Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures.

PURPOSE: This study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy. METHODS: Eighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms' severity related to hyposalivation. RESULTS: All patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients' self-assessment, with a median duration of 12 months (range, 3-36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7-18 points) to 7 points (range 4-13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04). CONCLUSION: Pilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.

Characterization of head and neck pain symptoms of patients presenting to a tertiary care pain clinic.

OBJECTIVE: To characterize the presentation and symptomatology of individuals presenting with pain in head and neck regions. METHODS: A retrospective chart-review was performed on patients with pain in the HFN presenting to a tertiary pain center in Turkey between January 2016 and January 2017. Information regarding the characteristics of pain and medical and treatment history were extracted and reviewed. RESULTS: Among 197 subjects, 135 (68.5%) were females. The average duration of pain was 60.13 ± 92.32 months. The pain was continuous in presentation and severe in intensity in 43.1% and 51.8% of the subjects, respectively. The pain was associated with at least one somatosensory symptom in 12.1% of subjects. Common diagnoses were trigeminal neuralgia, persistent idiopathic facial pain, and migraine headaches. CONCLUSION: Painful disorders of the HFN are associated with varying and perplexing signs and symptoms. Such patients should undergo a comprehensive clinical assessment with a multidisciplinary team.

Surgical treatment of hereditary gingival fibromatosis by diode laser: Report of five rare cases in the same family.

The pathogenesis of hereditary gingival fibromatosis (HGF) is largely unknown; however, the removal of excess tissue may often be necessary as it often causes aesthetic and functional problems. Gingivectomy is usually a treatment option that can be performed using a scalpel, cryotherapy, electrosurgery, or laser. This paper aims to evaluate the results of HGF treatments using a diode laser of five people from the same family. Three members of a family of five (two females and three males; 9-36 years old) underwent gingivectomy with a 3 W 300-micron fiber-tipped diode laser (Doctor Smile, Vicenza, Italy) at 810 nm wavelength. While all teeth of one member were extracted, the other member refused treatment. Relapse occurred in three members due to poor oral hygiene. The diode laser was reapplied and oral hygiene instructions were repeated. Patients were followed during the postoperative period for up to two years. HGF is a rare condition that clinicians should pay attention to in the diagnosis, treatment, and follow-ups. Since recurrences are due to dental plaque, oral hygiene instructions are essential and compliance is mandatory. Although there are many treatment approaches, the diode laser is the most indicated method due to many advantages such as providing a bloodless and more sterile operation field, performing an atraumatic surgery, ensuring earlier and ideal recovery, and minimizing postoperative pain.

Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography.

Background: This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT). Methods: In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test. Results: Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II. Conclusions: CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images.

Radiological evaluation of the periosteal reactions in the jaws: a retrospective CBCT study.

OBJECTIVES: The objective of this study is to evaluate the relationship between the radiological features of periosteal reactions (PR) and histopathological features of the lesions. METHODS: A total of 4605 CBCT images were evaluated and they were classified according to their radiological differential diagnosis. Images with pathologies were listed according to their histopathological examinations as cystic lesions, benign tumours, malignant tumours, fibro-osseous lesions and osteonecrosis, while images without pathologies were listed as traumas and others. All groups were reclassified as with or without the presence of detected PR. RESULTS: Pathologies and traumas were detected in 1801 of 4605 patients. There were 3 PR in 1140 cystic lesions, 4 PR in 102 benign tumours, 16 PR in 43 malignant tumours, 67 PR in 156 osteonecrosis/osteomyelitis cases and 3 PR in 262 trauma cases. As a result of the chi-square test between groups, there was a significant relationship between histopathologic diagnoses and periosteal reaction patterns (p = 0.000). CONCLUSIONS: Although there is a significant overlap between the patterns of PRs, PRs can be used to narrow the possibilities in the differential diagnosis. However, PRs alone are not sufficient variables for differential diagnosis in the absence of cortical bone destruction, localization, clinical and systemic findings.

Reliability and validity of the Turkish version of oral health impact profile for edentulous subjects.

