Pelin Güneri

Mandibular bone changes in sickle cell anemia: fractal analysis

OBJECTIVES The radiographic changes of mandibular bone texture was evaluated in patients with sickle cell anemia (SCA) and healthy controls. Fractal analysis was employed. STUDY DESIGN Thirty-five individuals (age range 11 to 40 years) who had been diagnosed as having homozygous SCA were enrolled as the patient group. Twenty-six healthy individuals within the same age range constituted the controls. Panoramic radiographs of all subjects were obtained using analog film and then digitized. All procedures for calculation of the fractal dimension were performed using Image J version 1.34s software (National Institutes of Health, Bethesda, MD). ROIs were selected as 64 x 64 pixel-sized squares, which were located between the first molar and second premolar teeth of the right mandibular segment. The fractal dimension (FD) was calculated by using the box-counting function. FD values of SCA and control groups were analyzed statistically by using Student t tests; alpha was set at 0.05. RESULTS The FD values for SCA patients were different from those of the healthy controls (mean FD SCA = 1.6855; mean FD controls = 1.7196); with a significance of P = .050. FD values for the SCA group had higher standard deviations (SD) than was the case for the healthy controls (SCA SD = 0.0859, control SD = 0.0459). When individuals were subclassified according to their age being younger than 20 or 20 years and over, the mean FD values of patients under 20 years of age were significantly lower than both the SCA patients over 20 years of age and all of the healthy controls (P < .05). CONCLUSION SCA patients under age 20 years showed lower FD values than the controls and this finding pointed to scarcity of trabecular bone in this group.

Benzydamine hydrochloride buccal bioadhesive gels designed for oral ulcers: Preparation, rheological, textural, mucoadhesive and release properties

This study developed and examined the characterization of Benzidamine hydrochloride (BNZ) bioadhesive gels as platforms for oral ulcer treatments. Bioadhesive gels were prepared with four different hydroxypropylmethylcellulose (HPMC) types (E5, E15, E50 and K100M) with different ratios. Each formulation was characterized in terms of drug release, rheological, mechanical properties and adhesion to a buccal bovine mucosa. Drug release was significantly decreased as the concentration and individual viscosity of each polymeric component increased due to improved viscosity of the gel formulations. The amount of drug released for the formulations ranged from 0.76 ± 0.07 and 1.14 ± 0.01 (mg/cm2 ± SD). Formulations exhibited pseudoplastic flow and all formulations, increasing the concentration of HPMC content significantly raised storage modulus (G′), loss modulus (G″), dynamic viscosity (ŋ′) at 37°C. Increasing concentration of each polymeric component also significantly improved the hardness, compressibility, adhesiveness, cohesiveness and mucoadhesion but decreased the elasticity of the gel formulations. All formulations showed non-Fickian diffusion due to the relaxation and swelling of the polymers with water. In conclusion, the formulations studied showed a wide range of mechanical and drug diffusion characteristics. On the basis of the obtained data, the bioadhesive gel formulation which was prepared with 2.5% HPMC K 100M was determined as the most appropriate formulation for buccal application in means of possessing suitable mechanical properties, exhibiting high cohesion and bioadhesion.

Late stage diagnosis of oral cancer: Components and possible solutions

Stage of disease at the diagnosis of oral cancer is thought to be a significant factor in prognosis and outcome (International Agency for Research on Cancer/World Health Organization, 2014). Unfortunately, we continue to diagnose almost 2/3 of these cancers at advanced stages of disease despite the ongoing research for devices/methods to aid the clinicians in detection and accurate oral mucosal lesion diagnosis. This paper explores both the nature of oral cancer and the adjuncts available for detection, and presents the current issues in diagnostic delays of oral cancer detection.

