Theoretical Background to Automated Diagnosing of Oral Leukoplakia: A Preliminary Report.

Oral leukoplakia represents the most common oral potentially malignant disorder, so early diagnosis of leukoplakia is important. The aim of this study is to propose an effective texture analysis algorithm for oral leukoplakia diagnosis. Thirty-five patients affected by leukoplakia were included in this study. Intraoral photography of normal oral mucosa and leukoplakia were taken and processed for texture analysis. Two features of texture, run length matrix and co-occurrence matrix, were analyzed. Difference was checked by ANOVA. Factor analysis and classification by the artificial neural network were performed. Results revealed easy possible differentiation leukoplakia from normal mucosa (p < 0.05). Neural network discrimination shows full leukoplakia recognition (sensitivity 100%) and specificity 97%. This objective analysis in the neural network revealed that involving 3 textural features into optical analysis of the oral mucosa leads to proper diagnosis of leukoplakia. Application of texture analysis for leukoplakia is a promising diagnostic method.

Protection and regeneration of esophageal, pharyngeal, and laryngeal mucosa as a major element in therapy of patients with esophageal and extraesophageal reflux symptoms.

Treatment of esophageal and extraesophageal reflux syndromes is mainly focused on inhibiting the secretion of hydrochloric acid. In spite of the high efficacy of proton pump inhibitors, approx. 30-60% of GERD patients experience daily symptoms. Beside acid reflux, other factors such as abnormal esophageal peristalsis, visceral hypersensitivity, ineffective esophageal clearance mechanisms, and impaired mucosal barrier also play an important role in generating GERD symptoms. An additional therapeutic proposition is a procedure aimed at improving the defense mechanisms of esophageal mucosa rather than inhibiting the damage-inducing factors. The preparation consisting of hyaluronic acid (HA), chondroitin sulfate (SC) and poloxamer 407 protects against harmful factors (hydrochloric acid, pepsin) and accelerates mucosal healing and regeneration, constituting a substantial element of monotherapy or add-on therapy in patients with gastroesophageal reflux disease.

Common benign and malignant oral mucosal disease.

BACKGROUND: Mucosal diseases of the oral cavity are relatively common, and patients often seek initial assessment from their general practitioner. OBJECTIVE: The aim of this article is to provide an overview of common oral mucosal diseases to help with formulating a differential diagnosis and stratifying the urgency of referral. DISCUSSION: Pathological mucosal conditions of the oral cavity and jaws commonly present as a mucosal ulcer or a white, red or pigmented lesion. In this review, the authors outline the most common conditions organised according to their clinical presentation and describe their typical appearance and management.

Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study.

PURPOSE: Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit. METHODS: The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform. RESULTS: The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%. CONCLUSIONS: The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.

Detection of Vascular Pathways of Oral Mucosa Influencing Soft- and Hard Tissue Surgeries by Latex Milk Injection.

In this methodological study, the purpose was to visualize the macroscopic vascular pathway of the oral mucosa. Corpses were injected and fixed with Thiel's solution for embalming to keep the natural color, fresh texture, and elasticity of the tissues. Latex milk injection is a technique used to stain blood vessels. A combination of Thiel's embalming method and latex milk injection allows surgeons to work on a raw specimen and identify the distribution and anastomosis of vessels macroscopically in the oral mucosa for flap/incision design in periodontal and maxillofacial surgeries. The latex milk contains radiopaque material that enables clinicians to visualize the pathway of the blood vessels radiographically. A step-by-step protocol is described for the correct adjustment of Thiel embalming and latex milk injection. The combined application of both methods allows the clinician to understand anatomical structures practically. As a result, proper incisions and flaps can be designed, which prevents neurovascular damage, intraoperative bleeding, and postoperative morbidity during patient surgery.

A Case Report on Stomatitis Venenata Due to the Use of Lip Balm.

