Xerostomia, the perception of general and oral health and health risk behaviours in people over 65 years of age.

BACKGROUND: This study investigated the association between xerostomia and health risk behaviours, general and oral health and quality of life. METHODS: A cross-sectional study involving 800 adults over 65 years of age residing in Spain using a computer-assisted telephone questionnaire. The severity of xerostomia was assessed through the Xerostomia Inventory (XI). Both univariate and adjusted multinomial logistic regression were used to determine the risk (OR) of xerostomia. RESULTS: The sample comprised of 492 females (61.5%) and 308 males, with a mean age of 73.7 ± 5.8 years. Some, 30.7% had xerostomia: 25.6% mild, 4.8% moderate and 0.3% severe, the majority being female (34.8% vs 24%; p = 0.003). The mean XI was 24.6 ± 6.3 (95% CI 19.2-24.8) for those with poor health, whereas it was 17.4 ± 6.3 (95%CI 16.1-18.6) in those reporting very good health (p < 0.001). This difference was also observed in terms of oral health, with the XI mean recorded as 14.7 ± 10.7 for very poor oral health and 6.4 ± 5.4 for those with very good health (p = 0.002). Logistic regression showed that the highest OR for xerostomia was observed among adults with poor general health (2.81; 95%CI 1.8-4.3; p < 0.001) and for adjusted model the OR was still significant (2.18; 95%CI 1.4-3.4; p = 0.001). Those who needed help with household chores had 2.16 higher OR (95%CI 1.4-3.4; p = 0.001) and 1.69 (95%CI 1.1-2.7; p = 0.03) in the adjusted model. Females had a higher risk of suffering from xerostomia than males. CONCLUSION: The strong association between xerostomia and the general and oral health status of older adults justifies the need for early assessment and regular follow-up.

Influence of loading and drilling on marginal bone loss around implants with a Dynamic Bone Management design: A single-blind, randomised, 12-month clinical trial.

PURPOSE: To evaluate marginal bone loss 6 and 12 months after prosthetic loading of implants with Dynamic Bone Management (Straumann, Basel, Switzerland) through the implementation of different drilling protocols. MATERIALS AND METHODS: A balanced, randomised, single-blind clinical trial was conducted with four parallel experimental arms: immediate loading and under-drilling, immediate loading and complete drilling, early loading and under-drilling, and early loading and complete drilling. Forty-four implants with a Dynamic Bone Management design and with a diameter of 3.75 mm and a length of 10.00 mm were placed in healed mature bone (more than 6 months post-extraction). RESULTS: The mean primary stability achieved was 60.6 ± 12.2 implant stability quotient, with a range from 21 to 75, and no differences were observed when considering the drilling protocol used, bone type or location. Early loading resulted in a loss of 0.728 mm (standard error 0.212; 95% confidence interval 1.134 to -0.325; t value -3.440), whereas immediate loading did not result in any bone loss. When the interaction between the loading and drilling protocols was studied, performing the complete drilling protocol in conjunction with early implant loading was found to result in lower marginal bone loss, with a marginal bone gain effect of 0.814 mm (standard error 0.283; 95% confidence interval -0.274 to 1.353; t value 2.880). CONCLUSIONS: Use of the complete drilling protocol in conjunction with early implant loading resulted in the lowest marginal bone loss at 12 months.

Association between xerostomia, oral and general health, and obesity in adults. A cross-sectional pilot study / Asociación entre xerostomía, salud bucal y general, y obesidad en adultos. Un estudio piloto transversal

