O. Di Fede

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.

Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study

Background  Lichen planus (LP) is a mucocutaneous inflammatory dermatosis that frequently involves the oral and genital mucosae. Patients with LP affecting these sites are often seen by oral medicine specialists or gynaecologists who work in isolation and depend heavily on histopathologists to help them in confirming the diagnosis. There are few studies in the literature combining the experiences of these specialists who share the care of patients with both oral and genital LP.

Human Buccal Mucosa as an Innovative Site of Drug Delivery

The authors review the ultra-structural aspects and permeability features of normal human oral mucosa, after having recently tested and used it as a new site of systemic drug delivery. The pertinent scientific literature from 1975 through 2009 has been analysed and discussed. Buccal epithelium is a relatively permeable, robust non-keratinized tissue and blood vessels drain directly into the jugular vein; due to its particular features, it has been of increasing interest to researchers as an alternative site of drug administration. The review describes the structure and function of the buccal mucosa, the rationale for transbuccal drug delivery and the main transmucosal drug delivery systems. Recent studies have investigated the delivery of a variety of drugs through the buccal mucosa in order to assess both local and systemic, either positive or adverse, effects. In conclusion, buccal mucosa may be considered a promising site for effective, safe and non-invasive transmucosal sustained drug delivery.

HCV infection and oral lichen planus: a weak association when HCV is endemic.

Abstract  Oral lichen planus (OLP), an immune‐mediated disorder, has been reported as an extra‐hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyperendemic areas such as southern Europe and Japan. The aim of this study was to investigate from an epidemiological standpoint whether HCV infection is an important factor affecting the relative risk of OLP in a Mediterranean population or whether this relates to the degree of HCV endemicity. Two cohorts of OLP patients resident in two different regions of southern Italy (Campania and Sicily; n = 859) were evaluated for HCV infection status and categorized into five age classes to respective region‐matched controls. No significant difference was found between OLP patients and the general population in this area, when data were corrected by the age‐stratified prevalence of HCV. Therefore, the age‐specific prevalence of HCV infection in OLP patients shows a close trend of direct association with increasing age, without significant differences with the general population of each geographical area. An aetiological link between OLP and HCV cannot be inferred solely by epidemiological data.

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.

Expression of salivary biomarkers in patients with oral mucositis: evaluation by SELDI-TOF/MS

OBJECTIVE This study aims to evaluate changes in proteomic salivary profile of patients with oral mucositis after adjuvant cancer treatments. MATERIALS AND METHODS Samples were collected from patients after adjuvant cancer therapies, and were analyzed by means of SELDI/TOF. Patients were separated in two groups: patients affected by mucositis (MUCOSITIS) and patient without mucositis (NO MUCOSITIS). All patients were divided in function of the anticancer treatment: patients who had radiotherapy (MUCOSITIS RADIO), had not radiotherapy (MUCOSITIS NO RADIO), had chemotherapy (MUCOSITIS CHEMO), and those who had not chemotherapy (MUCOSITIS NO CHEMO). Statistical evaluation PCA (Principal Component Analysis) was conducted with the software BIO-RAD Data Manager(™) (Version 3.5). RESULTS We found the increased peaks of 3443, 3487, and 4135 m/z in MUCOSITIS group, while 6237 m/z was reduced. These same peaks would the same modifications in MUCOSITIS RADIO, while in MUCOSITIS CHEMIO are increased 3443 and 6237 m/z but 3487, 4135 m/z are reduced. These data were confirmed by the PCA. CONCLUSION Anticancer therapy influenced the level expression of many salivary biomarkers in mucositis with a good significance. Therefore, 3443, 3487, 4135, and 6237 m/z are good biomarker candidates of oral mucositis.

Legal liability in bisphosphonate-related osteonecrosis of the jaw.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse reaction that may occur in patients administered with bisphosphonates (BP). This condition can cause high morbidity and hinder quality of life. Its treatment is complex and often unsatisfactory, and prevention strategies may have limited effectiveness, if any. Thus, managing patients treated with BP may result in exposure of the practitioner to legal liability or malpractice claims: legal actions pursuant to BRONJ are reported to be underway on three continents. Nonetheless, the attribution of liability, if any, is a complex process requiring, on the basis of current knowledge, a robust and pragmatic approach to the facts, which must be identified from the point of view of the time, place and individuals involved. This means a comprehensive consideration of the sequence of actions from bisphosphonates prescription to BRONJ occurrence (as well as immediately after, and any action potentially related to its causation or worsening) is required in order to determine if a breach in informing, diagnosing, managing or referring the patient took place, as well as determining if the patient was compliant in attending to prescriptions and follow-up programmes.