PURPOSE: The validated translations of the OHIP-EDENT exist in different languages; however, there is no reliable and validated Turkish translation. The present study was conducted to evaluate the reliability and to validate the Oral Health Impact Profile in edentulous subjects translated to Turkish (OHIP-EDENT-T). MATERIALS AND METHODS: The study sample included 104 conventional complete denture wearers (58 women and 46 men, mean age: 61.13 ± 9.43 years). The original English version of OHIPEDENT was translated into Turkish using a forward-backward method and applied to the subjects. The reliability of the OHIP-EDENT-T was evaluated using internal consistency and the test-retest method. Validity was determined as construct and convergent validity. The construct validity of OHIP-EDENT-T was assessed using exploratory and confirmatory factor analysis. RESULTS: The Cronbach's alpha value for OHIP-EDENT-T was 0.890. The intraclass correlation coefficient (ICC) was 0.749 for the OHIP-EDENT-T total score, and ICCs for the subscales ranged from 0.630 (95% CI = 0.501-0.823) to 0.859 (95% CI = 0.531-0.897), indicating good to excellent agreement. The Kaiser-Meyer-Olkin value for sampling adequacy was 0.820 and results of Bartlett's sphericity test indicated statistical significance (χ2=1139.767; df=171, p=0.001). This showed that factorial analysis could be applied to the data set. The three-factor structure of the scale explained 81.1% of the observed variance. The agreement of the three-factor solution was further tested with confirmatory factor analysis, and the fit index was found to be acceptable (chi-square fit test=1.449, RMSEA=0.040, GFI=0.94, CFI=0.93). CONCLUSION: Within the limitations of this study, it can be concluded that OHIP-EDENT-T is a valid and reliable instrument for evaluating the quality of life of edentulous patients.

An Alternative Classification Scheme for Accessory Mental Foramen.

BACKGROUND: The mental foramen (MF) is an important anatomical landmark on the mandible. MFs may occur singly or with extra foramina (accessory mental foramen (AMF)). OBJECTIVE: The aim of the present study was to discuss the importance of recognition and classification of AMFs. METHODS: This study assessed CBCT images of 593 patients (208 male, 385 female) and proposed an AMF classification scheme based on three different characteristics: (1) location of the AMF with respect to the MF; (2) relationship of AMFs with tooth apices; and (3) origin of the AMF. The chi-squared test was used to compare the qualitative data as well as descriptive statistical methods when the study data were evaluated. Significance was assessed at the p < 0.05 level. RESULTS: A total of 80 AMFs were found in 71 patients. Six cases involved bilateral AMFs, whereas three cases showed double AMFs. The most common AMF location was the region posterior of the MF. Notably, all the AMFs detected in line with the mesial half of the first molar were present in female patients. Based on AMF origins, 44.5%, 48.6%, and 6.7% of the AMFs were categorized as type I, type II, and a new category identified in this study, type III. CONCLUSION: This study revealed that some foramina locations were not considered in the previous classification. Recognition and identification of these foramina might be critical to prevent possible complications. The proposed classification scheme may facilitate this objective and can be a new focus for future studies.

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines.

PURPOSE: To update the clinical practice guidelines for the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS: A total of 9 new papers were identified within the scope of this section, adding to the 62 papers reviewed in this section previously. A new Suggestion was made for topical 0.2% morphine for the treatment of OM-associated pain in head and neck (H&N) cancer patients treated with RT-CT (modification of previous guideline). A previous Recommendation against the use of sucralfate-combined systemic and topical formulation in the prevention of OM in solid cancer treatment with CT was changed from Recommendation Against to No Guideline Possible. Suggestion for doxepin and fentanyl for the treatment of mucositis-associated pain in H&N cancer patients was changed to No Guideline Possible. CONCLUSIONS: Of the agents studied for the management of OM in this paper, the evidence supports a Suggestion in favor of topical morphine 0.2% in H&N cancer patients treated with RT-CT for the treatment of OM-associated pain.

Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review.