INTRODUCTION: Allergic reactions can manifest in various forms ranging from mild, almost unnoticeable reactions to life threatening anaphylaxis. Stomatitis venenata or contact stomatitis is described as a contact allergy of the oral mucosa which can occur due to repeated contact with the causative agent. Dental and cosmetic products, dental materials and dental therapeutic agents are the common allergens of the oral cavity. These allergies show varied clinical presentations, from swelling, pain, burning sensations to vesiculation, ulcerations, crusting and sloughing. Contact stomatitis due to cosmetic products have been on a rise recently due to the ease of availability and increase in their usage among individuals. AIM: The aim of this article is to present a case reports on an allergic reaction in a 17-year-old female triggered by the use of cosmetics. CASE REPORT: In the present article, we report a case of stomatitis venenata due to lip balm in a 17-year-old female for its rarity. CONCLUSION: Stomatitis venenata is a rare allergic condition that causes significant morbidity in an affected individual. Prompt recognition and elimination of the causative allergen followed by an appropriate therapy would help in complete resolution of this condition.

Daily Time of Radiation Treatment Is Associated with Subsequent Oral Mucositis Severity during Radiotherapy in Head and Neck Cancer Patients.

BACKGROUND: Limited treatment options are available for oral mucositis, a common, debilitating complication of cancer therapy. We examined the association between daily delivery time of radiotherapy and the severity of oral mucositis in patients with head and neck cancer. METHODS: We used electronic medical records of 190 patients with head and neck squamous cell carcinoma who completed radiotherapy, with or without concurrent chemotherapy, at Roswell Park Comprehensive Cancer Center (Buffalo, NY) between 2015 and 2017. Throughout a 7-week treatment course, patient mouth and throat soreness (MTS) was self-reported weekly using a validated oral mucositis questionnaire, with responses 0 (no) to 4 (extreme). Average treatment times from day 1 until the day before each mucositis survey were categorized into seven groups. Multivariable-adjusted marginal average scores (LSmeans) were estimated for the repeated- and maximum-MTS, using a linear-mixed model and generalized-linear model, respectively. RESULTS: Radiation treatment time was significantly associated with oral mucositis severity using both repeated-MTS (n = 1,156; P = 0.02) and maximum-MTS (n = 190; P = 0.04), with consistent patterns. The severity was lowest for patients treated during 8:30 to <9:30 am (LSmeans for maximum-MTS = 2.24; SE = 0.15), increased at later treatment times and peaked at early afternoon (11:30 am to <3:00 pm, LSmeans = 2.66-2.71; SEs = 0.16/0.17), and then decreased substantially after 3 pm. CONCLUSIONS: We report a significant association between radiation treatment time and oral mucositis severity in patients with head and neck cancer. IMPACT: Although additional studies are needed, these data suggest a potential simple treatment time solution to limit severity of oral mucositis during radiotherapy without increasing cost.

Bisphosphonate's Effect on Tongue Mucosa: An Experimental Electron Microscopy Study.

BACKGROUND AND OBJECTIVES: Bisphosphonates (BPs) are selective inhibitors of osteoclasts, used for the treatment of bone disorders. The objective of this study is to investigate the possible effects of BPs on the tongue's mucosa. MATERIALS AND METHODS: Specimens of the tongue of 20 female 12-month old Wistar rats were taken. Ten were used as control group, while in the remaining alendronate (Fosamax, Merck) was administered per os from 13 weeks. Observation of the harvested samples was made by Transmission Electron Microscopy (TEM). RESULTS: In the experimental group, focal alterations were observed to various extent in all specimens. The basement membrane was intact. Furthermore, an increase at the intercellular space was observed, predominantly at the middle layer, and the desmosomes were disorganized. In the lamina propria focal edema was observed. CONCLUSIONS: Investigation on the effect of BPs on the tongue's mucosa through TEM hasn't been documented in the past. According to our results, BPs seem to cause mild mucosal lesions on the tongue.

Enhanced junctional epithelial permeability in TRPV4-deficient mice.