A new approach to the treatment of recurrent aphthous stomatitis with bioadhesive gels containing cyclosporine A solid lipid nanoparticles: in vivo/in vitro examinations

Aim To develop a suitable buccal bioadhesive gel formulation containing cyclosporine A solid lipid nanoparticles (CsA SLNs) for the treatment of recurrent aphthous stomatitis. Methods The suitability of the prepared formulations for buccal application was assessed by means of rheological studies, textural profile analysis, and ex vivo drug-release studies. Plastic flows, typical gel-like spectra, and suitable mechanical properties were obtained from prepared formulations. The retention time was explored in in vivo distribution studies and the effect of the gel containing CsA SLNs on the healing of oral mucosal ulceration was investigated in an animal model. In vivo distribution studies are a very important indicator of the retention time of formulations at the application site. Results Distribution studies showed that 64.76% ± 8.35% of the formulation coded “F8+SLN” remained on the buccal mucosa 6 hours after application. For the second part of the in vivo experiments, 36 rabbits were separated into three groups: the first group was treated with the gel formulation without the active agent; the second group with the gel formulation containing CsA SLNs; and the third group, used as the control group, received no treatment. Wound healing was established by scoring of the rate of wound healing on Days 3, 6, 9, and 12. Histological observations were made on the same days as the scoring studies. The bioadhesive gel formulation that included CsA SLNs increased the rate of mucosal repair significantly. Conclusion This study has shown that the bioadhesive gel formulation containing CsA SLNs reported here is a promising candidate for the topical treatment of recurrent aphthous stomatitis.

Effects of hydroxychloroquine on salivary flow rates and oral complaints of Sjögren patients: a prospective sample study

OBJECTIVE The objective of this study was to evaluate whether hydroxychloroquine (HCQ) therapy effects subjective and/or objective complaints and salivary flow rates of patients with primary Sjögrens syndrome (PSS). STUDY DESIGN Thirty women recently diagnosed with PSS, scheduled for HCQ treatment (400 mg daily), participated and were clinically examined before initiation of 30 weeks of HCQ treatment. During baseline evaluation, both the objective and/or subjective oral findings were recorded. Unstimulated (uSFR) and stimulated salivary flow rates (sSFR) were determined. After initiation of HCQ treatment, study parameters were assessed at 6, 12, 18, 24, and 30 weeks. Each patient served as her own control; measurements of the baseline and control times were analyzed by ANOVA. RESULTS uSFR values increased significantly with HCQ treatment, but sSFR values, objective and/or subjective complaints did not change considerably. CONCLUSION A positive impact of 30 weeks of HCQ treatment only on uSFRs of SS patients was revealed.

Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time

PurposeThe identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy.MethodsWe performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community.ResultsDue to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs.ConclusionsThe knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.

In vitro antimicrobial effects of commercially available mouth-wetting agents.

Products have been developed to provide palliation for persons with dry mouth. In addition to mouth-wetting agents, some products incorporate antimicrobial constituents with the goal of improving oral microbial defenses. The aim of this in vitro study was to investigate the potential antimicrobial and antifungal effects of two commercially available saliva substitutes on Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans by using the agar-well diffusion method. Antimicrobial activity as measured by the size of the inhibition zone growth for S. mutans and L. acidophilus was observed only with Biotene Dry Mouth Oral Rinse® and BioXtra® gel. The zone of inhibition of Biotene Dry Mouth Oral Rinse was larger than that of BioXtra gel (p= 0.00, p < 0.01). No anticandidal effect was seen with any of the test products. The pH of the preparations, the variations between the amount of active ingredients within the products, and the potential antimicrobial effects of inactive ingredients should be investigated to determine the factors that impacted microbial inhibition.

