Oral Health Impact Profile in adult Polish population.

BACKGROUND: Oral Health Related Quality of Life (OHRQoL) is a significant patient-oriented outcome which should be considered in diagnostic, decision making and therapeutic process by dentists. OBJECTIVES: To evaluate the influence of a condition of teeth, oral mucosa and dentures on the OHRQoL among patients seeking dental treatment in the University Dental Clinic (UDC) in Kraków, Poland. MATERIAL AND METHODS: 250 patients took part in a cross-sectional study conducted in the UDC in Kraków. Collected clinical data included: oral mucosa and periodontal condition, number of Decayed, Missed and Filled Teeth (DMFT index), presence of dentures. Questionnaire part of the study has been based on OHIP-14 questionnaire. RESULTS: The condition of teeth worsened OHRQoL in following groups of patients: first-time visitors, smokers, with periodontal diseases and without oral mucosal diseases. There was a positive significant correlation between number of decayed teeth and OHRQoL related to teeth. The condition of oral mucosa significantly impaired OHRQoL in: women, patients with oral mucosal diseases and those who undergone prosthetic treatment in the last year. There was a correlation between number of missing teeth, DMFT index, age and subscale 2 of the form. The condition of dentures significantly impaired the OHRQoL in patients: who used removable dental prostheses, undergone prosthetic treatment in the last year and females. There was a positive correlation between subscale 3 of the questionnaire and number of missing teeth and DMFT index and a negative correlation with number of filled teeth within this subscale. CONCLUSIONS: Evaluation of patient's OHRQoL is one of important components for successful dental treatment.

Candida albicans Shields the Periodontal Killer Porphyromonas gingivalis from Recognition by the Host Immune System and Supports the Bacterial Infection of Gingival Tissue.

Candida albicans is a pathogenic fungus capable of switching its morphology between yeast-like cells and filamentous hyphae and can associate with bacteria to form mixed biofilms resistant to antibiotics. In these structures, the fungal milieu can play a protective function for bacteria as has recently been reported for C. albicans and a periodontal pathogen-Porphyromonas gingivalis. Our current study aimed to determine how this type of mutual microbe protection within the mixed biofilm affects the contacting host cells. To analyze C. albicans and P. gingivalis persistence and host infection, several models for host-biofilm interactions were developed, including microbial exposure to a representative monocyte cell line (THP1) and gingival fibroblasts isolated from periodontitis patients. For in vivo experiments, a mouse subcutaneous chamber model was utilized. The persistence of P. gingivalis cells was observed within mixed biofilm with C. albicans. This microbial co-existence influenced host immunity by attenuating macrophage and fibroblast responses. Cytokine and chemokine production decreased compared to pure bacterial infection. The fibroblasts isolated from patients with severe periodontitis were less susceptible to fungal colonization, indicating a modulation of the host environment by the dominating bacterial infection. The results obtained for the mouse model in which a sequential infection was initiated by the fungus showed that this host colonization induced a milder inflammation, leading to a significant reduction in mouse mortality. Moreover, high bacterial counts in animal organisms were noted on a longer time scale in the presence of C. albicans, suggesting the chronic nature of the dual-species infection.

Fibroblasts from recurrent fibrotic overgrowths reveal high rate of proliferation in vitro - findings from the study of hereditary and idiopathic gingival fibromatosis.

PURPOSE: Investigate the content of fibrotic fibrils in gingival tissue and the proliferation of fibroblasts collected from recurrent and non-recurrent hereditary gingival fibromatosis (HGF) and idiopathic gingival fibromatosis (IGF). METHODS: Gingival biopsies were collected from HGF (n = 3) and IGF (n = 3) donors with recurrent and non-recurrent gingival overgrowths and from a control group (Ctrl, n = 3). Hematoxylin staining was performed to evaluate the histomorphology of gingival tissue. Heidenhain's AZAN trichrome staining served for visualization of fibrotic fibrils in gingiva. Quantitative analysis of the content of fibrotic fibrils in gingival tissue was performed using a polarized light microscope. Proliferation was evaluated at 24 h, 48 h, and 72 h in fibroblast cultures using a cell proliferation ELISA assay based on 5-bromo-2'-deoxyuridine (BrdU). RESULTS: Numerous blood vessels and fibroblasts were observed in recurrent overgrowths, whereas moderate blood vessels and moderate to scanty fibroblasts were detected in non-recurrent overgrowths. Heidenhain's staining revealed numerous collagen fibers in both recurrent and non-recurrent overgrowths. Quantitative analysis in a polarizing microscope showed significant accumulation of fibrotic fibrils exclusively in the overgrowths with the recurrence. In all time-points, increased proliferation of cells from all recurrent overgrowths was observed, but not from overgrowths which do not reoccur. CONCLUSIONS: The study revealed that recurrent gingival overgrowths consist of highly fibrotic and dense connective tissue with numerous blood vessels and abundant fibroblasts. We also demonstrated that unlike fibroblasts derived from overgrowths, which did not present recurrence, fibroblasts derived from highly fibrotic and recurrent overgrowths maintain high rate of proliferation in vitro.

