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Oncological alertness in the practice of a primary care dentist
... Термин «онконастороженность» наиболее часто ассоциирован с лицами старшей возрастной группы, при этом следует отметить, что у детей также не стоит исключать предраковые заболевания и злокачественные опухоли. Особая ответственность стоит перед врачом-стоматологом детским при диагностике заболеваний СОР, так как в разные возрастные периоды ребенка слизистые поражения характеризуются особенностью клинических проявлений [7][8][9]. Аутофлуоресцентная стоматоскопия (АФС) наиболее широко внедрена в практику врача-стоматолога для ранней диагностики онкологических заболеваний полости рта у взрослого населения. Метод аутофлуоресцентной стоматоскопии обладает высокой чувствительностью к патологическим изменениям слизистой оболочки, а алгоритм применения прост и позволяет широко применять его на амбулаторном стоматологическом приеме [10][11][12][13]. ...
Subject. Currently, oral mucosa (OM) diseases in children are quite common. Pediatric dentists bear special responsibility in diagnosing OM disorders since mucosal lesions exhibit distinct clinical manifestations at different age periods. The method of autofluorescence stomatoscopy (AFS) is highly sensitive to pathological changes in the mucous membrane. Medical examination of children is an important medical measure for the diagnosis and prevention of dental diseases. The study presents the results of the use of AFS during preventive medical examinations and demonstrates the effectiveness of the AFS method in adolescents in the diagnosis of oral diseases, especially lesions of the oral mucosa. Objectives. To evaluate the oral mucosa condition in adolescents using AFS and assess the relationship between detected pathologies and the harmful habit of using electronic smoking devices. Methodology. During mass preventive examinations, 4,696 adolescents aged 15-17 (mean 16±0.6 years) were examined over 14 months. An anonymous questionnaire was created to identify harmful habits among teenagers. Results. Oral mucosa disorders were found in 1,643 individuals (35%). Adolescents with identified OM pathologies completed the anonymous survey. Results showed 38% used electronic smoking devices at least once daily. In 48% of adolescents, areas of keratinization were found on the mucous membranes of the cheeks. Inflammatory diseases of periodontal tissues were found in 46% of the examined patients. 6% of the teenagers were healthy. Conclusions. Our findings suggest a connection between oral mucosal hyperkeratosis in adolescents and electronic smoking device use. Further research will provide deeper analysis of OM pathology prevalence related to vaping. The study demonstrates the need to implement AFS in pediatric dental practice for diagnosing oral mucosa diseases.
Relevance . The incidence of malignant growths in the maxillofacial area has consistently increased over the years. Chemotherapy stands out as one of the most effective treatments for cancerous tumors. Chemotherapeutic drugs possess the capability to either inhibit the proliferation of malignant cells or cause damage to them. However, while acting on abnormal cells, cytostatic drugs also impact actively dividing cells in normal tissues, including the mucous membranes in the oral cavity. As a result, various complications are observed in every patient undergoing treatment for malignant neoplasms (MN), particularly chemotherapy (CT). The nature and severity of side effects undergo changes based on the specific drugs and cytostatic treatment regimen employed. Adverse reactions and side effects inherent to each drug category manifest at different points throughout a chemotherapy course and its aftermath. Oral mucosal (OM) complications, such as oral mucositis, may ensue as a consequence of CT side effects.
Materials and methods . In order to assess the effectiveness of screening for OM disorders arising as side effects of chemotherapy, a study involving 37 patients undergoing chemotherapy for an underlying condition was conducted. The screening study comprised two stages: Stage I involved a quality-of-life assessment utilizing questionnaires developed by the authors, while Stage II entailed a clinical examination of the oral mucosa. The obtained data were subjected to statistical analysis methods. Variation statistics were employed to assess the likelihood of data errors.
Results . Comprehensive OM diagnostics in patients undergoing chemotherapy for an underlying oncology condition enable the early identification of oral mucosal diseases and the prevention of complications. It is recommended to conduct a thorough clinical examination and employ toluidine blue staining during each follow-up visit. Any observed clinical or stained tissue changes, the emergence of new erythematous lesions, erosions, or ulcers may serve as indicators of malignant transformation.