BACKGROUND AND OBJECTIVE: As the interface between the oral cavity and the teeth, the junctional epithelial barrier is critical for gingival defense. The junctional epithelium is subject to mechanical stresses from biting force or external insults such as bacterial attacks, but little is known about the effects of mechanical stimuli on epithelial functions. Transient receptor potential vanilloid 4 (TRPV4) functions as a mechanosensitive nonselective cation channel. In the present study, based on marked expression of TRPV4 in the mouse junctional epithelium, we aimed to clarify the putative links between TRPV4 and junctional complexes in the junctional epithelium. METHODS AND RESULTS: Histological observations revealed that the junctional epithelium in TRPV4-deficient (TRPV4-/- ) mice had wider intercellular spaces than that in wild-type (TRPV4+/+ ) mice. Exogenous tracer penetration in the junctional epithelium was greater in TRPV4-/- mice than in TRPV4+/+ mice, and immunoreactivity for adherens junction proteins was suppressed in TRPV4-/- mice compared with TRPV4+/+ mice. Analysis of a mouse periodontitis model showed greater bone volume loss in TRPV4-/- mice compared with TRPV4+/+ mice, indicating that an epithelial barrier deficiency in TRPV4-/- mice may be associated with periodontal complications. CONCLUSION: The present findings identify a crucial role for TRPV4 in the formation of adherens junctions in the junctional epithelium, which could regulate its permeability. TRPV4 may be a candidate pharmacological target to combat periodontal diseases.

In Vivo Imaging of the Buccal Mucosa Shows Loss of the Endothelial Glycocalyx and Perivascular Hemorrhages in Pediatric Plasmodium falciparum Malaria.

Severe malaria is mostly caused by Plasmodium falciparum, resulting in considerable, systemic inflammation and pronounced endothelial activation. The endothelium forms an interface between blood and tissue, and vasculopathy has previously been linked with malaria severity. We studied the extent to which the endothelial glycocalyx that normally maintains endothelial function is involved in falciparum malaria pathogenesis by using incident dark-field imaging in the buccal mucosa. This enabled calculation of the perfused boundary region, which indicates to what extent erythrocytes can permeate the endothelial glycocalyx. The perfused boundary region was significantly increased in severe malaria patients and mirrored by an increase of soluble glycocalyx components in plasma. This is suggestive of a substantial endothelial glycocalyx loss. Patients with severe malaria had significantly higher plasma levels of sulfated glycosaminoglycans than patients with uncomplicated malaria, whereas other measured glycocalyx markers were raised to a comparable extent in both groups. In severe malaria, the plasma level of the glycosaminoglycan hyaluronic acid was positively correlated with the perfused boundary region in the buccal cavity. Plasma hyaluronic acid and heparan sulfate were particularly high in severe malaria patients with a low Blantyre coma score, suggesting involvement in its pathogenesis. In vivo imaging also detected perivascular hemorrhages and sequestering late-stage parasites. In line with this, plasma angiopoietin-1 was decreased while angiopoietin-2 was increased, suggesting vascular instability. The density of hemorrhages correlated negatively with plasma levels of angiopoietin-1. Our findings indicate that as with experimental malaria, the loss of endothelial glycocalyx is associated with vascular dysfunction in human malaria and is related to severity.

A pilot clinical evaluation of oral mucosal dryness in dehydrated patients using a moisture-checking device.

This study included 30 patients (17 males and 13 females; mean age, 73.7 ± 13.1 years) who were diagnosed with dehydration based on vital signs, skin symptoms, and blood test findings by emergency medicine physicians. First, the attending physician of our department measured oral mucosal dryness. Subsequently, the emergency medicine physician blindly divided the severity of dehydration into three stages according to clinical findings and blood test results. In this study, the oral moisture-checking device (Mucus®; Life Co., Ltd., Saitama, Japan) was used to measure the oral mucosal dryness. We examined the oral moisture level for each dehydration severity level and the correlations of each severity level of dehydration with the measured values. Spearman's correlation coefficient (Medcalc version 11.3 for Windows) was used for statistical analysis. P < 0.05 indicated significant differences. Twenty-six patients were diagnosed with dry mouth, and a moderate negative correlation was found between the severity of dehydration and oral moisture degree (r = -0.686). The correlation coefficient for the relationship between oral moisture degree and severity of dehydration was -0.686, indicating a negative correlation (P < .05). These results suggest that the oral mucosal dryness may be a useful index of dehydration severity.