Evaluation of enzymatic and non-enzymatic antioxidant status and biomarkers of oxidative stress in saliva of patients with oral squamous cell carcinoma and oral leukoplakia: a pilot study.

Objective: The study aimed to evaluate total antioxidant capacity as well as levels of various enzymatic and non-enzymatic antioxidants, and oxidative stress markers in saliva of patients with oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL). Material and methods: Twenty patients with OSCC, 20 patients with OL and 20 healthy subjects were enrolled into this prospective study. Total Antioxidant Capacity (TAC), activity of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) as well as levels of total glutathione (tGSH), reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG ratio, uric acid (UA), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) were estimated in saliva using appropriate biochemical methods. Results: The activity of SOD was significantly higher in OSCC group in comparison with OL and control groups. The levels of GSH were markedly lower in OSCC and OL patients as compared to the control group. Likewise, we found that GSH/GSSG ratio was markedly lower in the OSCC and OL groups. Levels of some biomarkers were influenced by clinical staging of OSCC and OL as well as by sociodemographic factors. Conclusions: The results of this pilot study suggest that salivary activity of SOD is higher in OSCC patients, whereas levels of GSH and GSH/GSSG ratio are lower in saliva of patients with OSCC and OL. Clinical staging of OSCC and OL, as well as some sociodemographic factors may also influence salivary antioxidant status.

TIMP-1 association with collagen type I overproduction in hereditary gingival fibromatosis.

OBJECTIVES: To investigate the processes associated with the excessive production of collagen I in hereditary gingival fibromatosis (HGF). MATERIALS AND METHODS: Three HGF subjects and five controls were enrolled in the study. Histomorphological and immunohistological analyses were performed on gingival tissues. The expression of heat-shock protein 47 (HSP47), collagen I, transforming growth factor-ß1 (TGF-ß1), connective tissue growth factor (CTGF), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) by gingival fibroblasts isolated from HGF and controls was analysed using qRT-PCR, Western blotting and ELISA. RESULTS: Considerable accumulation of fibrotic fibrils and increased synthesis of HSP47 were noted in HGF gingival tissues. The synthesis of collagen I, HSP47, TGF-ß1, CTGF and TIMP-1 was significantly elevated in HGF gingival fibroblasts compared with controls, while the production of MMP-1 was decreased. CONCLUSIONS: We report that fibrosis in HGF gingival tissues is associated with increased synthesis of HSP47. This finding was confirmed by an in vitro study, where excessive production of collagen I was associated with increased synthesis of HSP47, TGF-ß1 and CTGF by HGF gingival fibroblasts. Moreover, the shift in the TIMP-1/MMP-1 ratio identifies increased synthesis of TIMP-1 as one of the processes associated with collagen I overproduction in HGF fibroblasts.

Intraoral manifestation of systemic AL amyloidosis with unique microscopic presentation of intracellular amyloid deposition in striated muscles.

We report the history of a 59-year old patient with systemic AL amyloidosis of intraoral manifestation. The patient first presented with complaints about dysphagia and remarkable enlargement of the tongue with highly reduced mobility, as well as bilateral submucosal thickenings on the cheeks. Histopathological examination of the incisional biopsy of the buccal mucosa and underlying tissues revealed AL amyloidosis. The microscopic presentation was, however, unique, as the amyloid deposits were present intracellularly in the striated muscles. The subsequent bone marrow biopsy confirmed the diagnosis of primary amyloidosis/multiple myeloma - associated amyloidosis.

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025.

AIM: The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. MATERIAL AND METHODS: The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. RESULTS: The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. CONCLUSION: A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.

[Application of photodynamic therapy in dentistry ­ literature review].