Conclusion . It is advisable to incorporate screening diagnostics into each patient's dental visit to proactively prevent the onset of various pathological conditions.
In the context of the coronavirus infection (COVID-19) pandemic, there is an acute problem of timely provision of high-quality medical care to the population, which determines the relevance of the introduction of telemedicine technologies in dentistry. Telemedicine technologies in the mode of delayed consultations were carried out for 6 months in the treatment of 15 patients with diseases of the oral mucosa in the «doctor-doctor» segment. As a result of the remote consultations, confirmation of the diagnosis and the prescribed treatment was obtained in 14 clinical cases (94%), in one case one of the methods of laboratory examination was recommended. The advantages of telemedicine technologies were identified: availability, cost-effectiveness, the possibility of developing a comprehensive plan for examining and treating a patient as a result of the interaction of doctors.
At present, a significant increase in inflammatory-destructive pathologies of the oral mucosa has been revealed. However, despite the high prevalence and the trend towards a constant increase in the number of diseases, there is no single diagnostic algorithm for examining and managing these patients in dental practice. To solve the above problems, a complex system of a patient-oriented approach to the diagnosis and monitoring of the inflammatory-destructive process in diseases of the oral mucosa was developed.
Aim. To evaluate the effectiveness of the developed complex system of a patient-oriented approach to the diagnosis and monitoring of inflammatory-destructive diseases of the oral mucosa.
Materials and methods. A survey of 60 patients with inflammatory-destructive diseases of the oral mucosa was carried out, which were divided into 2 groups. In the main group, diagnostics and monitoring were carried out using the developed system, in the control group – according to the generally accepted scheme.
Results. Taking into account the data of the study, we can confidently speak about the clinical effectiveness of the developed complex system of a patient-oriented approach to the diagnosis and monitoring of the inflammatory-destructive process in diseases of the oral mucosa. When managing patients using the proposed system, a personalized approach is provided, the dynamics of the course of the pathological process is objectively and accurately assessed, certain periods of clinical observation are offered in order to correct the prescribed therapy regimen.
Conclusions. The use of a patient-oriented approach in the diagnosis and monitoring of the system helps to reduce the time of regeneration of inflammatory-destructive diseases of the oral mucosa, improves the effectiveness of the treatment of this pathology, and also improves the patient's quality of life.
Background:
Lichen planus is a chronic inflammatory mucocutaneous disease which frequently involves the oral mucosa. The most common types of oral lichen planus (OLP) are reticular (asymptomatic) and erosive (ulcerative) with malignant potentiality. The aims of the present study are to assess the cellular stress level in both types of OLP lesions with respect to oxidative stress, DNA damage and inflammation.
Materials and methods:
Freshly diagnosed untreated 25 OLP reticular type and 25 OLP erosive (OLP-E) type patients aged 35-55 years were enrolled in the study along with age and sex-matched 25 healthy subjects as control. Tissue antioxidant enzymes were measured biochemically, single-cell DNA damage was measured by comet assay and the molecular markers for inflammation were assessed by using semi-quantitative reverse transcriptase-polymerase chain reaction. Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test.
Results:
Oxidative stress was significantly greater in OLP-E type compared to the reticular. mRNA expression of cyclooxygenase-2 was significantly elevated (P < 0.0001) in erosive form, but such expression of nuclear factor kappa beta, tumor necrosis factor-alpha, Interleukin-6 and inducible nitric oxide synthase did not significantly differ between the two disease groups. Comet assay revealed a higher degree of DNA strand breakage in erosive lesions.
Conclusions:
The unhandled free radicals may imbalance the homeostatic network toward pro-inflammatory, DNA damaging responses, creating a vicious cell-damaging spree resulting in stress. Molecular analyses showed that erosive lichen planus is more under stress than the reticular form.