Alterations of Mitochondrial Biology in the Oral Mucosa of Chilean Children with Autism Spectrum Disorder (ASD).

Autistic Spectrum Disorder (ASD) is characterized by the impairment of socio-communicative skills and the presence of restricted and stereotyped behavior patterns. Recent researches have revealed the influence of mitochondrial physiology on the development of ASD. Several research groups have identified defects in respiratory complexes, coenzyme-Q10 deficiency, increased oxidative damage, decreased of superoxide dismutase (SOD2). A study on the influence of mitochondrial physiology on the development of ASD can provide new alternatives and challenges. That is why we set ourselves the general objective to initiate studies of mitochondrial physiology in Chilean children with ASD. A sample of oral mucosa was collected in a group of 12 children diagnosed with ASD and 12 children without ASD. In children with ASD, we found a significant increase in mitochondrial DNA levels. Likewise, in these children, an increase in the protein oxidation was observed. Finally, a downward trend in the expression of the HIGD2A and SOD2 genes was observed, while DRP1, FIS1, MFN1, MFN2, and OPA1 gene expression show an upward trend. The increment of mitochondrial DNA, high oxidative stress, and high expression of the MFN2 gene could help as a scanner of the mitochondrial function in children with ASD.

A lower impact of an acute exposure to electronic cigarette aerosols than to cigarette smoke in human organotypic buccal and small airway cultures was demonstrated using systems toxicology assessment.

In the context of tobacco harm-reduction strategy, the potential reduced impact of electronic cigarette (EC) exposure should be evaluated relative to the impact of cigarette smoke exposure. We conducted a series of in vitro studies to compare the biological impact of an acute exposure to aerosols of "test mix" (flavors, nicotine, and humectants), "base" (nicotine and humectants), and "carrier" (humectants) formulations using MarkTen® EC devices with the impact of exposure to smoke of 3R4F reference cigarettes, at a matching puff number, using human organotypic air-liquid interface buccal and small airway cultures. We measured the concentrations of nicotine and carbonyls deposited in the exposure chamber after each exposure experiment. The deposited carbonyl concentrations were used as representative measures to assess the reduced exposure to potentially toxic volatile substances. We followed a systems toxicology approach whereby functional biological endpoints, such as histopathology and ciliary beating frequency, were complemented by multiplex and omics assays to measure secreted inflammatory proteins and whole-genome transcriptomes, respectively. Among the endpoints analyzed, the only parameters that showed a significant response to EC exposure were secretion of proteins and whole-genome transcriptomes. Based on the multiplex and omics analyzes, the cellular responses to EC aerosol exposure were tissue type-specific; however, those alterations were much smaller than those following cigarette smoke exposure, even when the EC aerosol exposure under the testing conditions resulted in a deposited nicotine concentration approximately 200 times that in saliva of EC users.

Oral mucosa pressure ulcers in intensive care unit patients: A preliminary observational study of incidence and risk factors.

