTMD (OR = .295, 95% CI = 0.098 to 0.887, P = .030). CONCLUSIONS: Painful TMD patients who report headache in the temple area and are diagnosed as having local myalgia rather than myofascial pain with referral probably do not have HAattrTMD. The diagnosis of HAattrTMD may point to a central sensitization process and possible current/future chronic TMD conditions.

The association between specific temporomandibular disorders and cervicogenic headache.

BACKGROUND AND AIMS: Upper neck signs, symptoms and hypomobility have been shown to present with a higher prevalence in patients with temporomandibular disorders (TMDs). However, there is currently no evidence of an association between specific TMDs and cervicogenic headache (CGH). Therefore, the aim of this study was to evaluate the odds ratio and the relative risk of CGH in patients with specific TMDs. METHOD: 116 participants, including 74 patients with TMD (pain-related/intraarticular/mixed TMD) and 42 healthy controls took part in this study. The TMD diagnosis was made by senior faculty members of the Dental School according to the Diagnostic Criteria for TMD, while the cervical diagnosis was made by a qualified senior physical therapist. The analysis comprised the evaluation of the odds ratio of CGH among patients with TMD and the relative risk (RR) for CGH during 14-24 months of follow-up. RESULTS: Significantly higher odds ratios of cervicogenic headache were found among pain-related and mixed TMD (12.17 and 10.76, respectively) versus healthy controls. During the 14-24 months of follow-up, there was no significant difference of relative risk for CGH among patients with TMD versus healthy controls. SUMMARY AND CONCLUSIONS: The results support a clear clinical association between painful TMD (pain-related and mixed TMD) and cervicogenic headache.

A retrospective analysis of dental implantation under anticoagulant treatment.

OBJECTIVES: To present our experience treating patients who have undergone dental implantation under no change in their constant anticoagulant treatment. PATIENTS AND METHODS: A retrospective study on patients who have undergone dental implantation. The study group consisted of patients under oral anticoagulants for at least 6 months before dental implantation. The control group was consisted of healthy patients with no oral anticoagulant treatment. Bleeding events were recorded and treated during the first 2 weeks postoperatively. RESULTS: A total of 193 patients were included in the study. Seventy-two of them who were under anticoagulants served as a study group and the rest (121 patients) served as a control group. Mean age: 65 years old in the study group and 59 years old in the control group. Gender: male to female ratio was higher in the study group and lower in the control group. Four patients in the study group and 7 patients in the control group presented postoperative bleeding and were treated successfully by additional local hemostasis methods. CONCLUSION: With the limitation of this study, it can be concluded that patients under oral anticoagulant treatment can undergo dental implantation safely. Bleeding events are rare and can be controlled by local hemostasis. CLINICAL RELEVANCE: Prior to dental implant insertion, patients under oral anticoagulants can continue their constant medical treatment. The procedure can be performed on outpatient basis under local hemostasis.

The Association between Emotional Stress, Sleep, and Awake Bruxism among Dental Students: A Sex Comparison.

Psychosocial factors may play an important role in the etiology of sleep and awake bruxism. The purpose of this study was to assess the relationship between emotional stress and bruxism in male and female dental students at various stages of their education. Dental education in Israel is based on a six-year curriculum, divided into three stages: pre-medical studies (yr. 1-2), manual skills (yr. 3-4), and clinical experience (yr. 5-6). Each stage requires different capabilities and skills. Questionnaires regarding psychological state (SCL-90) measuring depression, anxiety, and somatization as well as stress evaluation questioners (Perceived Stress Scale questionnaire 14) were completed by 387 dental students in the 1st to 6th years. Sleep and awake bruxism were evaluated based on the respondent's awareness. During the manual stage of studies, a significant increase was identified, albeit with weak correlations, between stress scales, depression, anxiety, somatization, and the prevalence of awake bruxism, particularly among males. Only in females was sleep bruxism correlated with emotional parameters, whereas no significant difference in sleep bruxism was observed in males throughout the stages of the study. The manual years of dental education were found to be linked to higher levels of emotional distress and awake bruxism, particularly in men. Sleep bruxism, on the other hand, was not directly linked to emotional factors, implying a distinct etiology.