INTRODUCTION: The reporting of osteonecrosis of the jaw (ONJ) related to anticancer agents without known antiresorptive properties (non-antiresorptives), such as antiangiogenics, tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapy is increasing. OBJECTIVE: To review characteristics of ONJ in cancer patients receiving non-antiresorptives. METHODS: A systematic review of the literature between 2009 and 2017 was conducted by the Bone Study Group of MASCC/ISOO. RESULTS: Of 6249 articles reviewed and from personal communication, 42 ONJ cases related to non-antiresorptives were identified. No gender predilection was noted. Median age was 60 years and ONJ stage 2 was most common, with predilection for posterior mandible. Exposed bone, pain, and infection were common at diagnosis. In comparison to bone targeting agents (BTAs), radiology, histology, and management were similar, with medication often discontinued. Delayed diagnosis (median 8 weeks) was noted. Important differences included earlier time to ONJ onset (median 20 weeks), absence of trigger event (40%), and greater likelihood of healing and shorter healing time (median 8 weeks) as compared to BTA-related ONJ. Gastrointestinal cancers predominated, followed by renal cell carcinomas compared to breast, followed by prostate cancers in BTA-related ONJ, reflecting different medications. CONCLUSIONS: Data about non-antiresorptive-related ONJ is sparse. This type of ONJ may have better prognosis compared to the BTA-related ONJ, suggested by greater likelihood of healing and shorter healing time. However, the delay in diagnosis highlights the need for more education. This is the first attempt to characterize ONJ associated with different non-antiresorptives, including BRAF and immune checkpoint inhibitors.

REST Final-Exon-Truncating Mutations Cause Hereditary Gingival Fibromatosis.

Hereditary gingival fibromatosis (HGF) is the most common genetic form of gingival fibromatosis that develops as a slowly progressive, benign, localized or generalized enlargement of keratinized gingiva. HGF is a genetically heterogeneous disorder and can be transmitted either as an autosomal-dominant or autosomal-recessive trait or appear sporadically. To date, four loci (2p22.1, 2p23.3-p22.3, 5q13-q22, and 11p15) have been mapped to autosomes and one gene (SOS1) has been associated with the HGF trait observed to segregate in a dominant inheritance pattern. Here we report 11 individuals with HGF from three unrelated families. Whole-exome sequencing (WES) revealed three different truncating mutations including two frameshifts and one nonsense variant in RE1-silencing transcription factor (REST) in the probands from all families and further genetic and genomic analyses confirmed the WES-identified findings. REST is a transcriptional repressor that is expressed throughout the body; it has different roles in different cellular contexts, such as oncogenic and tumor-suppressor functions and hematopoietic and cardiac differentiation. Here we show the consequences of germline final-exon-truncating mutations in REST for organismal development and the association with the HGF phenotype.

Desquamative gingivitis: A review.

Desquamative gingivitis (DG) is characterized by the erythematous gingiva, desquamation and erosion of the gingival epithelium, and blister formation. It is a common clinical manifestation in several diseases. Contact allergic reactions to various oral hygiene products and chemical agents have also been reported to represent as DG. The management of DG has been a major problem, largely because the etiology of the disease has been elusive. In this paper, we aimed to review the current literature on the pathogenesis, diagnosis management and prognosis of DG.

Comparison of the tooth brushing habits of primary school age children and their parents.

PURPOSE: As they grow, children develop their attitude and behavior related to tooth brushing by taking their parents' oral-dental health behavior as an example. The purpose of this study was to assess whether there was a similarity in tooth brushing between primary school-age children and their parents presenting to the Department of Oral, Dental and Jaw Diseases and Surgery and the Department of Pedodontics, School of Dental Medicine, Istanbul University. PATIENTS AND METHODS: The study included 126 children and their parents, as totally 252 subjects. The data on oral hygiene of the subjects were obtained using a questionnaire form including questions on the qualitative-quantitative tooth brushing habits of the children and their parents and the socio-demographic characteristics of their families. RESULTS: In most of the cases, there was a similarity between children and their parents in terms of the frequency of dentist visits, the therapy they underwent in their last dentist visit, the cause of caries, the frequency of tooth brushing, the material used for oral hygiene, the duration of tooth brushing, method of tooth brushing, and tooth sites most brushed, which showed a significant association between children and their parents (p<0.01). CONCLUSION: Correct knowledge given to the children by their families will positively affect the oral-dental health of the children. Thus, firstly, correct knowledge should be given to the parents so that they can successfully carry out their responsibility in being the correct model for their children in oral-dental health.

The prevalence of oral mucosal lesions in children:a single center study.