The article presents the data of a comprehensive assessment of the course of the wound process using modern methods. The effectiveness of additional physical methods of sanitation in local treatment has been proved. It was found that the proposed diagnostic algorithm made it possible to identify the features of the wound process, as well as the features and patterns of pathomorphological changes. The proposed clinical diagnostic algorithm can be used to assess the effectiveness of various means of local wound treatment, including physical methods of influencing the wound process (2 figs, bibliography: 11 refs).
With an increasing body of evidence that SARS-CoV-2 is an airborne pathogen, droplet character formed during speech, coughs, and sneezes are important. Larger droplets tend to fall faster and are less prone to drive the airborne transmission pathway. Alternatively, small droplets (aerosols) can remain suspended for long time periods. The small size of SARS-CoV-2 enables it to be encapsulated in these aerosols, thereby increasing the pathogen’s ability to be transmitted via airborne paths. Droplet formation during human respiratory events relates to airspeed (speech, cough, sneeze), fluid properties of the saliva/mucus, and the fluid content itself. In this work, we study the fluidic drivers (fluid properties and content) and their influence on factors relating to transmissibility. We explore the relationship between saliva fluid properties and droplet airborne transmission paths. Interestingly, the natural human response appears to potentially work with these drivers to mitigate pathogen transmission. In this work, the saliva is varied using two approaches: (1) modifying the saliva with colloids that increase the viscosity/surface tension, and (2) stimulating the saliva content to increased/decreased levels. Through modern experimental and numerical flow diagnostic methods, the character, content, and exposure to droplets and aerosols are all evaluated. The results indicate that altering the saliva properties can significantly impact the droplet size distribution, the formation of aerosols, the trajectory of the bulk of the droplet plume, and the exposure (or transmissibility) to droplets. High-fidelity numerical methods used and verify that increased droplet size character enhances droplet fallout. In the context of natural saliva response, we find previous studies indicating natural human responses of increased saliva viscosity from stress and reduced saliva content from either stress or illness. These responses both favorably correspond to reduced transmissibility. Such a finding also relates to potential control methods, hence, we compared results to a surgical mask. In general, we find that saliva alteration can produce fewer and larger droplets with less content and aerosols. Such results indicate a novel approach to alter SARS-CoV-2’s transmission path and may act as a way to control the COVID-19 pandemic, as well as influenza and the common cold.
The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.
Tactile and pain sensitivity of the oral mucosa has been the subject of study of a number of researchers. However, the numerical values of the thresholds of the excitation of the baro - and mechanoreceptors of the mucosa of the oral cavity not sufficiently detailed in the literature, experimental data is highly scattered, often presented without specifying the method of measurement or sections of the jaws, which were received. However, the authors note the unequal sensitivity of the mucous membrane in its different areas and its dependence on the presence or absence of a number of chronic diseases. Systematic study on the diagnosis of sensitivity associated with dental prostheses of the prosthetic bed tissues to pressure, virtually no. In this report the authors made some attempt to rectify this gap. It shows the numerical values of thresholds of pain sensitivity of the mucous membrane of the oral cavity of humans and animals by mechanical action on the basis of literary data and results of numerical analysis of the mathematical model “obturator maxillary prosthesis - mucosa the edges of the defect of the upper jaw”. The average value of the lower threshold of pain sensitivity was 20,72 g/m2 according to the data of different authors, and the upper limit was 63,82 g/m2.
Patient‐based outcomes complement clinical data with patients’ self‐evaluation of their physical, psychological, and social well‐being, and as such facilitate clinical decision‐making, assessing the quality of care provided, and evaluating practices and policies. Some validated generic oral health‐related quality of life measures used in recent research indicated a high performance. There is a proportional relationship between the quality of life and periodontitis, ie, the higher the level of periodontitis, the poorer the oral health‐related quality of life. This relationship is heightened by the presence of symptoms such as bleeding, halitosis, and mobility. On the other hand, periodontal treatment has demonstrated the capability to improve quality of life substantially. Future research should focus on questionnaires that are able to explain the interlinked pathways between periodontal conditions, approaches to treatment approaches, and patients’ well‐being. The acquisition of new knowledge in the field is essential for the whole community, as we treat people not millimeters.