Tinnitus in Temporomandibular Disorders: Axis I and Axis II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To examine the associations of self-reported presence of tinnitus with subtypes of temporomandibular disorders (TMD) as assessed by Axis I of the Diagnostic Criteria for TMD (DC/TMD) and with psychologic characteristics as assessed by Axis II. METHODS: This retrospective controlled study included 108 consecutive TMD patients referred to the Tel Aviv University Orofacial Pain Clinic. Each patient received full Axis I and Axis II diagnoses according to the DC/TMD. The patients were asked about currently experiencing tinnitus. Pearson chi-square test and Fisher exact test were used to test the associations between categorical variables. Mann-Whitney test was used to assess differences in continuous variables between categories. A P value < .05 was considered statistically significant. RESULTS: Thirty-three (30.6%) TMD patients reported experiencing tinnitus. There was a significantly higher prevalence of myofascial pain with referral (P = .008) and nonspecific physical symptoms (P = .014) among the TMD patients who reported tinnitus. In addition, those patients reported significantly longer pain duration compared to TMD patients without tinnitus (P = .039). CONCLUSION: This study emphasizes the necessity of assessing both Axes I and II according to the DC/TMD in future studies and supports creating a standardized tinnitus screener tailored to TMD patients for future studies on tinnitus in TMD patients.

Relationship between specific temporomandibular disorders and impaired upper neck performance.

Upper neck impairments are more prevalent in patients with temporomandibular disorders (TMDs) but the differences between specific types of TMDs are unclear. This study evaluated the distribution of such impairments among different forms of TMD. In total, 116 participants (86 women and 30 men, age range 21-75 yr) were investigated. Forty-two individuals had no TMDs and were assigned to the control group. The remaining 74 patients were assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) findings: pain-related (n = 37); intra-articular (n = 17); or mixed (combined pain-related and intra-articular) (n = 20). Analyses of impairments included between-group comparisons of key parameters of upper neck performance (active/passive mobility and muscular capabilities) and pain (subjective neck disability and pain sensitivity). Patients in the pain-related and mixed TMD groups were found to have decreased upper neck mobility in the cervical flexion-rotation test compared with patients in intra-articular and control groups, as well as poorer capabilities of the deep neck flexor muscles in the cranio-cervical flexion test compared to the control group. It was concluded that patients with pain-related TMD diagnoses are more likely to experience significant upper-neck hypomobility and poor muscular capabilities than patients with intra-articular diagnoses of TMD.

Palatal Erythema with Histological Psoriasiform Pattern: An Enigmatic Oral Finding Shared by a Range of Conditions.

Long standing, asymptomatic, well-demarcated erythema of the hard palate with a histopathological psoriasiform pattern comprises a challenging diagnosis. We present a series of patients with such clinical and histological findings and discuss the possible diagnoses. We collected all patients with palatal erythematous lesions that had well-documented clinical examination. Excluded were patients with definitive diagnosis of oral infections (e.g. candidiasis), neoplastic/pre-neoplastic lesions, auto-immune diseases, reactive lesions, blood disorders and vascular malformations. Thirteen patients (six females, seven males, age range 11-56 years) were included. Histopathologically, a psoriasiform pattern was observed in all biopsied lesions. One patient was diagnosed with hereditary mucoepithelial dysplasia (HMD) and four with cutaneous psoriasis. The remaining eight patients were otherwise healthy. A combination of persistent, asymptomatic palatal erythematous lesion with psoriasis-like histopathology may represent an oral manifestation of HMD or psoriasis, concomitant to extra-oral features. In lack of any known medical background, the term "oral psoriasiform mucositis" is suggested.

Awake and Sleep Bruxism Among Israeli Adolescents.

