Andrea Sardella

Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review

Background  An association between hepatitis C virus (HCV) infection and lichen planus (LP) has been investigated, but results have been inconsistent.

Benzydamine hydrochloride oral rinses in management of burning mouth syndrome. A clinical trial.

OBJECTIVE The purpose of this study was to evaluate the efficacy of the topical use of benzydamine hydrochloride 0.15% oral mouthwashes in the control of burning mouth syndrome symptoms. STUDY DESIGN In this double-blind, randomized, longitudinal investigation, each of 30 patients with burning mouth syndrome was assigned to one of 3 management modalities. Those in group A received an oral rinse solution of benzydamine hydrochloride 0.15% 3 times a day for 4 weeks, those in group B received a placebo 3 times a day for 4 weeks, and those in group C did not receive any kind of treatment. A visual analog scale was used for evaluation of the symptoms; a Kruskal-Wallis analysis of variance exact test was performed on the resulting data. RESULTS The findings of this investigation failed to reveal significant differences among the groups. CONCLUSIONS The clinical application of benzydamine hydrochloride oral rinses in the treatment of patients with burning mouth syndrome did not demonstrate significative efficacy in comparison with use of a placebo solution.

Tooth Extraction in Patients Taking Intravenous Bisphosphonates: A Preventive Protocol and Case Series

PURPOSE To test the efficacy of a protocol in preventing the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction. PATIENTS AND METHODS In this prospective case series, consecutive subjects treated with intravenous bisphosphonates who needed tooth extraction underwent a protocol aimed at reducing the risk of BRONJ, based on local and systemic infection control by means of mechanical and chemical reduction of the local bacterial load plus antibiotic prophylaxis. RESULTS We performed 38 extractions in 23 patients treated with intravenous bisphosphonates, mainly zoledronate, for a mean of 17.5 months (range, 3-36 months). Five patients already had signs of BRONJ caused by tooth extractions performed elsewhere. The mean follow-up was 229.5 days (range, 14-965 days), and no case of BRONJ was recorded. CONCLUSIONS Despite the methodologic limitations of the study design, the proposed preventive protocol appears to reduce the risk of BRONJ after tooth extraction in a group of subjects treated with intravenous bisphosphonates.

Plant Polyphenols and Oral Health: Old Phytochemicals for New Fields

Despite the protective role of diets rich in fruit plant polyphenols against some cancers and chronic degenerative and inflammatory diseases, insufficient emphasis has been placed on oral health. Numerous studies have aimed to ascertain the role of polyphenols in the prevention and treatment of oral diseases; however, even when in vitro evidence appears convincing, the same is not true for in vivo studies, and thus there is a general paucity of solid evidence based on animal and clinical trials. To the best of our knowledge, only two reviews of polyphenols and oral health have been published; however, neither considered the potential role of whole plant extracts, which contain mixtures of many polyphenols that are often not completely identified. In the present study, our main aim was to review the current state of knowledge (search period: January 1965 to March 2011) on the effects of plant extracts/polyphenols on oral health. We found data on grapes, berries, tea, cocoa, coffee, myrtle, chamomile, honey/propolis, aloe extracts and the three main groups of polyphenols (stilbenes, flavonoids and proanthocyanidins). Their effects on caries, gingivitis, periodontal disease, candidiasis, oral aphtae, oral mucositis, oral lichen planus, leukoplakia and oral cancer were investigated. The data suggest that there is a lack of strong evidence, in particular regarding randomized clinical trials. However, a fascinating starting point has been provided by pre-clinical studies that have shown interesting activities of polyphenols against the most common oral diseases (caries, periodontitis and candidiasis), as well as in oral cancer prevention.

Miconazole as adjuvant therapy for oral lichen planus: a double-blind randomized controlled trial

Background  Topical steroids are the first choice for the treatment of oral lichen planus (OLP). Antifungal drugs are often employed together with them, to prevent secondary oral candidosis, although it has been suggested anecdotally that they can also be beneficial for OLP itself.

Hypericum perforatum extract in burning mouth syndrome: a randomized placebo-controlled study.