Introduction: A biomarker is a biological indicator of normal or pathogenic processes. Identification of biomarkers is useful for the prevention, diagnosis and prognosis of diseases as well as for monitoring the progression of pathological disorders. Several types of molecules present in biological fluids can act as biomarkers such as DNA, coding and non-coding RNA, lipids, metabolites, proteins and even microbes. In this context, saliva emerges as a useful diagnostic tool for the detection of biomarkers involved with oral and systemic diseases, since it reflects the pathophysiological conditions of the organism and allows early, rapid, practical and noninvasive detection of biomarkers.
Areas covered: This review discusses the properties of saliva as a diagnostic tool and addresses the main identified biomarkers related to dental caries, periodontal disease, head and neck cancer and other types of cancer of considerable incidence among the world population.
Expert commentary: Despite extensive efforts which have been directed toward the identification of one or a combination of biomarkers with good predictive values for the early detection of dental caries, periodontal disease and cancer, these biomarkers still need validation before chairside point-of-care devices can be widely used in the clinic.
Background:
Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease with numerous clinical manifestations. There is no consensus about the ideal oral management for this group of patients to date. This review aimed to describe the broad spectrum of orofacial and clinical manifestations and their therapeutic approaches.
Methods:
Studies concerning orofacial manifestations of SLE and dental treatment modalities were selected by a literature search (1978-2019) using Google Scholar, PubMed/MEDLINE electronic databases.
Results:
The initial search strategy provided a total of 129 articles, and of these, 30 were included for qualitative synthesis. The reviewed studies revealed that SLE patients are more at risk of compromised oral and dental health exhibiting increased risk of periodontal diseases and temporo-mandibular joint disorders. The use of systemic drugs especially immunosuppressive and anticoagulants in SLE patients may also influence their oral management.
Conclusion:
Results emphasize the need to carry out, at an early stage of the disease, an appropriate oral management of these patients to improve oral health related quality of life and to prevent the need of more invasive therapeutics. A multidisciplinary approach is needed for dental and medical management of such patients.
The proper diagnosis is a critical factor to reduce further disturbances at the early stage of the disease and plays an important role in increasing the success rate of the therapy. The traditional diagnostic tools such as biopsy or blood collection are always associated with patient’s discomfort, the possibility of infections and time-consuming procedures. This article describes the non-invasive and easily accessible saliva as a source of numerous molecular biomarkers. The salivary fluid can provide information about the pathological changes not only in the oral area but also in other parts of the body, therefore salivary tests may be promising tools for risk prediction and treatment monitoring of many disorders.
Autoimmune bullous diseases are a group of chronic inflammatory disorders caused by autoantibodies targeted against structural proteins of the desmosomal and hemidesmosomal plaques in the skin and mucosa, leading to intra-epithelial or subepithelial blistering. The oral mucosa is frequently affected in these diseases, in particular, in mucous membrane pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus. The clinical symptoms are heterogeneous and may present with erythema, blisters, erosions, and ulcers localized anywhere on the oral mucosa, and lead to severe complaints for the patients including pain, dysphagia, and foetor. Therefore, a quick and proper diagnosis with adequate treatment is needed. Clinical presentations of autoimmune bullous diseases often overlap and diagnosis cannot be made based on clinical features alone. Immunodiagnostic tests are of great importance in differentiating between the different diseases. Direct immunofluorescence microscopy shows depositions of autoantibodies along the epithelial basement membrane zone in mucous membrane pemphigoid subtypes, or depositions on the epithelial cell surface in pemphigus variants. Additional immunoserological tests are useful to discriminate between the different subtypes of pemphigoid, and are essential to differentiate between pemphigus and paraneoplastic pemphigus. This review gives an overview of the clinical characteristics of oral lesions and the diagnostic procedures in autoimmune blistering diseases, and provides a diagnostic algorithm for daily practice.
