C. Di Liberto

Oral manifestations of eating disorders: a critical review

BACKGROUND Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED. METHODS Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed. RESULTS Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances. CONCLUSION Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.

A new delivery system of clobetasol‐17‐propionate (lipid‐loaded microspheres 0·025%) compared with a conventional formulation (lipophilic ointment in a hydrophilic phase 0·025%) in topical treatment of atrophic/erosive oral lichen planus. A Phase IV, randomized, observer‐blinded, parallel group clinical trial

Background  Topical application of clobetasol‐17‐propionate has been diffusely reported as an efficacious therapy in atrophic/erosive oral lichen planus (OLP), without exposing the patient to systemic side‐effects. However, prolonged contact and respective topical effects on the oral mucosa should be avoided.

Oral pathology in untreated coelic disease

Background Many coeliac disease patients with atypical symptoms remain undiagnosed.

Saliva variations in gastro-oesophageal reflux disease

OBJECTIVES The protective role of saliva in the case of oesophageal exposition to gastric acid has long been studied but some contradictions still remain. The main end-point of this study was to evaluate if a qualitative and quantitative alteration in salivary secretion exists in patients affected by GERD. METHODS One hundred and twenty patients (T group) with clinically and endoscopically diagnosed GERD, and 98 healthy subjects (C group) have been evaluated; salivary tests (i.e. basal flow rate, stimulated flow rate, pH, [Na(+)] and [K(+)]) were performed, socio-demographical variables and oral GERD-related symptoms were taken into account. SPSS 10.5 software was used for statistical univariate and multivariate analyses. RESULTS GERD patients and controls were found to have a similar basal flow rate but different stimulated salivary function [T group mean value 0.989 ml/min (+/-0.48718) vs. C group 1.2197 ml/min (+/-0.6108), pH [T group mean value 8.935 (+/-0.471) vs. C group 7.879 (+/-0.526)] and a higher K(+) concentration. In GERD patients we also registered a significant association with xerostomia [69/120 (57.5%) vs. 28/98 (28.7%)] and an oral burning sensation [58/120 (48.3%) vs. 19/98 (19.3%)]. CONCLUSIONS Our findings assess that salivary secretion is altered in GERD patients and highlight the need for further investigations in order to define the role of saliva in the etiopathogenesis of GERD.

Oral mucosa of coeliac disease patients produces antiendomysial and antitransglutaminase antibodies: the diagnostic usefulness of an in vitro culture system.

Background  Antiendomysial (EmA) and antitransglutaminase (anti‐tTG) antibodies are the most specific indirect marker of coeliac disease (CD). It is not known whether the oral mucosa of patients with CD is able to produce these antibodies or not.

Histomorphology of healthy oral mucosa in untreated celiac patients: unexpected association with spongiosis

BACKGROUND The jejunal mucosa is the major site involved in celiac disease, but modifications have also been found in the gastric, rectal and esophageal mucosa. Few studies have focused on the histomorphological features of the oral mucosa in celiac disease patients. Our objectives were: (i) to assess the presence, quality and intensity of lymphocytic infiltrate in clinically healthy oral mucosa and its relation to celiac disease severity (villous height to crypt depth ratio); and (ii) to detect any other histological features connected to celiac disease. METHODS Twenty-one untreated celiac disease patients (age range 13-68 years) with clinically healthy oral mucosa were enrolled and compared with 14 controls. Intestinal and oral biopsies were carried out and specimens were evaluated after staining with hematoxylin and eosin. RESULTS Intra-epithelial lymphocyte B and T infiltrates of the oral mucosa were found to be similar in both groups; likewise, intensity of the lymphocytic infiltrate in the lamina propria was similar in both groups and was not related to intestinal damage; important signs of spongiosis were found to be more significantly present in celiac disease patients compared with controls (P = 0.0002). CONCLUSIONS Our study showed that the healthy oral mucosa of untreated patients does not reflect the intestinal damage by celiac disease, but it is unexpectedly affected by spongiosis, as being detected for the first time in the literature. This latter feature could be related to gliadin ingestion and could contribute to explain the higher susceptibility of celiac disease patients to suffering from oral mucosa lesions.

Oral pathology in untreated coelic disease: ORAL AND DENTAL LESIONS IN UNTREATED COELIC DISEASE

Background Many coeliac disease patients with atypical symptoms remain undiagnosed.