PURPOSE: This study examined the incidence of oral mucosa pressure ulcers (PUs) in intensive care unit (ICU) patients and the relationship between biomechanical and physiological variables in onset of PUs. METHODS: A prospective observational descriptive study design was used. We recruited patients over 18 years of age with endotracheal tube (ETT) insertion in three ICUs in a tertiary hospital in Korea. We analysed 113 patient-days of data. Patient assessments and medical record reviews were conducted to gather biomechanical and physiological data. Fisher's exact tests and χ2 test and Spearman's rank correlations were used to compare data. RESULTS: The highest incidence of oral mucosa PUs occurred in lower oral mucosa (36.3%). There was a significant relationship between lower oral mucosa PU stage and bite-block or airway use (r = .20, p = .036), commercial ETT holder use (r = 0.19, p = .048), sedative use (r = -0.22, p = .022), and plasma protein (r = 0.20, p = .033). Upper oral mucosa PU stage was related to commercial ETT holder use (r = 0.19, p = .044), haemoglobin(r = 0.24, p = .011), haematocrit (r = 0.27, p = .004), and serum albumin (r = -0.24, p = .012). Stage was related to commercial ETT holder use in both sites (r = 0.28, p = .003), haematocrit (r = 0.19, p = .039), and serum albumin (r = -0.23, p = .015). CONCLUSION: Oral mucosa PUs developed more frequently and healed more quickly than general skin PUs. Taken together, these data indicate that biomechanical and haematological variables are risk factors associated with PU incidence should be considered in intensive care patients.

Premalignant and malignant oral mucosal lesions: Clinical and pathological findings.

The second article in this continuing medical education series discusses the clinical and histopathologic features of common premalignant and malignant lesions of the oral cavity. It is imperative for dermatologists to be able to appropriately recognize suspicious lesions, determine the need to obtain a biopsy specimen, counsel, and refer patients presenting with premalignant or malignant conditions. Given the higher rates of mortality and morbidity of oral mucosal malignancies because of late diagnosis, appropriate treatment with multidisciplinary care in a timely manner is essential to patients with these neoplasms.

Dietary Fatty Acids and Other Nutrients in Relation to Inflammation and Particularly to Oral Mucosa Inflammation. A Literature Review.

Oral mucosa is site of inflammatory process development. When they are chronic, they provide a microenvironment based on cytokines and inflammatory mediators that contribute to cancer initiation, progression, invasion, and metastasis. Certain dietary fatty acids (FAs) have immunomodulatory, inflammatory, and antiinflammatory effects. This review examined the literature on inflammation, mainly referred to the oral mucosa, and its association with dietary FAs and other nutrients. A Pubmed search of studies published in English until June 2018 was carried out. N-3 FAs have shown immunomodulatory and antiinflammatory activity in certain human diseases. These FAs and their mediators may inhibit inflammation, angiogenesis, and cancer via multiple mechanisms. Studies on cellular models of murine and human intestinal mucosa indicate association between dietary n-3 FA intake and the inflammatory state of mucosa membranes. Nevertheless scarce information on the association between dietary FAs and oral inflammation could be found. Based on the evidence, we hypothesize that n-3 FAs reduce the oral mucosa inflammation thus decreasing the risk of developing precancerous lesions and cancer. Molecular and clinical studies referred to this topic should be carried out as a contribution to the oral cancer prevention.

Virulence factors of Candida species from the oral mucosa and prostheses of elderly people from a riverside community in the Amazon state, Brazil / Fatores de virulência de espécies de Candida provenientes da mucosa oral e das próteses dos idosos de uma comunidade ribeirinha no Amazonas - Brasil

Abstract Introduction Candida albicans is the yeast most commonly affecting the oral cavity, sometimes causing infection. However, several factors may be associated with the onset of candidiasis, which may be related not only to the hygiene and health of individuals, but also to the pathogenicity of these microorganisms. Objective To evaluate the virulence factors of Candida yeasts isolated from the oral mucosa of elderly people living in the "Comunidade Lago do Limão", municipality of Iranduba, Amazonas state, Brazil. Material and method Testes were performed to assess the production of urease, proteinase, phospholipase and hemolysin. Statistical analysis used the Fisher's exact test and the Chi-squared test. Result Prevalence of non-albicans species was observed. As for virulence factors, all isolates were negative ureases, and there was prevalence of very strong proteinase production, whereas most isolates did not produce this enzyme in the phospholipase test. All yeasts analyzed presented hemolysin production, with grade IV hemolysis as the most prevalent. There was no statistically significant difference between the virulence of isolates from the oral cavity and the prostheses of the elderly analyzed. Conclusion Several virulence factors may present with high intensity in the presence of oral microbiota changes. In addition, non-albicans species present number of virulence factors similar to that of C. albicans, with high pathogenicity. This study allows a better analysis of candidiasis prevention strategies aiming to promote improvement in the health and quality of life for the elderly.