In this review, we provide an update on the current and future applications of saliva for diagnostic purposes. There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a “mirror of the body,” can reflect the physiological and pathological state of the body. Therefore, it serves as a diagnostic and monitoring tool in many fields of science such as medicine, dentistry, and pharmacotherapy. Introduced in 2008, the term “Salivaomics” aimed to highlight the rapid development of knowledge about various “omics” constituents of saliva, including: proteome, transcriptome, micro-RNA, metabolome, and microbiome. In the last few years, researchers have developed new technologies and validated a wide range of salivary biomarkers that will soon make the use of saliva a clinical reality. However, a great need still exists for convenient and accurate point-of-care devices that can serve as a non-invasive diagnostic tool. In addition, there is an urgent need to decipher the scientific rationale and mechanisms that convey systemic diseases to saliva. Another promising technology called liquid biopsy enables detection of circulating tumor cells (CTCs) and fragments of tumor DNA in saliva, thus enabling non-invasive early detection of various cancers. The newly developed technology—electric field-induced release and measurement (EFIRM) provides near perfect detection of actionable mutations in lung cancer patients. These recent advances widened the salivary diagnostic approach from the oral cavity to the whole physiological system, and thus point towards a promising future of salivary diagnostics for personalized individual medicine applications including clinical decisions and post-treatment outcome predictions.
Impact statement
The purpose of this mini-review is to make an update about the present and future applications of saliva as a diagnostic biofluid in many fields of science such as dentistry, medicine and pharmacotherapy. Using saliva as a fluid for diagnostic purposes would be a huge breakthrough for both patients and healthcare providers since saliva collection is easy, non-invasive and inexpensive. We will go through the current main diagnostic applications of saliva, and provide a highlight on the emerging, newly developing technologies and tools for cancer screening, detection and monitoring.
In article the most often arising diseases from skin are described and a mucosa of an oral cavity at patients with a diabetes mellitus: mechanisms of their emergence, prophylaxis methods.
Background
Knowledge about the magnitude of Oral Health‐Related Quality of Life (OHRQoL) impairment across dental patient populations is essential for clinical practice, public health, and research. Within the project Mapping Oral Disease Impact with a Common Metric, this systematic review aimed to describe functional, pain‐related, aesthetic, and broader psychosocial impact of oral conditions with a single metric using OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact .
Methods
A search using PubMed, EMBASE, Cochrane, CINAHL, and PsycINFO was performed on June 8, 2017, and updated on January 14, 2019. Only publications in the English language were considered. To characterize the extent of available standardized and clinically relevant OHRQoL information, we determined the number of publications, dental patient populations, which are clinically similar, and patient samples within each population with four‐dimensional OHRQoL information using the Oral Health Impact Profile (OHIP) questionnaire. A quality assessment and a publication bias assessment were performed.
Results
We identified 171 publications that characterized 199 dental populations and 329 patient samples with four‐dimensional OHRQoL information. The vast majority of populations were only characterized by one patient sample. Study quality was not related to OHRQoL magnitude, and substantial publication bias could be excluded.
Conclusions
Standardized and clinically relevant information using the four OHRQoL dimensions Oral Function , Orofacial Pain , Orofacial Appearance , and Psychosocial Impact was available for a significant number of dental patient populations. Findings can provide a framework to interpret OHRQoL impairment of individual patients, or groups of patients, for clinical practice, public health, and research.
The high prevalence of dental diseases, increase of population exactingness to availability and quality of dental medical care predetermine the development of relevant management decisions. The purpose of study was to define the priorities of demand of medical technologies in dental polyclinic. The evaluation of importance of the technologies implemented in case of particular dental diseases was given based on analysis of 37.3 thousand visits of adult population to dental polyclinic and implementation of more than 200 thousand dental manipulations. The 13 groups of technologies applied were established. The calculation of the coefficient of relative importance and its integrated evaluation was carried out. It is established that most of implemented technologies in dental polyclinic were targeted to treatment of caries of teeth and other defects of tissues of tooth that made 37.4% of all dental medical care provided and also pulpitis (20.9%), periodontitis and periapiсal pathology (25.1%). The most demanded technologies are treatment of caries, restoration of crown of tooth, all-diagnostic procedures, anesthesia, survey and consultation. The preventive manipulations consisted 69.2% of all important for patient technologies. The established quantitative importance of dental technologies defines perspective of their demand and main positions of dental polyclinic in development of corresponding strategy.