Application of fractal analysis in hyperparathyroidism

OBJECTIVES Primary hyperparathyroidism (HPT) is a condition caused by an overproduction of parathormone, in excess of the amount required by the body. Its most common cause is a parathyroid gland adenoma and parathyroidectomy is currently the only curative treatment for primary HPT. We present a case history of a 65-year-old patient who was diagnosed with primary HPT after the recognition of dental problems. METHODS Dental complaints of the patient alerted the dentists, and the patient was referred for further medical evaluation. In addition to his current medical status, his medical records including the biochemical parameters of bone metabolism recorded between 2001 and 2006 were reviewed. The panoramic films of the patient obtained between 1997 and 2008 were also assessed with the fractal analysis method. RESULTS After consideration of the radiographical, biochemical and clinical evaluations of the patient, the final diagnosis was made as hyperparathyroid adenoma and surgical removal was scheduled. Soon after surgery, alkaline phosphatase, calcium and intact parathormone levels returned to normal. The fractal analysis value of the mandibular alveolar bone also increased. CONCLUSIONS Dentoalveolar changes observed in HPT include alveolar bone demineralization. The fractal dimension (FD) analysis of the bone tissue has been introduced as an alternative method to investigate the quality of the alveolar bone. FD values of the patient showed osteoporotic bone characteristics between 1997 and 2006 until the date of parathyroidectomy. Mandibular bone FD analyses revealed a prominent development, which was also observed in dual energy X-ray absorptiometry values.

Development, characterization, and in vivo assessment of mucoadhesive nanoparticles containing fluconazole for the local treatment of oral candidiasis.

This study aimed to develop a suitable buccal mucoadhesive nanoparticle (NP) formulation containing fluconazole for the local treatment of oral candidiasis. The suitability of the prepared formulations was assessed by means of particle size (PS), polydispersity index, and zeta potential measurements, morphology analysis, mucoadhesion studies, drug entrapment efficiency (EE), in vitro drug release, and stability studies. Based on the optimum NP formulation, ex vivo drug diffusion and in vitro cytotoxicity studies were performed. Besides, evaluation of the antifungal effect of the optimum formulation was evaluated using agar diffusion method, fungicidal activity-related in vitro release study, and time-dependent fungicidal activity. The effect of the optimum NP formulation on the healing of oral candidiasis was investigated in an animal model, which was employed for the first time in this study. The zeta potential, mucoadhesion, and in vitro drug release studies of various NP formulations revealed that chitosan-coated NP formulation containing EUDRAGIT® RS 2.5% had superior properties than other formulations. Concerning the stability study of the selected formulation, the formulation was found to be stable for 6 months. During the ex vivo drug diffusion study, no drug was found in receptor phase, and this is an indication of local effect. The in vitro antifungal activity studies showed the in vitro efficacy of the NP against Candida albicans for an extended period. Also, the formulation had no cytotoxic effect at the tested concentration. For the in vivo experiments, infected rabbits were successfully treated with local administration of the optimum NP formulation once a day. This study has shown that the mucoadhesive NP formulation containing fluconazole is a promising candidate with once-a-day application for the local treatment of oral candidiasis.

Efficacy of topical benzydamine hydrochloride gel on oral mucosal ulcers: an in vivo animal study

The aim of this study was to investigate the effect of benzydamine hydrochloride bioadhesive gel on healing of oral mucosal ulceration in an animal model. For in vivo determination of the effects of the bioadhesive gel, 36 rabbits were separated into three groups: the first group was treated with the gel formulation without active agent, the second group with the gel formulation containing benzydamine, and the third group received no treatment. Clinical healing was established by measuring the area of the ulcer in each test group on days 3, 6, 9 and 12. Histological healing was determined on the same days. Benzydamine containing gel applications resulted in a decrease in the ulcer area in 12 days (p=0.000). Histological evaluation showed that the benzydamine group had a higher mean histological score than the base and the control groups during the whole test period, and the difference between the benzydamine group and the control group was significant (p=0.04). The bioadhesive gel formulation of benzydamine hydrochloride showed a statistically significant increased rate of mucosal repair in this experimental standard mucosal wound animal study. It is a candidate for the topical treatment of oral mucosal ulcerative lesions.