Fabio Camacho-Alonso

Quality of life in patients with burning mouth syndrome

OBJECTIVE To study the quality of life in patients with burning mouth syndrome (BMS), our primary aim was to compare BMS patients with healthy controls and the secondary aim was to compare subgroups of BMS patients on the type of therapy received; using the Medical Outcome Short Form Health Survey Questionnaire (SF-36) and the Oral Health Impact Profile (OHIP-49) as measurement instruments. METHOD Sixty consecutive patients (10 males and 50 females) with BMS were studied in the Department of Oral Medicine (Faculty of Medicine and Dentistry, University of Murcia, Spain), while 60 healthy patients were used as controls. The Spanish version of the SF-36 was used to evaluate general quality of life, together with the OHIP-49 in its Spanish version. RESULTS Regarding general quality of life as assessed with the SF-36, and on comparing the BMS vs. the control groups, lower scores were obtained in the former in all domains (P < 0.001). The OHIP-49 in turn yielded significant differences in each of the domains vs. the controls. No significant differences were found between the patients with BMS in any domain regarding parafunctional habits and the presence of dentures. In relation to the different treatments, significant differences were recorded in functional limitation (P = 0.02) and physical pain (P = 0.033). CONCLUSION Patients with BMS yield poorer scores on all scales vs. the healthy controls when applying the SF-36 and OHIP-49.

A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain

OBJECTIVES This study describes the clinicopathological characteristics of a group of patients with oral lichen planus (OLP) in south-eastern Spain. MATERIALS AND METHODS A retrospective descriptive study was made of 550 patients clinically and histopathologically diagnosed with OLP in the period 1991-2007. Patient gender, age, the prevalence of hepatitis C, symptoms and malignization were recorded. The clinical forms were classified as reticular-papular and atrophic-erosive. RESULTS Of the 550 patients, 128 (23.3%) were men and 422 (76.7%) women. The mean age was 56.35 +/- 13.67 years (range 14-91). The prevalence of hepatitis C was 3.5%. The red clinical forms were the most frequent, with 359 cases (64.2%). The lesions were asymptomatic in 159 patients (28.9%). Five patients developed oral squamous cell carcinoma (0.9%); none of these subjects was smokers. CONCLUSIONS Patients with OLP present different clinical manifestations. Women were more frequently affected by the disease, and the malignant transformation rate was under 1%.

Efficacy of topical Aloe vera in patients with oral lichen planus: a randomized double-blind study.

BACKGROUND   Different treatments have been used in application to symptomatic oral lichen planus (OLP), with variable results, perhaps caused by the refractory nature of the disease. The objective of this study was to evaluate the efficacy of the topical application of aloe vera (AV) in OLP compared with placebo. METHODS A total of 64 patients with OLP were randomized in a double-blind study to either AV (32 patients) or placebo (32 patients), at a dose of 0.4 ml (70% concentration) three times a day. A Visual Analog Scale was used for rating pain, with the application of a clinical scale for scoring the lesions, the Oral Health Impact Profile 49 (OHIP-49), and the Hospital Anxiety-Depression (HAD) scale. The patients were evaluated after 6 and 12 weeks. RESULTS No statistically significant differences were recorded between both groups in relation to pain after 6 and 12 weeks. In the AV group, complete pain remission was achieved in 31.2% of the cases after 6 weeks, and in 61% after 12 weeks. In the placebo group, these percentages were 17.2% and 41.6%, respectively. There were no adverse effects in any of the groups. In relation to quality of life, significant differences were observed between the two groups in the psychological disability domain and total OHIP-49 score. CONCLUSION The topical application of AV improves the total quality of life score in patients with OLP.

Premalignant nature of oral lichen planus. A retrospective study of 550 oral lichen planus patients from south-eastern Spain

The most important complication of oral lichen planus (OLP) is the development of squamous cell carcinoma (SCC)--this being an association that remains subject to controversy. This study aims to examine the incidence and clinical presentation of oral malignancies associated with OLP. A retrospective study was made of 550 patients diagnosed with OLP according to the criteria of the World Health Organization, in the period between 1991 and 2007, in south-eastern Spain 128 males (23.3%) and 422 females (76.7%). A clinical protocol was applied in all cases (sociodemographic data, habits and hepatitis C markers), with histological confirmation of the disease. Five of the 550 patients (0.9%) developed SCC. The mean duration of follow-up was 24+/-20.83 months. The tongue was the most common location. The exact incidence of malignant transformation of OLP is difficult to establish, due to the possible contribution of external risk factors that may be of relevance in oral malignancy.

Efficacy of alpha lipoic acid in burning mouth syndrome: a randomized, placebo-treatment study

To study the efficacy of alpha lipoic acid (ALA) in a group of patients with burning mouth syndrome (BMS). Sixty BMS patients, 30 treated with ALA (Thioderm) 800 mg day(-1) for 8 weeks and 30 patients on the same protocol with a placebo. The symptomatology was measured on a Visual Analogue Scale (VAS). Sixty patients (54 females and 6 males, mean age 64.37 +/- 11.61 years) were included. Thirty-nine patients completed the treatment (23 with ALA and 16 with a placebo). Reviews were carried out at 0, 1 and 2 months. No statistically significant differences were found in the average pre- and post-treatment values for pain with the VAS scores, obtained in the placebo (6.6 +/- 2.5 - 2.8 +/- 25 = 3.8 +/- 3.7) versus ALA (6.3 +/- 2.8 - 4.0 +/- 2.7 = 2.2 +/- 2.6). Only one patient pertaining to the group treated with ALA abandoned because of adverse gastrointestinal side effects. The results showed no significant differences between the two groups.

Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update

BACKGROUND The search for new drugs capable of controlling the symptoms and signs of oral lichen planus (OLP) with minimal side-effects remains an important challenge. OBJECTIVE A literature review is made to evaluate the effectiveness and safety of topical tacrolimus and pimecrolimus in the treatment of OLP. MATERIAL AND METHOD A review was made of the studies published between 1999 and 2008 in relation to the topical application of tacrolimus and pimecrolimus in OLP. RESULTS The data obtained point to the need for larger randomized, placebo-controlled studies with carefully selected and standardized endpoints, to allow adequate comparison between treatments. The adverse effects were fundamentally of a local nature, and in particular included burning sensation in the application zone. All the studies consulted found the treatment to be effective over short periods of time, with lesion recurrences after suppression of the drug. The long-term safety remains to be established. CONCLUSION There is need for larger placebo-controlled, randomized studies with carefully selected and standardized outcome measures.

Measuring the impact of oral mucosa disease on quality of life

Our objective was to study the quality of life in patients with oral mucosa disease. Two hundred sixteen consecutive patients with oral pathology were studied at the Department of Oral Medicine, University of Murcia (Spain). Sixty patients had burning mouth syndrome, 100 oral lichen planus, 41 recurrent aphthous stomatitis and 15 had and other oral mucosa disorders. The instruments applied were the Spanish version of the SF-36, used to evaluate general quality of life, and the OHIP-49, Spanish version, to measure oral health-related quality of life. With respect to oral quality of life (OHIP-49 all items), the worst scores were found for burning mouth syndrome. The group formed by other mucosal lesions presented the lowest scores for the domains role physical and general health in the SF-36. Oral mucosa diseases have a negative impact on health and quality of life. Administration of specific and generic questionnaires provides a detailed picture of the impact of oral diseases on patients, which adds information that may be useful in clinical practice.

An experimental study of bisphosphonate-induced jaws osteonecrosis in Sprague-Dawley rats.

OBJECTIVE Patients undergoing treatment with bisphosphonates may develop jaw lesions consisting mainly of bone necrosis. The present study describes a model of maxillary osteonecrosis in Sprague-Dawley rats, applying bisphosphonates and examines the changes occurring after tooth extraction. MATERIAL AND METHODS A total 200 animals were included in a randomized prospective study involving the following groups: group I (control, 20 rats without drug treatment), group II (60 animals administered dexamethasone 1 mg/kg/day for 7, 14 and 21 days, in subgroups of 20 animals each), group III (60 animals administered pamidronate daily at a dose of 3 mg/kg) and group IV (60 animals administered pamidronate and dexamethasone). In all groups, molar extraction was carried out on the right upper maxillary or mandibular side 8, 15 and 22 days after the start of dosing. The rats were killed 14 and 28 days after extraction in all groups. RESULTS A total of 18 cases of osteonecrosis were recorded in the group administered pamidronate and dexamethasone. Osteonecrosis affected the upper maxilla in 10 cases and the mandible in eight cases, and was circumscribed to the extraction zone in all cases. Osteonecrosis was not seen in any of the other groups. CONCLUSIONS The administration of pamidronate and dexamethasone in rats subjected to molar extraction increases the risk of osteonecrosis.

Quality of life in patients with Sjögren’s syndrome and sicca complex

To investigate the general and oral quality of life in patients with Sjögrens syndrome (SS) and sicca complex. Forty-four patients with SS were studied consecutively, 33 were primary SS and 11 secondary SS, classified in accordance with the Vitali European criteria. The Spanish version of the Medical Outcome Short Form (36) Health Survey questionnaire (SF-36) was used to evaluate general quality of life and the Oral Health Impact Profile (OHIP-49) Spanish version to study oral quality of life. Regarding general quality of life using the SF-36, when comparing the SS and the control groups, lower scores were obtained in the SS groups in all domains and on comparing primary and secondary SS, lower scores were found for primary SS in all the subscales. With respect to oral quality of life using the OHIP-49 (all items), we found lower scores for the primary SS group with respect to the control group. Patients with primary SS present lower scores for both oral and general quality of life.

Perioperative antibiotic regimen in rats treated with pamidronate plus dexamethasone and subjected to dental extraction: a study of the changes in the jaws.

PURPOSE Osteonecrosis of the jaws is a well-known condition associated with long-term bisphosphonate use. This study analyzed the prophylactic effect of antibiotic treatment in Sprague-Dawley rats treated with pamidronate plus dexamethasone and subjected to oral surgery in the form of dental extraction. MATERIALS AND METHODS One hundred twenty animals were included in a randomized prospective study. Animals in group I (n = 60) were treated with dexamethasone 1 mg/kg and pamidronate 3 mg/kg 3 times per week for 7, 14, and 21 days. All were subjected to right mandibular or maxillary molar extraction 8, 15, and 22 days after the start of dosing. Animals in group II (n = 60) received the same treatment except for the addition of penicillin 0.1 mL/kg per day for 3 days before and 4 days after extraction. Rats in the 2 groups were sacrificed 14 and 28 days after extraction. A clinical and histologic evaluation was performed. RESULTS In group I, osteonecrosis was documented in 18 cases (34.6%; affecting the upper and lower jaws in 10 and 8 cases, respectively). In group II, osteonecrosis was documented in 5 cases (9.61%; affecting the upper and lower jaws in 3 and 2 cases, respectively). The difference between the 2 groups was statistically significant (P = .002). CONCLUSIONS The adoption of preventive measures (antibiotic prophylaxis) in invasive dental procedures results in a significant decrease in osteonecrosis of the jaws associated with bisphosphonate use.