In vivo Reflectance Confocal Microscopy (RCM) allows to optically biopsy vital tissues, non-invasively and in real time. It results in horizontal virtual slices at a microscopic resolution and correlating with conventional histopathology. The aim of the present work is to describe RCM cellular and architectural findings in oral mucosae affected by erosive-ulcerative diseases, thus highlighting in vivo the wellknown histological peculiarities. A series of conventionally diagnosed Recurrent Aphthous stomatitis (RAS) and Pemphigus Vulgaris (PV) erosive and/or ulcerative oral lesions underwent RCM imaging to establish the application of RCM imaging to this kind of inflammatory non-tumoral lesions. A total of 12 RAS-related lesions and 8 PV-related lesions were considered. RCM imaging was capable to visualize their microscopic peculiarities, mainly inflammatory infiltrate, vessel dilation (RAS) and acantholytic cells, intraepithelial clefts and inflammatory cell carpets (PV). Despite RCM may result unnecessary to diagnose oral lesions referred to RAS and PV, its capability to highlight their main microscopic features could be advantageously used to monitor the healing or worsening of the clinical situation as well as the responsiveness/refractoriness to therapy.
The electrochemical properties of CoCrMo alloy immersed in different artificial saliva with or without Ca2+ and albumin were studied by open circuit potential (OCP), electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PP), and meanwhile the microstructures features, phase identification and chemical composition of the alloy were analyzed by SEM, EDS, XRD and RA-IR to further understand the electrochemical behavior of the alloy. The results indicated that the self-passivation behavior of the alloy occurred universally and was obviously distinct with each other in different acidic artificial saliva. No phase transformation was observed and the oxide layer and corrosion products exhibited amorphous nature. There was an obvious complexation of the adsorbed albumin with the alloy, and the adsorption capacity of albumin increased with the prolongation of immersion time. The adsorbed albumin presenting black stripped spots had a certain inhibition to the formation of passivation film, and Ca2+ in saliva promoted the further adsorption of albumin as an intermediate bridge, going against the improvement of the corrosion resistance of passivation film/alloy system. In addition, the passivation state of the alloy surface was changed by different methods to investigate the adsorption behavior of albumin and its influence on the further passivation behavior in depth. Hitherto, we tried to propose a model to explain the dynamic adsorption process of albumin and its influencing mechanism on the growth behavior of passivation film.
Objectives:
To evaluate the efficacy and safety of apremilast in treating oral ulcers (OUs), the cardinal and high-disabling feature of Behçet's disease (BD).
Methods:
Twelve consecutive patients affected by BD with recurrent/relapsing OUs resistant and/or intolerant to conventional therapy were enrolled and prospectively followed. The primary endpoint was the number of OUs at week 12. Secondary endpoints were modification from baseline to week 12 in Behçet's Syndrome Activity Score (BSAS), Behçet's Disease Current Activity Form (BDCAF) score, Behçet's Disease Quality of Life (BDQOL) scale and pain of OUs, as measured by a visual analogue scale (VAS). All adverse events (AEs) were recorded during follow-up. Non-parametric tests (Wilcoxon rank test) were used and a P-value <0.05 was considered statistically significant.