Burning mouth syndrome (BMS) or stomatodynia is characterized by a spontaneous burning pain in the oral mucosa without known cause or recognized treatment. This double-blind, randomized, placebo-controlled, single-center study evaluated the effects of systemic Hypericum perforatum extract in patients with BMS. Forty-three patients participated, of whom 39 (35 women, four men, aged 64.9 +/- 4.7 years) completed the study. The patients took indistinguishable 300-mg capsules containing either H. perforatum extract (hypericin 0.31% and hyperforin 3.0%) or placebo three times a day for 12 weeks. The intensity of burning pain was evaluated using a 10-cm visual analog scale (VAS) before the first dose and at visits after 4, 8, and 12 weeks. Furthermore, we also recorded the number of oral mucosa sites with reported burning symptoms and the self-reported descriptions of the patients condition before and after the treatment. Pain, measured using the VAS, was similar at the beginning of the study and even though a slightly better performance in the test group, the difference was not statistically significant (P = 0.2216). The results failed to demonstrate that 300 mg of H. perforatum extract taken three times a day for 12 weeks improved the pain of BMS patients, although the general reduction in the number of sites with reported burning sensation, a less accurate and objective score, was significant.

GM-CSF mouthrinses in the treatment of severe oral mucositis: A pilot study

OBJECTIVE The aim of this open trial was to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthrinses as a potential treatment in reducing the duration of severe oral mucositis in patients undergoing bone marrow transplantation for hematologic malignancies. STUDY DESIGN The study group was composed of 10 consecutive patients suffering from severe oral mucositis during bone marrow transplantation procedures. The control group was similar to the study group in age and gender and comprised 29 historical patients with similar clinical characteristics. Freshly prepared GM-CSF mouthwash (0.5 microg/mL) was administered to the study population for 1 minute 3 times per day after oral hygiene procedures, starting from the first day of mucositis until clinical improvement of oral lesions. The study and control populations were compared with respect to duration of severe oral mucositis (1-9 days, 10-19 days, > or =20 days). RESULTS There was no statistically (chi2 exact test) significant difference in mean mucositis score between the study group (11.9+/-6.1) and the control group (16.6+/-8.9). However, the duration of severe mucositis appeared to be reduced; 60% of the GM-CSF mouthrinse patients had severe mucositis for less than 9 days, whereas only 28% of the controls had severe mucositis for less than 9 days. In addition, 10% of the GM-CSF mouthrinse patients experienced severe mucositis lasting 20 or more days, whereas 34% of the controls experienced severe mucositis for 20 or more days. CONCLUSIONS These findings suggest that GM-CSF may reduce the duration of severe mucositis, but controlled, double-blind clinical trials are now required.

Localised maxillary ridge expansion with simultaneous implant placement: A case series

The placement of implants in edentulous areas is often compromised by a thin alveolar crest, which widens the space between the two cortical bones; this offers advantages from aesthetic, biomechanical, and functional points of view. We present our results using the osteotome technique for the creation of a site for an implant, followed by immediate placement of the implant in thin edentulous maxillae, and the stability of the bony expansion over time. Twenty-three patients (six men and seventeen women) with partial edentulism associated with horizontal resorption of the ridges were treated by this technique to obtain a wider bony base for better placement of the implants. At the same time, 36 endosseous titanium implants were inserted. Three to four months later, the patients were rehabilitated with implant-supported prostheses. All implants were successfully osseointegrated and loading began after 61-197 days. All implants inserted were 4.1 mm in diameter, and between 10 and 15 mm long. All the implant-supported prostheses functioned acceptably, with no signs or symptoms such as paraesthesiae, dysaesthesiae, or pain. Within the limits of this study this technique seems to be reliable and simple with little morbidity, and rehabilitation was as good as that after other techniques such as autogenous bone grafts or guided bone regeneration. Survival and the success of implants placed were consistent with those placed in non-reconstructed bone.

Iatrogenic Cushing's syndrome and topical steroid therapy: case series and review of the literature

Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushings syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment.

Primary oral tuberculosis: a case series from Bucharest, Romania

Tuberculosis (TB) is a chronic granulomatous disease that affects various systems of the body. Although the pulmonary form is most common, TB can also occur in the lymph nodes, kidneys, bones, and oral cavity. Oral TB is often a consequence of active pulmonary TB and is relatively rare. Here, we report a series of cases that emphasize the importance of considering oral TB in the differential diagnosis of mucosal lesions. In addition, although primary oral TB was previously considered a disease of the young, these cases demonstrate that it may occur in subjects of all ages.