Photodynamic therapy (PDT) is based on the principle that the target cells are destroyed by means of toxic reactive oxygen species generated upon the interaction of a photosensitizer, light and oxygen. This method is nowadays widely applied in various branches of medicine, mainly in oncology and dermatology. It is also applied in dentistry in the treatment of oral potentially malignant disorders (like lichen planus or leukoplakia) and infectious conditions (periodontitis, herpetic cheilitis, root canal disinfection). The application of the photodynamic therapy in the abovementioned indications is worth attention, as the method is noninvasive, painless, and the results of the published studies seem promising. The present article aims at presenting the principle of the photodynamic therapy and, based on the literature, the possibilities and results of its application in dentistry.

[The impact of tobacco on oral health - based on literature].

Tobacco is the most popular overused substance in the world. There are two types of tobacco products: smoke and smokeless ones. The aim of this article is to explain the impact of tobacco on mucosa and describe the most common diseases of oral cavity among the tobacco users. The nicotine, the main component of tobacco, stimulates the central nervous system, addicting firmly and fast. The nicotine influences on metabolism of proteins and nucleic acids and disorders functioning of defense-andrepair system. The tobacco smoke provides also physical damages because increases temperature inside the mouth and burns tissues. In the clinical examination tobacco users have: hyperpigmentosis, black hairy tongue, superficial glossitis, periodontitis, leucoedema, nicotinic stomatitis, leukoplakia or neoplasm. Patients often claim on halitosis, bad taste or xerostomia. Dentistry provides a huge role on prevention, early detection of lesions and finally motivation for quitting smoking habits.

[Unilateral idiopathic gingival fibromatosis--a case report]. / Jednostronny idiopatyczny przerost dziasel--opis przypadku.

Gingival fibromatosis is a painless gingival overgrowth. It may result in difficulties with proper dental hygiene keeping, mastication and occlusion. Herein, a case of a 10-year-old patient was described. The patient reported to the Department of Periodontology and Oral Medicine of the Jagiellonian University Medical College in Krakow due to the problems with permanent teeth eruption (23-26), chewing and dental hygiene maintaining. Based on medical history, clinical examination, diagnostic tests and histopathological study of gingival tissue biopsies the patient was diagnosed with unilateral idiopathic gingival fibromatosis. After oral cavity hygienization, patient un- derwent dental surgery procedures by gingivectomy and gingivoplasty. The follow-up examination 2 and 6 months post operation showed un- eventful healing, proper tooth eruption, improved oral hygiene and chewing function. Twelve months post surgery no recurrence was noted. Due to the etiological diversity of gingival lesions occurring as an overgrowth, accurate medical history, clinical examination, laboratory tests and histopathological study are needed. Accurate diagnos- tics is crucial mainly to exclude he- matological and oncological diseases. Gingivectomy being the "gold method" of gingival fibromatosis treatment was effective and sufficient to cure the case presented in this article.

Reasons for patients' visits in the dental offices of Cracow in the years 2005-2006 and 2013-2014.

INTRODUCTION: Caries is a serious health problem affecting the Polish population, mostly due to a low level of health awareness, which is reflected in irregular check-ups and a tendency for patients to visit the dentist only when they are already experiencing pain. OBJECTIVE OF THE STUDY: to compare patients' reasons for visiting dental offices and the treatment they received during the years 2005-2006 and 2013-2014. MATERIAL AND METHODS: Data was obtained from 495 medical files stored in 4 randomly selected dental offices in Cracow. Information was gathered on age, sex, place of residence, reasons for visiting the dentist, referrals, frequency of dental visits and procedures performed. RESULTS: The study showed that women visited dental offices more frequently (56%) than men. The participants were aged between 1 and 91. The majority of the patients lived in large towns or cities (81.6%). Approximately 50% of the patients visited a dental office once a month. The study showed a significant increase in one-time visits (from 18.5% to 30.6%). The most frequent motivation for visiting a dental office was to receive conservative treatment, while the least common reasons were prophylaxis and tooth injuries. CONCLUSIONS: Throughout the period under review, changes occurred in the profile of the patients who visited dental offices during these periods. One alarming trend was the significant increase in the number of patients who visited dental offices only once (12%). The main reason why patients visited dental offices did not change--more than 60% came to have caries treated but often after a single visit they did not continue the treatment despite needing to do so.

Clinical crown lengthening - a case report.