Results:
After 12 weeks of apremilast, there was a significant reduction in the number of OUs [0.58 (s.d. 0.67) vs 3.33 (s.d. 1.45) at baseline, P = 0.02] that was paralleled by improvement in disease activity: BSAS was 16.8 (s.d. 9.1) [from 45.9 (s.d. 19.6) at baseline] (P = 0.02), BDCAF score was 0.72 (s.d. 0.65) [vs 2.45 (s.d. 1.0) at baseline] (P = 0.04) and the VAS score for pain decreased to 23.3 (s.d. 13.7) [vs 67.9 (s.d. 17.2) at baseline] (P = 0.02). Consistently, an improvement of BDQOL was assessed (P = 0.02). Clinical improvement led to complete steroid discontinuation in six patients and a tapering of the prednisone dose in two patients (P = 0.016). Colchicine was discontinued in six of nine patients (P = 0.031). AEs related to apremilast occurred in four patients (mainly due to gastrointestinal AEs), leading to drug discontinuation in all of them.
Conclusion:
Our preliminary real-world data support the use of apremilast as an effective therapeutic strategy against BD-related recurrent OUs resistant or intolerant to first-line therapy.
Objectives:
The holy grail of biomarker research in periodontology is to develop a high impact diagnostics which have a significant impact on clinical decision-making, patient outcomes and healthcare providers. In the field of periodontal diagnostics, oral fluid-based biomarkers have been studied mainly in the gingival crevicular fluid (GCF) and saliva.
Methods:
A literature search was performed using the Cochrane library and PubMed databases from 2000 to January 2017.
Results:
Currently, there are more than 90 different components in the GCF that have been investigated as diagnostic and prognostic markers of periodontal disease progression involving; inflammatory mediators, markers of oxidative stress, host-derived enzymes, tissue-breakdown products and mediators of bone homeostasis. Furthermore, various biomarkers in saliva have been proposed which reveal a promising outlook for saliva as a key diagnostic medium for periodontal disease. Recent systematic reviews with high value of evidence have shown that potential salivary biomarkers can provide important complimentary diagnostic information and can be used as tests for screening diagnosis, prognosis and predicting periodontal disease progression.
Conclusion:
Future developments in proteomic analysis and personalized medicine will pave the way allowing novel diagnostic tools. Still, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.
Clinical relevance:
Still, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.
Importance:
Inflammatory bowel diseases (IBD), such as Crohn disease and ulcerative colitis, are chronic relapsing conditions that affect a growing number of children worldwide. The pathogenesis of these disorders is complex and thought to be mediated by the interplay between genetic susceptibility, microbial dysbiosis, and environmental factors that result in a dysregulated immune system. This dysregulation ultimately mediates intestinal inflammation and clinical symptoms typically observed in patients with IBD including abdominal pain, diarrhea, and poor growth. A dramatic increase in the incidence of IBD has been observed in the past 2 decades, mainly in developed countries but also in developing regions. This increased incidence has paralleled changes in diet, sanitation conditions, and lifestyle habits.
Observations:
The increased incidence of IBD can likely be attributed to more than evolving genetic diversity alone and strongly suggests that environmental factors are playing an increasingly critical role in the development of these disorders and in the modulation of IBD clinical phenotypes over time. Here, we review the data suggesting how different environmental factors may modulate the risk of developing IBD including diets, smoking, lifestyle choices, enteric infections, appendectomy, air pollution, and the use of medications, with an emphasis on antibiotics. We will also discuss how early-life events can influence the subsequent likelihood of developing one of these diseases and suggest directions that can help decrease the risk of IBD in particularly high-risk populations.
Conclusions and relevance:
Dramatic lifestyle changes in the last century have substantially improved the quality of life but are also associated with increased risk of various diseases. Pediatricians should be aware of the changing epidemiology of IBD and environmental factors that modulate the risk of developing these conditions.
Purpose of review:
A resurgence of interest in salivary biomarkers has generated evidence for their value in assessing adrenal function. The advantages of salivary measurements include only free hormone is detected, samples can be collected during normal daily routines and stress-induced cortisol release is less likely to occur than during venepuncture. We review the use of salivary biomarkers to diagnose and monitor patients for conditions of cortisol excess and deficiency and discuss the value of measuring salivary cortisone versus salivary cortisol.