Introduction: Sleep and awake bruxism are potential risk factors for oral hard tissue damage, failure of dental restorations and/or temporomandibular disorders. Identifying the determinants of sleep and awake bruxism among adolescents will enable development of preventive interventions for those at risk. Objectives: To determine emotional, behavioral and physiological associations of sleep and awake bruxism among Israeli adolescents. Methods: Two thousand nine hundred ninety-three Israeli high school students, from five different high schools in Israel, were approached in the classroom and requested to complete online questionnaires on sleep and awake bruxism, emotional aspects, smoking, alcohol consumption, oral habits, facial pain, and masticatory disturbances. The final study sample concerning awake and sleep bruxism included 2,347 participants. Results: 1,019 (43.4%) participants reported not experiencing any form of bruxism (neither sleep nor awake), 809 (34.5%) reported awake bruxism, 348 (14.8%) reported sleep bruxism and 171 (7.3%) reported both sleep and awake bruxism. Multivariate analyses (Generalized Linear Model with a binary logistic dependent variable) showed that one of the prominent variables affecting the occurrence of sleep bruxism was anxiety (mild, moderate and severe anxiety, Odds Ratios (OR) of 1.38, 2.08, and 2.35, respectively). Other variables associated with sleep bruxism were stress (each point in the stress scale increased the risk of SB by 3.2%), temporomandibular symptoms (OR = 2.17) and chewing difficulties (OR = 2.35). Neck pain showed a negative association (OR = 0.086). Multivariate analyses for awake bruxism showed an effect of moderate anxiety (OR = 1.6). Other variables associated with awake bruxism were stress (each point in stress scale increased the risk of AB by 3.3%), high and low levels of facial pain (OR = 2.94 and 1.53, respectively), creaks (OR = 1.85) and oral habits (OR = 1.36). Sleep bruxism was found to be a predictor for awake bruxism, and vice versa. In both cases ORs were 8.14. Conclusions: Among adolescents, sleep and awake bruxism are associated with emotional aspects as well as with facial pain symptoms and/or masticatory system disturbances. Awareness is recommended to decrease potential risks to teeth, dental restorations, and the masticatory system.

Pain Catastrophizing and Pain Persistence in Temporomandibular Disorder Patients.

AIMS: To describe pain catastrophizing in temporomandibular disorder (TMD) patients in relation to disability and pain persistence. METHODS: A total of 163 TMD patients underwent a complete TMD evaluation according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), including the Pain Catastrophizing Scale (PCS). Patients were divided into subgroups according to their PCS, Graded Chronic Pain Scale (GCPS), and pain persistence scores. The GCPS and pain persistence subgroups were assigned as dependent variables in a stepwise multiple logistic regression model. The ability of the DC/TMD Axis II parameters and of the PCS to discriminate between patients of low and high disability (according to the GCPS) and low and high pain persistence were examined using area under the receiver operating characteristic (ROC) curve. α < .05 was considered to reflect statistical significance. RESULTS: Significant differences were found between high and low pain catastrophizing patients as to socioeconomic parameter, Axis I diagnoses, pain persistence, and Axis II evaluation. The parameters with significant discriminant ability for pain persistence were pain catastrophizing, depression, and nonspecific physical symptoms, with no significant differences between them. Depression increased the odds of high disability by 1.2, while pain catastrophizing increased the odds for high pain persistence more than 6-fold. Pain catastrophizing was not significantly associated with pain disability, and depression was not significantly associated with pain persistence. CONCLUSION: High-pain catastrophizing TMD patients were similar to patients with other chronic pain conditions, but differed from TMD patients as a group. The findings of this study support the addition of an assessment for pain catastrophizing to the DC/TMD for early identification of TMD patients who might be at higher risk for developing chronic pain.

Comparing Axis II Scores According to the RDC/TMD and DC/TMD in Israeli Patients.

AIMS: To use the Symptom Checklist-90-Revised (SCL-90-R)-based instruments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the Primary Care Evaluation of Mental Disorders (PRIME-MD)-based instruments of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in order to compare these Axis II scores in temporomandibular disorder (TMD) patients. METHODS: Demographic and socioeconomic data, Axis I diagnoses, and Axis II evaluations (depression, nonspecific physical symptoms, anxiety, and Graded Chronic Pain Scale [GCPS]) were compared between two groups of patients-142 TMD patients diagnosed according to the RDC/TMD (RDC group) and 157 TMD patients diagnosed according to the DC/TMD (DC group). Pearson's chi-square test, Fisher's exact test, and Mann-Whitney test were used, and P values were adjusted for multiple comparisons. RESULTS: The prevalences of severe depression, nonspecific physical symptoms, and anxiety were significantly lower in the DC group than in the RDC group, with no differences between groups for Axis I diagnoses, characteristic pain intensity (CPI), or GCPS. CONCLUSION: Within the limitations of this study, the present findings reveal differences in the presence of severe depression, nonspecific physical symptoms, and anxiety between the RDC and DC groups. The differences may reflect the cut-off scores of the SCL-90-R and the PRIME-MD tools.

Cervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects.