Resumo Introdução A Candida albicans é a levedura que mais acomete a cavidade oral, podendo causar infecção. Porém diversos fatores podem estar associados ao aparecimento da candidíase, que podem estar relacionados com a higiene e saúde dos indivíduos, mas também com a patogenicidade destes microrganismos. Objetivo Avaliar os fatores de virulência de leveduras do gênero Candida isoladas da mucosa oral dos idosos residentes na Comunidade Lago do Limão - Iranduba - Amazonas - Brasil. Material e método Foram realizados os testes de urease, proteinase, fosfolipase, e avaliação da produção de hemólise. Na análise estatística utilizou-se teste Exato de Fisher e Quiquadrado. Resultado Obteve-se a prevalência de espécies não-albicans, quanto aos fatores de virulência, todos os isolados foram ureases negativos, houve prevalência de produção muito forte de proteinase, enquanto que no teste da fosfolipase, a maioria dos isolados não apresentou produção desta enzima; todas as leveduras analisadas apresentaram produção de hemolisina, sendo mais prevalente a hemólise grau IV. Não houve diferença estatisticamente significativa entre a virulência dos isolados oriundos da cavidade oral e da prótese dos idosos analisados. Conclusão Diversos fatores de virulência podem apresentar-se com alta intensidade na presença de alterações da microbiota oral. Além disso, as espécies não-albicans apresentam fatores de virulência tanto quanto a C. albicans, com graus de patogenicidade elevados. Este estudo permite a análise de estratégias de prevenção da candidíase, com intuito de promover melhor saúde e qualidade de vida para os idosos.

Standardized nursing and therapeutic effect of oxycontin on oral mucosal pain in nasopharyngeal carcinoma patients.

AIM: This study aims to explore the standardized nursing and therapeutic effect of OxyContin on oral mucosal pain in nasopharyngeal carcinoma (NPC) patients with concurrent chemoradiotherapy. MATERIALS AND METHODS: From March 2016 to December 2017, 60 patients with NPC were selected from the Sun Yat-Sen University Cancer Center. Patients consuming OxyContin for moderate and severe pain were divided into the experimental group and control group, respectively. All the patients were given OxyContin 10 mg orally, and the dose was adjusted according to the degree of pain relief until it was significantly relieved. At the same time, the combination of analgesic drugs with standardized nursing intervention for pain was granted, and the analgesic effect, adverse effects, and quality of life of both groups were analyzed. RESULTS: There was no significant difference between the total dose of radiotherapy and OxyContin. OxyContin could significantly improve the quality of life in patients with moderate pain (P < 0.05), while the effect was not significant in patients with severe pain. CONCLUSION: Patients with NPC having oral mucosal pain after radiotherapy and chemotherapy need intervention at the earliest. The application of OxyContin and cancer pain standardized nursing care can improve the analgesic efficacy, reduce drug adverse effects, and improve the patient's quality of life.

Cell culture models of oral mucosal barriers: A review with a focus on applications, culture conditions and barrier properties.

Understanding the function of oral mucosal epithelial barriers is essential for a plethora of research fields such as tumor biology, inflammation and infection diseases, microbiomics, pharmacology, drug delivery, dental and biomarker research. The barrier properties are comprised by a physical, a transport and a metabolic barrier, and all these barrier components play pivotal roles in the communication between saliva and blood. The sum of all epithelia of the oral cavity and salivary glands is defined as the blood-saliva barrier. The functionality of the barrier is regulated by its microenvironment and often altered during diseases. A huge array of cell culture models have been developed to mimic specific parts of the blood-saliva barrier, but no ultimate standard in vitro models have been established. This review provides a comprehensive overview about developed in vitro models of oral mucosal barriers, their applications, various cultivation protocols and corresponding barrier properties.