Recent findings:
Developments in laboratory techniques have enabled the measurement of salivary hormones with a high level of sensitivity and specificity. In states of altered cortisol binding, salivary biomarkers are more accurate measures of adrenal reserve than serum cortisol. Salivary cortisone is a superior marker of serum cortisol compared with salivary cortisol, specifically when serum cortisol is low and during hydrocortisone therapy when contamination of saliva may result in misleading salivary cortisol concentrations.
Summary:
Salivary cortisol and cortisone can be used to assess cortisol excess, deficiency and hydrocortisone replacement, with salivary cortisone having the advantage of detection when serum cortisol levels are low and there is no interference from oral hydrocortisone.
Behçet's disease (BD) is a chronic, relapsing, inflammatory multisystem disease of unknown etiology. Oral ulcers, genital ulcers, cutaneous lesions, and ocular and articular involvement are the most frequent features of the disease. Mucocutaneous lesions are considered hallmarks of the disease, and often precede other manifestations. Therefore, their recognition may permit earlier diagnosis and treatment with beneficial results for prognosis. BD is particularly prevalent in "Silk Route" populations but has a global distribution. The disease usually starts around the third or fourth decade of life. Sex distribution is roughly equal. The diagnosis is based on clinical criteria, as there is no pathognomonic test. Genetic factors have been investigated extensively, and association with human leukocyte antigen (HLA)-B51 is still known as the strongest genetic susceptibility factor. The T-helper 17 and interleukin (IL)-17 pathways are active, and play an important role, particularly in acute attacks of BD. Neutrophil activity is increased in BD, and the affected organs show a significant neutrophil and lymphocyte infiltration. HLA-B51 association and increased IL-17 response are thought to play a role in neutrophil activation. Treatment is mainly based on the suppression of inflammatory attacks of the disease using immunomodulatory and immunosuppressive agents. Although treatment has become much more effective in recent years with the introduction of newer drugs, BD is still associated with considerable morbidity and increased mortality. Male sex, younger age of onset and increased number of organs involved at the diagnosis are associated with a more severe disease and, therefore, require more aggressive treatment.
Purpose:
To propose a treatment protocol for management of implant candidates suffering from active lichen planus.
Materials and methods:
Twenty-three patients who were diagnosed with active lichen planus were referred to a dental practice seeking dental implants. Patients received dental implants using open flap technique and sequential osteotomy. After a healing time of 6 weeks, implants were put into occlusal contact using interim prostheses. Of the 55 inserted implants, 42 failed after a short clinical service time (7 to 11 weeks). Failed implants were surgically removed, and osteotomy sites were carefully cleaned using manual curettes and scrubbing of osteotomy walls. CD4/CD8 cell count and gingival biopsies were collected from the surgical sites. Patients were put on an ascending dose (5 mg/10 days) of oral corticosteroids until a daily dose of 20 mg/day was achieved and maintained for 2 weeks. All patients received ten sessions of low-energy soft tissue laser irradiation at the implant insertion sites to assess soft tissue healing through improving blood circulation, reduction of inflammation, and sterilization of the osteotomy region. After approximately 8 weeks, a new set of 42 implants was placed, and definitive restorations were cemented using early loading technique. Marginal bone levels around inserted implants were periodically evaluated every 3 months using digital periapical radiographs (α = 0.05).
Results:
Primary blood tests revealed a high CD8 cell count, while soft tissue biopsies revealed infiltration of inflammatory cells at the epithelium soft tissue interface of the examined tissue. Repetition of immunological investigations after administration of the oral corticosteroids and soft tissue laser irradiation revealed reduction of CD8 cell counts and disappearance of inflammatory cell infiltration of the examined soft tissue biopsy. Patients reported marked improvement of the oral mucosa after treatment. All implants (n = 42) were functional after 3 years of clinical observation. There was an initial reduction in marginal bone level after 3 months from insertion time, after which it remained constant during the following observation periods.
Conclusion:
Active lichen planus should be managed with oral corticosteroids and soft tissue laser irradiation before insertion of dental implants.
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