Maintaining healthy parodontium during teeth restoration procedures is an indispensable condition for obtain- ing regular functionning and esthetics. Thus, the knowledge of correct anatomy and the influence of filling and complement on paradontium tissue is vital. Difficulty in maintaining appropriate gingival biological width (GBW) is a frequent problem encountered in this type of reconstruction. Preservation of unchanged biological width conditions predictible treatment result and, what is more, lack of inflammatory lesions in marginal parodontium. The ideal situation for parodontium is localizing the filling/complement border supragingivaly, which is at least 3 mm from alveolar process edge. In the case, when the above conditions are impossible to fulfil, elongation of clinical crown is a metod of choice. The effect is possible to achieve by surgical treatment or combined orthodontic - surgical treatment. Surgical treatment is faster and preferred procedure for indirect reconstruction, where achieving high clinical crown is necessary. Three clinical cases of performing method of surgical clinical crown elongation were presented in the article. Performing the described procedure enables correct tooth crown reconstruction and, what is most important, keeping individual toothing.

[Erythema exudativum multiforme--case report]. / Rumien wysiekowy wielopostaciowy--opis przypadku.

Erythema exudativum multiforme (EM) is an acute mucocutaneous disease. Etiology of this disease is not clear. 50% - 60% cases of EM is induced by HSV infection (herpes simplex virus 1, herpes simplex virus 2). EM lesions may appear as red macules, erosions, ulcerations and hemorrhagic crusts. The study describes the case of 22 - year - old male who had characteristic lesions for EM after HSV infection.

[Stevens-Johnson Syndrom and Toxic Epidermal Necrolysis--based on literature]. / Zespól Stevensa-Johnsona oraz zespól toksycznej nekrolizy naskórka--na podstawie pismiennictwa.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TEN) also known as Lyell's syndrome, are acute autoimmune dermatoses, which are potentially life threatening. They are both forms of necrotic skin reactions which causes epidermis to separate from dermis as a result of abnormal process induced by drugs or infections. Historically they were classified as a form of exudative erythema multiforme, but nowadays they are categorized as different disease entities. The reason is more severe clinical course in case of SJS and TEN, and known causes (medicines, infections). The criterion for distinguishing the two forms is based on the quantitative evaluation of the surface of affected skin. In case of SJS the affected area comprise up to 10% of body surface area, while in Lyell's syndrome it is over 30%. If affected skin surface ranges from 10% to 30%, it is defined as overlapping syndrome.

Interleukin-6 and neopterin levels in the serum and saliva of patients with Lichen planus and oral Lichen planus.

BACKGROUND: Lichen planus together with its oral variant is a chronic, inflammatory disease of the skin and the mucosa of unclear aetiology and with an unpredictable course that still poses a major problem in terms of diagnosis and treatment. The objective of this study was to assess the concentrations of interleukin-6 (IL-6) and neopterin in saliva and serum of patients with lichen planus (including reticular and erosive form of oral lichen planus) and to compare them with the concentrations observed in healthy controls. METHODS: The study material comprised serum and saliva samples from 56 patients diagnosed with lichen planus and 56 healthy volunteers. The ELISA test was used to measure concentrations of IL-6 and neopterin in the serum and saliva of the study participants. RESULTS: The concentrations of IL-6 in saliva and serum of patients with lichen planus were significantly higher than in controls (P = 0.0002; P < 0.0001). The difference remains significant after adjustment for gingivitis and age. Patients with atrophic-erosive oral lichen planus had significantly higher IL-6 concentrations in their saliva compared to patients with reticular form of disease (P = 0.01). The concentrations of neopterin were significantly higher in the serum but not in saliva of lichen planus patients vs. controls (P <0.0001). CONCLUSIONS: Serum levels of proinflammatory cytokines IL-6 and neopterin are increased in lichen planus as well as the salivary concentrations of IL-6. The differences observed in IL-6 levels in patients with erosive-atrophic forms of oral lichen planus may indicate a substantial role played by the cytokine in the disease.

[Pseudohalitosis and halitophobia]. / Pseudohalitoza i halitofobia.

Halitosis, or bad breath occurs in 25 % of the population. 85% of the causes are located within the oral cavity (for example: periodontitis, pathologicaly coated tongue or poor oral hygiene). This is the reason why the dentist is often the first person, who sees patients presenting this problem. While some patients feel that their breath smells bad, people with genuine halitosis usually do not notice this fact, which has been called the "bad breath paradox". For people in whom symptoms of halitosis are not present, and yet they complain about having them, psuedohalitosis or halitophobia are described. The phenomena responsible for the increase in the number of cases of halitophobia and pseudohalitosis are advertising of oral hygiene products and the fact that patients pay more attention to the quality of mouth odour. It is important to make a correct diagnosis, identify the causes of the disease and to take appropriate steps in order to cure the patient. The paper presents, on the basis of literature, causes of pseudohalitosis and halitophobia and describes the treatment of patients who have been diagnosed with these conditions.