PURPOSE: Studies regarding oral health are mainly conducted on adult population and there is a lack of epidemiologic data on the oral health of children. The purpose of this study was to evaluate the prevalence and distribution of oral lesions in Turkish children. MATERIALS AND METHODS: A cross-sectional survey was carried out on total of 1041 Turkish children attended by the outpatient Oral Medicine and Surgery Department of Istanbul University. RESULTS: Examinations were performed and 277 of whom had a total of more than 30 different type of lesions detected. The fissured tongue (3.4%) was the most frequent lesion, followed by traumatic lesions (3.2%) and the cheek biting (2.5%). CONCLUSION: This is the first study in Turkey on oral lesions in this age group. We hope that our study will be a baseline data for future studies and for sure there is a need for more goodquality epidemiological studies in this area.

Evaluation of pemphigus cases involving oral mucosa.

PURPOSE: Pemphigus, defines a group of disorders in autoimmune etiology which could be life-threatening and clinical manifestations are mainly epithelial blistering affecting cutaneous and/or mucosal surfaces including oral mucosa. The aim of our study is to evaluate the clinical appearance of pemphigus with oral involvement by reported 15 pemphigus cases. MATERIAL AND METHODS: This retrospective study of 15 cases of pemphigus obtained over a period of 7 years from 2006 to 2013 in Istanbul University, Dentistry Faculty, Oral Medicine and Surgery Department was designed. RESULTS: Age distribution of pemphigus was from 15 to 59 years with an average age of 41.3 years. Of the 15 patients, the male:female ratio was 1:2.75 (4 male, 11 female). The most common clinical various of pemphigus was pemphigus vulgaris, diagnosed in all patients. The buccal mucosa (34.3%) was the most commonly affected site followed by tongue (20%), gingiva (17.1%), palate (11.4%), lips (11.4%) and floor of mouth (5.7%). CONCLUSION: Our explanation of this conclusion, while speculative, is that socioeconomic situation related stress in males and hormonal changes like pregnancy and menostasis in females; systemic disease and using drugs; dental trauma and bruxism could be responsible for flare up in the disease.

Carcinoma of the tongue: a case-control study on etiologic factors and dental trauma.

BACKGROUND: Carcinoma of the tongue is the most common intra-oral malignancy in Western countries. Incidence and mortality rates have increased in recent years, and survival has not improved. This study aimed to determine etiologic factors for tongue cancer with age-sex matched case-control data. MATERIALS AND METHODS: 47 patients with carcinoma of the tongue referred to our oral medicine clinic between years 2005-2006 were analyzed and compared with control group data. The medical records , including family history of cancer, dental trauma, and history of abuse of alcohol and tobacco products was recorded for all subjects. Chi square comparison tests and linear regression analysis were performed using the SPSS program for statistics. RESULTS: Patient and randomly selected control groups each consisted of 30 male and 17 female subjects with mean ages 53.2 (± 12.6) and 52.6 (± 11.5) years respectively. Smoking and alcohol abuse proportions were significantly higher in the patient group (p=0.0001, p<0.0001 respectively). Chronic mechanical trauma was observed in 44.7% of the patients and 17.0% of the control group (p=0.004). Similarly, family history of cancer of any type (for the first degree relatives) was found to be more common in the patient group (p=0.009). On regression analysis, alcohol abuse, family history of cancer, smoking, chronic mechanical traumas appeared as significant etiologic factors (p=0.0001). CONCLUSIONS: We believe that field cancerization may become evident in oral and oropharyngeal mucosa with multiple steps of molecular changes starting from the first sign of dysplasia with chronic exposure to etiological factors. Chronic trauma cases need particular attention to search for very early signs of cancer.

Is the MDR1 C3435T polymorphism responsible for oral mucositis in children with acute lymphoblastic leukemia?

BACKGROUND AND AIM: Although the functional consequences of MDR-1 polymorphisms have been the subject of numerous studies, to the best to our knowledge, associations with clinical side effects of anticancer drugs have yet to be assessed. Our aim was to clarify any role of the C3435T polymorphism of the MDR1 gene in oral mucositis and its relation with elevated reactive oxygen species (ROS) levels, in children with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: The distribution of the MDR-1 C3435T polymorphism in 47 patients with ALL was determined by RFLP and compared with that of 68 healthy controls. RESULTS: There were no association in distribution of genotypes of MDR-1 C3435T polymorphism and the risk of ALL. Oral mucositis were detected in 78.7% (n=37) of the patients and significantly related to the MDR-1 CT genotype (p=0.042), as confirmed by logistic regression analysis. CONCLUSION: Our preliminary data suggest that children carrying the CT genotype are more prone to develop oral mucositis, which might mean that the heterozygous genotype leads to accumulation of more reactive oxygen species. Since a limited number of patients was investigated, further studies are needed to confirm these findings.