Background: The objective of this study was to analyse the association between oral and general health variablesand obesity indicators with the sensation of dry mouth or xerostomia as evaluated on the Xerostomia Inventory(XI).Material and Methods: A total of 354 randomly selected subjects participated in this cross-sectional pilot studyand completed an anonymous questionnaire. Anthropometric, clinical, and xerostomic variables were evaluated.Kruskal-Wallis, ANOVA and Bonferroni test were used for multiple comparisons. ROC curves and multinomiallogistic regression were used to determine the (OR) risk of xerostomia.Results: A total of 30.7 % of respondents reported xerostomia based on XI. The dry mouth question, the XItaken as a “gold standard”, showed a diagnostic sensitivity of 70.37 %, and a specificity of 83.27 % (AUC=0.768,p<0.001). Logistical regression showed the highest xerostomia OR was associated to patients with bad self-per-ceived health, 6.31 (CI 95% 2.89-13.80, p<0.001). In the model adjusted for tooth mobility, bone or respiratorydiseases, and the consumption of anxiolytics and antidepressants, the OR was 3.46 (CI 95% 1.47-8.18, p=0.005).Conclusions: a high prevalence of xerostomia was found in this cross-sectional pilot study, which was significantlymore frequent in women, and increased with age. Xerostomia was associated to several systemic diseases, psycho-logical conditions, and oral functional disorders such as tooth mobility.These preliminary results can serve as the basis for developing guidelines for the application of innovative mea-sures designed to improve the quality of life of individuals with xerostomia.(AU)

Efficacy of different formulations of nystatin in an experimental model of oral candidiasis in sialoadenectomized rats.

BACKGROUND/PURPOSE: Oral candidiasis is the most common fungal infection of the oral cavity and has become a focus of attention in recent years because of its association with highly topical immunosuppressive conditions. The aims of this study were to determine the value of microbiological, clinical and histological parameters of Candida albicans colonisation of the dorsal tongue surface as indicators of disease severity, and to evaluate therapeutic response to different formulations of nystatin. MATERIALS AND METHODS: We used 84 males, 2-month-old Sprague-Dawley sialoadenectomized rats. Different formulations of nystatin were used to evaluate the therapeutic response. The animals were randomized to 2 groups with each of 42 animals and received the experimental treatments from day 17-22. RESULTS: 100% of the rats showed evidence of infection. At 5 and 10 days of starting treatment with nystatin + chitosan, and at 10 days of starting nystatin + orabase, the number of animals with positive dorsal tongue culture decreased significantly (p < 0.05), acting the Nystatin + chitosan more rapidly against Candida. In the control group, the percentage of normal papillae on day 22 and 27 was 83.33% (SD = 1.50) and 79.08% (SD = 2.30), respectively. Significant differences were observed in the mean O'Grady score at 5 and 10 days (p < 0.0001). CONCLUSION: The model has been shown to be effective in inducing infection, and that the combination of nystatin and chitosan yielded the best therapeutic outcomes at both 5 and 10 days after infection.

Psychological disorders and quality of life in oral lichen planus patients and a control group.

OBJECTIVES: Oral lichen planus (OLP) is a common disease whose aetiopathogenesis is linked to psychological disorders. This study aims to determine the influence of anxiety and depression in OLP patients, define the perception of quality of life in these patients and check for potential differences between atrophic/ ulcerative and reticular lesions. MATERIALS AND METHODS: A group of 48 OLP patients and a control group of 40 patients were selected. In order to assess anxiety, depression and quality of life, Hospital Anxiety and Depression Scale (HADS) and Oral Health Impact Profile 14 (OHIP-14) tests were completed. RESULTS: OLP patients showed higher scores on HADS (anxiety p < 0.01, depression p < 0.05) and OHIP-14 (physical pain p < 0.05, psychological discomfort p = 0.001). Patients with reticular lesions obtained higher scores in HADS (anxiety p = 0.001, depression p < 0.001), whereas patients with atrophic/ ulcerative lesions obtained higher scores in OHIP-14 (p = 0.02). CONCLUSIONS: Psychological disorders play an important role as a trigger for OLP and are responsible for many relapses. Psychological support would be advisable in order to improve their mental health, as this would have a positive impact on their quality of life and would lead to a better progression of the disease.

Correlation between clinical and pathological features of oral lichen planus: A retrospective observational study.