BACKGROUND: Temporomandibular Disorders (TMD) refer to several common clinical disorders which involve the masticatory muscles, the temporomandibular joint (TMJ) and the adjacent structures. Although neck signs and symptoms are found with higher prevalence in TMD patients compared to the overall population, whether limitation of cervical mobility is an additional positive finding in this cohort is still an open question. OBJECTIVE: To compare the physiological cervical range of motion (CROM) and the extent of rotation during cervical flexion (flexion-rotation test, FRT) in people with TMD (muscular origin) and healthy control subjects. METHOD: The range of motion of the neck and FRT was measured in 20 women with myogenic TMD and 20 age matched healthy controls. RESULTS: Women with myogenic TMD had significantly lower FRT scores compared to their matched healthy women. No difference was found between groups in CROM in any of the planes of movement. The FRT was positive (less than 32°) in 90% of the TMD participants versus 5% in the healthy control but the findings were not correlated with TMD severity. CONCLUSION: The results point out a potential involvement of the upper cervical joints (c1-c2) in women with myogenic TMD.

Comorbidity between depression and anxiety in patients with temporomandibular disorders according to the research diagnostic criteria for temporomandibular disorders.

AIMS: To examine the extent of depression, anxiety, somatization, and comorbidity between depression and anxiety in patients with temporomandibular disorders (TMD) by adding the Symptom Checklist-90 Revised self-report questionnaire for anxiety to the Research Diagnostic Criteria for TMD. METHODS: A total of 207 Israeli TMD patients were included in this retrospective study. Data included levels of depression, anxiety, somatization, and comorbidity in the study group as a whole, in chronic pain TMD patients compared to acute pain TMD patients, and in chronic pain TMD patients according to their Graded Chronic Pain Scale score. Spearman correlation was used to assess the level of correlation between depression, anxiety, and somatization. Fisher exact test or Pearson chi-square test was used to compare the categorical variables. RESULTS: When depression, anxiety, somatization, and comorbidity were analyzed in a multidimensional approach, there were statistically significant differences between subgroups as to depression and somatization only. No statistically significant differences were found as to anxiety and comorbidity. CONCLUSION: Multidimensional assessment enabled differentiation between findings of depression, anxiety, somatization, and comorbidity in subgroups of TMD patients. The findings of no statistically significant differences between subgroups of TMD patients as to anxiety and comorbidity support previous studies on TMD and anxiety, which suggest a less significant role of anxiety in chronic TMD patients as compared to depression and somatization.

The effect of desalivation on the malignant transformation of the tongue epithelium and associated stromal myofibroblasts in a rat 4-nitroquinoline 1-oxide-induced carcinogenesis model.

The aim of our study was to analyse desalivated rat tongue epithelium for histopathological changes, proliferating cell nuclear antigen (PCNA), and epithelium-associated stromal myofibroblasts [SMF; alpha-smooth muscle actin (alphaSMA)] following 0.001% 4-nitroquinoline 1-oxide (4NQO) administration in drinking water. Results were compared with those of identically treated but salivated specimens. 4NQO was administered for 7, 14, 22 and 28 weeks. Tongue length was divided into anterior, middle and posterior 'thirds'. The histopathological changes per 'third' were scored as normal epithelium, hyperplasia, dysplasia, carcinoma-in-situ, and superficial and invasive carcinoma. The PCNA and alphaSMA stains were assessed by a point-counting method. At all time points, the histopathological changes in the anterior and middle thirds were higher in the desalivated than in the salivated group (P < 0.05) but almost identical in the posterior third (P > 0.05). PCNA scores were significantly lower in the desalivated vs. the salivated group at almost all time points and tongue thirds (P < 0.05). SMF were usually scarce in both groups, but there was a significant surge in the posterior third at 28 weeks: the score in the desalivated group was only about one-half that of the salivated group (P < 0.05). The absence of saliva seems to promote malignant transformation of the tongue epithelium in the early stages. PCNA cannot be regarded as a marker of proliferation and probably contributes to this process by other mechanisms. Emergence of SMF seems to be highly dependent on growth factors from saliva in addition to factors from cancerous cells.

Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature.

Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder: A Case Report and Review of the Literature Shoshana Reiter Ephraim Winocur Carole Goldsmith Alona Emodi-Perlman Meir Gorsky Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large-sized arteries, most commonly the extracranial branches of the carotid artery. Early diagnosis and treatment are essential to avoid severe complications. This article reports on a GCA case and discusses how the orofacial manifestations of GCA can lead to misdiagnosis of GCA as temporomandibular disorder. GCA should be included in the differential diagnosis of orofacial pain in the elderly based on the knowledge of related signs and symptoms, mainly jaw claudication, hard end-feel limitation of range of motion, and temporal headache.