[Necrotizing sialometaplasia--diagnostic difficulties--literature review]. / Necrotizing sialometaplasia--trudnosci diagnostyczne--przeglad pismiennictwa.

Necrotizing sialometaplasia is a benign, self-limiting inflammatory process, which concerns small salivary glands. This kind of lesion is very rare, with difficulties in clinical and histopathological diagnosis. Ulceration is the dominating symptom, which may suggest that it is a malignancy. Lesions usually heal spontaneously.

Influence of diet on oral health in young adults--pilot study.

INTRODUCTION: Diet is a factor that can modify, among others, the course of caries, dental erosive lesions and periodontal disease. It is important to know the influence of diet on the clinical oral condition in young adults. MATERIAL AND METHODS: 20 women and 20 men aged 19-21 participated in the study. During a clinical examination of the patients the following clinical indices were estimated: Ap- proximal Plaque Index (API), Bleeding on Probing (BOP) and DMFT indices. The frequency and quality of food products consumed were noted in a special questionnaire. Results with p ≤ 0.05 were considered statistically significant. RESULTS: The average API value for the female participants was 77.37%, BOP--23.84% and DMFT--9.9. The t-test results for independent samples showed that women who consumed meat and meat products two times a week or more, had statistically higher API (p = 0.01) and BOP (p = 0.05) values, than the mean value for these indexes. Women who consumed grain products and grain-based products two times a week or more, had higher API values compared to the mean value for this index (p = 0.02). The average API value for the male participants was 34.25%, BOP--10.15% and DMFT--9.05, respectively. Men who consumed milk and dairy products three times a week or less had statistically lower API (p = 0.05) and BOP values (p = 0.02), relative to the mean index values. CONCLUSIONS: The chemical composition and texture of the food intake can affect oral health. Besides instruction in oral hygiene, doctors and dentists should also assess the eating habits of their patients.

Identification of a new genetic variant (G231N, E232T, N235D) of peptidylarginine deiminase from P. gingivalis in advanced periodontitis.

Chronic periodontitis (CP), an inflammatory disease of periodontal tissues driven by a dysbiotic subgingival bacterial biofilm, is also associated with several systemic diseases, including rheumatoid arthritis (RA). Porphyromonas gingivalis, one of the bacterial species implicated in CP as a keystone pathogen produces peptidyl arginine deiminase (PPAD) that citrullinates C-terminal arginine residues in proteins and peptides. Autoimmunity to citrullinated epitopes is crucial in RA, hence PPAD activity is considered a possible mechanistic link between CP and RA. Here we determined the PPAD enzymatic activity produced by clinical isolates of P. gingivalis, sequenced the ppad gene, and correlated the results with clinical determinants of CP in patients from whom the bacteria were isolated. The analysis revealed variations in PPAD activity and genetic diversity of the ppad gene in clinical P. gingivalis isolates. Interestingly, the severity of CP was correlated with a higher level of PPAD activity that was associated with the presence of a triple mutation (G231N, E232T, N235D) in PPAD in comparison to W83 and ATCC 33277 type strains. The relation between mutations and enhanced activity was verified by directed mutagenesis which showed that all three amino acid residue substitutions must be introduced into PPAD expressed by the type strains to obtain the super-active enzyme. Cumulatively, these results may lead to the development of novel prognostic tools to assess the progress of CP in the context of associated RA by analyzing the ppad genotype in CP patients infected with P. gingivalis.

[Halitosis--diagnosis and treatment]. / Halitoza--diagnostyka i leczenie.

Halitosis (bad breath) applies to according to various authors--even 25-50% of the population. Volatile sulfur compounds are frequently encountered in the exhaled air. The article presents the most common causes of halitosis. It is believed that approximately 80-90% of the causes of halitosis are located in the head area (mouth, ear, nose, throat), whereas the remaining cases correspond to systemic illness, such as of the stomach and lung, certain medications or food. This paper describes different means to assess halitosis, which can be helpful in determining the diagnosis. The article describes ways to treat the symptoms and causes of halitosis associated with oral cavity. In patients who have had another source of halitosis, additional diagnostic procedures and appropriate treatment must be performed. Given the prevalence of the problem of the malodour and its impact on the quality of everyday life, halitosis is a phenomenon that should not be underestimated. The causes need to be detected and an appropriate therapy must be performed. Patients with diagnosed halitophobia should be directed to appropriate specialists.