Oral lichen planus (OLP) is a common, chronic, inflammatory disease of autoimmune origin. The aim of this study is to determine the correlation of the histopathological features with clinical aspects and variants of OLP.We have retrospectively studied a group of 59 adult patients with confirmed clinical and histopathological diagnosis of OLP from the Oral Pathology Unit of the University of Santiago de Compostela (Spain). Clinical parameters: age, gender, location of the lesions, clinical type, toxic habits, and concomitant treatments were evaluated. Histopathologically, the epithelial response (hyperplasia vs atrophy), presence of ulceration, degree of interface lesion and distribution, intensity, and composition of the inflammatory infiltrate were analyzed.Patients treated with several systemic drugs had more atrophic/erosive forms of OLP (P = .019). Plasma cells were found more commonly in cases showing deep inflammatory involvement of the connective subepithelial tissue than in those where inflammation was only superficially located (P <.001). Their presence was also associated with epithelial erosion-ulceration (P <.01).In conclusion, patients treated with several drugs had more atrophic/erosive forms of OLP and frequently associated with a deep specific inflammatory pattern based on plasma cells. Our results could suggest that drug intake by some patients might confer a supplementary aggravating character to the disease, alone or in conjunction with other non-identified factors. More studies should be carried out to confirm this trend and to assess whether this characteristic, can actually influence the evolution of the lesions.

Lichen planus and diabetes mellitus: Systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to perform a systematic review and meta-analysis answering the following questions: (a) "What is the prevalence and risk of oral lichen planus among patients with diabetes mellitus?" and (b) "What is the prevalence and risk of diabetes mellitus among patients with oral lichen planus?". MATERIAL AND METHODS: A bibliographic search was conducted in PubMed/Medline and Scopus database from 1966 to March 2018, using the following terms: "Lichen planus" AND "Diabetes mellitus" AND "Prevalence" AND "Oral mucosal lesions". RESULTS: Twenty-two studies were included in this review. Twelve studies assessed the prevalence of diabetes mellitus among patients with lichen planus. The prevalence reported ranges from 1.6% to 37.7% with a relative risk of 2.432. Ten studies assessed the prevalence of lichen planus among patients with diabetes mellitus which showed a prevalence of lichen planus ranging from 0.5% to 6.1% with a relative risk of 1.4. CONCLUSIONS: Contradictory results were found when analyzing the relationship between lichen planus and diabetes mellitus. Diverse factors should be considered when studying this association for a correct interpretation of results. Diabetes mellitus has high prevalence and morbidity, which is why new case-control studies are needed to further investigate this association.

Knowledge About the Relation Between Tobacco and Disease and the Attitude Toward Advising the Cessation of Its Consumption Among a Group of Spanish Dental Students.

Tobacco is one of the leading causes of preventable death in the developed world. Smoking is associated with a large number of oral pathologies, such as cancer and periodontitis. Dental professionals can play a key role in preventing these health problems. The objectives of this study were (1) to analyze tobacco consumption habits among a group of Spanish dental students, and (2) to assess their knowledge, perceptions, and attitudes regarding procedures to help patients quit smoking. A cross-sectional descriptive study was carried out at the Faculty of Medicine and Dentistry of Santiago de Compostela (Galicia, Spain). Three validated questionnaires were distributed, and the obtained data was processed using SPSS. One hundred twenty out of 220 surveys were completed. Of the students, 18.3% were smokers and the average number of smoked cigarettes per day was 7.5. Tobacco dependence and the intention to give up the habit were low (Fagerström Test) and doubtful (Richmond test), respectively. The majority of students (94.2%) considered it appropriate to promote tobacco use cessation (TUC) activities. A great divergence of criteria regarding tobacco-associated pathologies was found among courses. This article provides positive data about the motivation of dental students to implement TUC strategies. Nevertheless, the usefulness of these interventions makes it necessary to modify the university curricula in order to improve the education on this issue to reduce the incidence of future health problems.

Oral lichen planus and its relationship with systemic diseases. A review of evidence.