Saliva: Its Value as a Biological Matrix and Current Methods of Sampling

Saliva is a non-invasive medium, its analysis is useful to measure a wide range of hormones, drugs, narcotics, antibodies, host, microbial, fungal and viral DNA up to salivary mRNA; hence, it has been suggested to be an easy and reliable biomarker in disease diagnostics, such as inflammatory mouth infections/diseases, and in normal health surveillance. In light of this potential, our primary endpoint is to review the current knowledge on saliva analyses and its recent methods of sampling.

Osteonecrosi dei mascellari associata a bisfosfonati, denosumab e farmaci anti-angiogenetici nei pazienti oncologici e osteoporotici: diagnosi e terapia

Riassunto Obiettivi Fornire un percorso utile alla diagnosi e al trattamento dell’osteonecrosi delle ossa mascellari (solitamente definita ONJ, OsteoNecrosis of the Jaws). Materiali e metodi Gli autori del lavoro, recentemente estensori e collaboratori – su mandato della Societa Italiana di Chirurgia Maxillo-Facciale (SICMF) e della Societa Italiana di Patologia e Medicina Orale (SIPMO), delle Raccomandazioni clinico-terapeutiche sull’osteonecrosi delle ossa mascellari associata a bisfosfonati e sua prevenzione – hanno esaminato le informazioni scientifiche disponibili in merito alla ONJ associata all’assunzione sia di bisfosfonati sia di denosumab e/o anti-angiogenetici, e revisionato l’epidemiologia, i fattori di rischio, la clinica e i criteri diagnostici. Vengono proposti protocolli di prevenzione primaria e secondaria, di management odontoiatrico e terapia della ONJ sia per il paziente oncologico sia per il paziente non oncologico, principalmente osteoporotico. Risultati e conclusioni L’osteonecrosi delle ossa mascellari da bisfosfonati, ma anche, negli ultimi anni, da denosumab e anti-angiogenetici, si puo considerare la piu emergente delle patologie odontoiatriche severe: negli ultimi 10 anni si sono registrati migliaia di casi in letteratura, con importanti implicazioni sulla qualita di vita del paziente. La comunita medica e odontoiatrica ha percepito in questi anni la severita della patologia, ma anche la necessita di darsi regole e ridisegnare il percorso preventivo e assistenziale di tale malattia: in tutte le nazioni industrializzate, e parimenti in Italia, sono state stilate linee guida o raccomandazioni per la prevenzione e cura della ONJ, malattia inizialmente associata solo ai bisfosfonati per via endovenosa in pazienti oncologici, ma poi rilevata, sebbene con frequenza inferiore, anche nei pazienti non oncologici, principalmente osteoporotici, in terapia con bisfosfonati per os.

Odontoiatria di genere: la condizione femminile nella pratica odontoiatrica

Riassunto Obiettivi Scopo dello studio e esaminare la condizione femminile in relazione alla professione odontoiatrica e le patologie orali che possono colpire in particolare il sesso femminile, con i relativi trattamenti. Materiali e metodi Oltre a riportare l’esperienza e il contributo personale degli autori, sono state effettuate ricerche in PubMed, Embase e Scopus. Risultati e conclusioni Sono state esaminate la figura dell’odontoiatra donna e la sua collocazione nell’ambito professionale, nonche le sue caratteristiche lavorative in relazione sia ai pazienti sia alla propria famiglia. Sono state poi analizzate le piu comuni condizioni patologiche del cavo orale che, pur non essendo appannaggio esclusivo del sesso femminile, si manifestano piu frequentemente, o con caratteristiche peculiari, soprattutto nelle donne in eta adolescenziale e senile. Una disamina attenta e approfondita e stata quindi dedicata alle problematiche delle donne in gravidanza e durante l’allattamento, con particolare attenzione alle decisioni operative da prendere e all’uso dei farmaci.