Implant-assisted dental rehabilitation of a patient with maxillary rhabdomyosarcoma.

Rhabdomyosarcoma is a malignant, soft tissue neoplasm consisting of cells derived from the primitive mesenchyme that exhibit a profound tendency to undergo myogenesis. Multimodality therapy for tumors in the head and neck regions has a significant effect on maxillofacial skeletal growth, dental development, and the whole ecologic system of the oral cavity. Here we aimed to discuss the influence of head-neck cancer therapy in pediatric patients with long-term follow-up and present a case with implant-assisted dental rehabilitation and also functional and aesthetic outcomes.

The efficacy of a topical gel with triester glycerol oxide in denture-related mucosal injuries.

OBJECTIVE: The efficacy of a topical gel with triester glycerol oxide for treating ulcerations related to new complete dentures was studied and compared with a placebo gel. MATERIALS AND METHODS: Fifty edentulous patients were enrolled in this double-blind clinical study. All subjects received new maxillary and mandibular complete dentures and were recalled 1, 3 and 7 days after denture placement. Twenty-five subjects received topical gel with triester glycerol oxide (TGO), and 25 subjects received topical gel without TGO. At each visit, pain and discomfort with the new dentures was assessed, and at the last visit, healing of ulcerations was also graded by a clinician. Subjects also graded the gel's taste, smell and ease of use. RESULTS: Specifically, there was no statistically significant difference in ulcer healing (p > 0.05), ratings of smell, taste and ease of use (p > 0.05) or pain and discomfort scores (p > 0.05). However, within-group differences were observed in pain and discomfort scores between follow-up sessions (p = 0.01 for all comparisons). CONCLUSION: Clinically, TGO gel is not effective in the treatment of mucosal injuries occurring following placement of complete dentures.

Association of vitamin D receptor Taq I polymorphism and susceptibility to oral squamous cell carcinoma.

BACKGROUND: It has been hypothesised that vitamin D receptor (VDR) gene polymorphisms may influence both the risk of cancer occurrence and prognosis. MATERIALS AND METHODS: The distribution of VDR Taq I polymorphism in 64 patients with OSCC was determined by polymerase chain reaction based restriction fragment length polymorphism (RFLP) and compared with that of 87 healthy controls. RESULTS: There was a significant difference in the distribution of VDR Taq I genotypes between OSCC patients and healthy controls. Patients with the VDR Tt genotype were found to be at significantly higher risk for OSCC than those with other genotypes (p=0.036). In particular, female OSCC patients were at higher risk (p<0.001) for oral cancer. CONCLUSION: These results suggest that the VDR Taq I polymorphism may be associated with susceptibility to OSCC. Female predilection of the OSCC risk in association with VDR gene polymorphism should also be investigated.

Role of L-MYC polymorphism in oral squamous cell carcinoma in Turkey.

BACKGROUND: An association between restriction fragment length polymorphism (RFLP) of known oncogenes and a predisposition to develop cancer has been postulated. Our aim was to test the hypothesis that there was an association between the L-MYC S allele in oral squamous cell carcinoma (OSCC) and a predisposition for the disease. PATIENTS AND METHODS: The distribution of L-MYC polymorphism in 80 patients with OSCC was determined by polymerase chain reaction-based RFLP and compared with that of 60 healthy controls. RESULTS: There was no significant difference between patients with OSCC and healthy controls. Patients with the L-MYC S allele and a positive family history of cancer were found to be 1.74 times more at risk for OSCC than those with any other genotype (95% confidence interval=0.88-3.45). Moreover, tumor recurrence was higher among individuals carrying a L-MYC S allele than those with any other allele type. CONCLUSION: L-MYC polymorphism was not a significant marker for predicting susceptibility to OSCC in this population but may be a useful marker for identifying patient susceptibility to tumor recurrence and to developing OSCC, especially in individuals having a family history of cancer.