BACKGROUND: Oral lichen planus (OLP) is one of the most common dermatological diseases which are present in the oral cavity. It is a chronic autoimmune, mucocutaneous disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. OBJECTIVE: Review the relevant information to OLP and its relationship with systemic diseases. MATERIAL AND METHODS: Searches were carried out in the Medline/PubMed, Lilacs, Bireme, BVS, and SciELO databases by using key-words. After an initial search that provided us with 243 papers, this number was reduced to 78 from the last seven years. One of the first criteria adopted was a selective reading of the abstracts of articles for the elimination of publications that presented less information regarding the subject proposed for this work. All the selected articles were read in their entirety by all of the authors, who came to a consensus about their level of evidence. The Scottish Intercollegiate Guidelines Network (SIGN) criteria were used as the criteria of methodological validation. RESULTS: Only 9 articles showed an evidence level of 1+, 2+, 3 or 4, as well as a recommendation level of A, B, C or D. Three of them were non-systematic reviews, one was a cohort study and only one was a controlled clinical trial. Three of the studies were case series, with respective sample sizes of 45, 171 and 633 patients. CONCLUSIONS: Several factors have been associated with OLP. Patients with OLP are carriers of a disease with systemic implications and may need the care of a multidisciplinary team. The correct diagnosis of any pathology is critical to making effective treatment and minimizes iatrogenic harm. For OLP is no different, taking into account its association with numerous systemic diseases that require special attention from health professionals. Periodic follow-up of all patients with OLP is recommended. Key words:Oral lichen planus, etiopathogenesis, systemic diseases.

Clinical value of diascopy and other non-invasive techniques on differential diagnosis algorithms of oral pigmentations: A systematic review.

OBJECTIVES: To determine the diagnostic value of diascopy and other non-invasive clinical aids on recent differential diagnosis algorithms of oral mucosal pigmentations affecting subjects of any age. MATERIAL AND METHODS: Data Sources: this systematic review was conducted by searching PubMed, Scopus, Dentistry & Oral Sciences Source and the Cochrane Library (2000-2015); Study Selection: two reviewers independently selected all types of English articles describing differential diagnosis algorithms of oral pigmentations and checked the references of finally included papers; Data Extraction: one reviewer performed the data extraction and quality assessment based on previously defined fields while the other reviewer checked their validity. RESULTS: Data Synthesis: eight narrative reviews and one single case report met the inclusion criteria. Diascopy was used on six algorithms (66.67%) and X-ray was included once (11.11%; 44.44% with text mentions); these were considered helpful tools in the diagnosis of intravascular and exogenous pigmentations, respectively. Surface rubbing was described once in the text (11.11%). CONCLUSIONS: Diascopy was the most applied method followed by X-ray and surface rubbing. The limited scope of these procedures only makes them useful when a positive result is obtained, turning biopsy into the most recommended technique when diagnosis cannot be established on clinical grounds alone. Key words:Algorithm, differential diagnosis, flow chart, oral mucosa, oral pigmentation, systematic review.

Oral leiomyosarcoma: the importance of early diagnosis.

OBJECTIVE: Present a case clinic of leimyosarcoma. BACKGROUND: Leiomyosarcomas (LMSs) are malignant mesenchymal tumours of smooth muscle differentiation that grow rapidly and whose prognosis is dependent upon the tumour site and disease stage. Their location in the oral cavity is considered extremely rare due to the lack of smooth muscle tissue in that area. MATERIALS AND METHODS: We present an LMSs case of the buccal mucosa in an elderly patient patient with a follow-up of 4 years. CONCLUSION: Early diagnosis and treatment play a key role in a better prognosis.

Malignant transformation of oral lichen planus by a chronic inflammatory process. Use of topical corticosteroids to prevent this progression?

BACKGROUND: Oral lichen planus is a potentially malignant disorder with a capacity, although low, for malignant transformation. Of all the factors related to the process of malignant transformation, it is believed that the chronic inflammatory process plays a key role in the development of oral cancer. This inflammatory process is capable of providing a microenvironment based on different inflammatory cells and molecules that affect cellular growth, proliferation and differentiation. OBJECTIVES: The objectives of our study are: to review the available evidence about the possible relationship between the chronic inflammatory process present in oral lichen planus and its malignant transformation, to discuss the potential therapeutic implications derived from this relationship and to study the role that topical corticosteroids play in the control of oral lichen planus inflammation and its possible progression to malignant transformation. CONCLUSION: The maintenance of a minimum dose of topical corticosteroids could prevent the inflammatory progression of oral lichen planus to oral cancer.

Intracellular pH regulation in oral squamous cell carcinoma is mediated by increased V-ATPase activity via over-expression of the ATP6V1C1 gene.

Oral squamous cell carcinomas represent more than 90% of all head and neck cancers, and comprise about 4% of all malignancies in western countries. Tumor cell mobility related to increasing intracellular pH results in impaired proliferation and metastasis, suggesting an important role of pH regulation in solid cancer tumorigenesis. The mechanism of physiological pH regulation has been shown to be activated in several solid tumors through constitutive activation of the ATPase complex. How cells regulate this mechanism has not been elucidated in human cancer in detail. The present study, using expression profiling by cDNA array analysis of oral squamous cell carcinoma cells, identified the V-ATPase system as a significant regulatory mechanism. ATP6V1C1 was the most strongly over-expressed gene in oral squamous cell carcinoma at the mRNA level compared to other genes of the V-ATPase complex. These findings provide evidence that intracellular pH regulation is mainly controlled by expression of a single gene, ATP6V1C1, notwithstanding the possible action of other secondary regulatory factors.

Gene expression profile in oral squamous cell carcinoma: a pilot study.

PURPOSE: To study the gene expression profile of oral squamous cell carcinomas. MATERIALS AND METHODS: Gene expression profile was investigated in oral squamous cell carcinomas in 5 patients using the Atlas Glass Human 3.8 I Microarray (which detects cDNA obtained from cellular total RNA) (Clontech Laboratories, Palo Alto, CA). Data were normalized by the LOWESS method. Statistical significances of deviations from a 1:1 ratio were evaluated by t tests, with P<.05. RESULTS: Of the 3,757 genes analyzed, 322 (8.6%) were significantly overexpressed in tumoral tissue with respect to normal tissue, while 104 (2.8%) were significantly underexpressed. The affected genes fell into a wide range of functional categories. CONCLUSION: We consider that cDNA microarrays are of clear value for investigating the biology of these tumors, and that this technology may help in the molecular classification of oral squamous cell carcinomas and in the identification of targets for gene therapy.

Microarrays de DNA en el cáncer oral / DNA microarrays in oral cancer

Uno de los principales objetivos en la investigación sobre el cáncer en la actualidad es el estudio de marcadores que puedan predecir el pronóstico o la respuesta al tratamiento de forma individual. El número de genes implicados en los distintos pasos de la carcinogénesis oral aumenta a medida que se investiga sobre el tema. Los microarrays de DNA permiten el análisis simultáneo de la expresión de cientos de genes de un tejido en un solo experimento. El formato paralelo del ensayo permite el estudio de diferencias en la expresión genética entre células normales y enfermas, puesto que la actividad de cada gen en el microarray puede ser comparada en dos poblaciones celulares distintas. El objetivo de este trabajo es hacer una breve revisión de los estudios realizados por diversos autores que han intentado identificar genes relacionados con el cáncer oral, así como clasificarlo en subgrupos según los patrones de expresión genética; lo que permitirá una precoz detección, mejor diagnóstico y pronóstico del cáncer oral (AU)

One of the principal aims of modern cancer research is to identify markers allowing individual prediction of prognosis or response to treatment. In this connection, the number of genes thought to be involved in the different stages of different types of oral cancer increases apace. DNA microarrays allow simultaneous evaluation of the expression of hundreds of genes in a single assay. The parallel format of microassay slides is designed to allow rapid comparison of gene expression between two samples, for example tumor cells and healthy cells. This article reviews studies that have aimed to identify genes related to oral cancer, and to classify these genes into groups that are commonly co-expressed. These studies suggest that DNA microarrays are set to become routine tools in the detection, diagnosis, characterization and treatment of oral cancers (AU)

DNA microarrays in oral cancer.

One of the principal aims of modern cancer research is to identify markers allowing individual prediction of prognosis or response to treatment. In this connection, the number of genes thought to be involved in the different stages of different types of oral cancer increases apace. DNA microarrays allow simultaneous evaluation of the expression of hundreds of genes in a single assay. The parallel format of microassay slides is designed to allow rapid comparison of gene expression between two samples, for example tumor cells and healthy cells. This article reviews studies that have aimed to identify genes related to oral cancer, and to classify these genes into groups that are commonly co-expressed. These studies suggest that DNA microarrays are set to become routine tools in the detection, diagnosis, characterization and treatment of oral cancers.