Peter C. Reade

Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors

Several studies have reported that musculoskeletal disorders of the stomatognathic system, commonly known as temporomandibular disorders (TMD) resemble musculoskeletal disorders and chronic pain disorders in general. There is also general consensus that combined biomedical and biopsychosocial methods best support the assessment and management of the cardinal features of TMD, i.e., pain and dysfunction or physical (peripheral) and psychosocial (central) factors. This overview of the aetiology of TMD will outline conceptualizations of past models and present the current view that patients with TMD should be assessed according to both the physical disorder and the psychosocial illness impact factors. The conceptual theories outlined in this review include biomedical models related to temporomandibular joints, muscles of mastication and occlusal factors, psychological models and the biopsychosocial models. An integrated and multidimensional approach concerning physical and psychosocial factors in temporomandibular pain and dysfunction is presented as an example of how the biopsychosocial model and information processing theory may apply in the conceptualization and management of TMD for various health care professionals.

Oral discomfort at menopause

The relationship between oral discomfort and menopause was assessed in 149 women who were divided into three groups determined by response to a questionnaire. The groups consisted of 50 premenopausal women (30 to 43 years old), 47 menopausal women not receiving medical treatment for symptoms of menopause (37 to 66 years old), and 52 menopausal women attending a menopause clinic before and during treatment for menopausal symptoms (30 to 63 years old). The last group had a general medical assessment, including psychological and oral examinations with oral smears and cultures, and the following blood tests: full blood examination, follicle-stimulating hormone, oestradiol, folate, vitamin B12, iron, and total iron binding capacity. Of this last group, 33% reported oral discomfort but had no obvious organic abnormalities that could account for this symptom. The prevalence of oral discomfort was found to be significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%). The results also showed an association between oral discomfort and psychological symptoms in menopausal women. Approximately two thirds of the menopausal women with oral discomfort, but without oral clinical signs, found that this symptom was relieved after hormone replacement therapy. The results indicated that oral discomfort is a common symptom of menopause, that it often occurs without overt clinical signs, and that it frequently resolves during appropriate hormone replacement therapy.

Candida albicans: a review of its history, taxonomy, epidemiology, virulence attributes, and methods of strain differentiation

The dimorphic yeast Candida albicans has been recognized as an increasingly important human pathogen particularly in immunocompromised hosts because of advanced age, infection or immunosuppressive therapy. This review outlines the history, taxonomy and epidemiology of this medically important yeast as well as discussing some of characteristics which are purported to be related to its virulence. Methods utilized for strain differentiation in the study of the epidemiologic relationship of members of this species are discussed.

Salivary immunoglobulin A levels in normal subjects, tobacco smokers, and patients with minor aphthous ulceration

There seems to be no relationship between time of day and SlgA concentration in pooled unstimulated saliva. Such concentrations are more accurately expressed as a range of normal. A selected group of tobacco smokers showed a decrease in SlgA concentrations when compared with a matched control group, and a group of patients with minor aphthous ulcerations showed no deviation from the control range. The significance of the decrease in SlgA concentrations in chronic tobacco smokers is discussed in the light of this being due to an immunosuppressive effect of the combustion products of tobacco and the possibility of the incidence of intraoral neoplastic disease being increased in tobacco smokers by this effect.

Lichen planus: A theory of pathogenesis

From a continuing study of 108 cases of oral mucosal lichen planus, including so-called drug-induced lichenoid reactions, the response of patients to topical therapy and to drugs implicated in inducing the lichenoid reactions was used to construct a hypothetical model regarding the pathogenesis of the condition. The results were interpreted to indicate that lichen planus is a predetermined condition or diathesis, perhaps genetically based, rather than a simple cause-and-effect disorder.

Referral patterns of patients with oral squamous cell carcinoma, Australia

Early diagnosis is an important factor affecting the prognosis of patients with oral cancer. Delays in diagnosis have been variously reported as being linked to the patient, the clinician or both. The purpose of this study was to investigate the referral patterns of patients with oral cancer by medical and dental practitioners, in order to assess the delays in diagnosis and to establish the reasons for these delays. 51 consecutive patients diagnosed with oral mucous membrane squamous cell carcinoma were retrospectively reviewed. In this study it was found that over one-third of the patients (38%) delayed seeking professional advice for more than 3 months after first being aware of the lesion. Initial delays in diagnosis of oral cancer was identified in one-third of the cases (17 patients), with antimicrobial medications prescribed and denture adjustments constituting the most frequently administered inappropriate therapy. General medical practitioners were more likely to encounter and refer patients with more advanced (T4) primary oral cancers than their dental colleagues. The findings of this study raise the concern that lack of patient awareness and inappropriate clinical management prevails in a community that should be better informed.

The use of an elimination diet in the treatment of recurrent aphthous ulceration of the oral cavity

The involvement of components of food in the causation of recurrent aphthous ulceration of the oral mucosa is controversial. To test the proposition, seventeen patients with RAU which had been resistant to other forms of treatment were studied with the aid of a strict elimination diet. Five patients abandoned the difficult diet, and of the remaining twelve there were five patients who had remission of RAU while on the diet. In four of these five patients a particular food was identified which, when eliminated from the normal diet, led to either marked improvement or resolution. The results of this study clearly indicate the participation of food components in the etiology of some cases of RAU .

The prevalence of Candida albicans in the mouths of tobacco smokers with and without oral mucous membrane keratoses

Abstract The prevalence of Candida albicans in the oral cavity was studied in 127 patients and correlated with their sex, age, oral mucous membrane keratoses, and tobacco-smoking habits. The finding of the fungus in swabs taken from the oral mucosa and saliva was not related to the presence of oral mucous membrane keratoses or to tobacco smoking. The prevalence of the fungus in the mouth was significantly greater in women than in men, as was its prevalence in the older age groups of women.

Angiotensin-converting enzyme inhibitors implicated in oral mucosal lichenoid reactions

The use of angiotensin-converting enzyme inhibitors (captopril and enalapril) to control hypertension has increased in recent years. Despite extensive reports of hematologic, gastrointestinal, and cutaneous side effects, no specific incidence of oral mucosal lichenoid reactions caused by these drugs have been reported. It is the purpose of this article to present two case reports, bringing the attention of clinicians to oral mucosal lichenoid drug reactions in which these drugs may be implicated.

Experimental induction of oral squamous cell carcinomas in mice with 4-nitroquinolone-1-oxide.

The oral mucosa of mice is resistant to the action of a variety of carcinogens. In this study, the water-soluble carcinogen 4-nitroquinoline-1-oxide (4NQO) was applied repeatedly to the palates of male CBA mice for 2, 4, 6, 8, 12, or 16 weeks, and the animals were observed for the remainder of the 50-week experimental period. Oral epithelial atypia and squamous cell carcinoma were observed with increasing prevalence as the period of carcinogen exposure was increased. Carcinomas developed by 50 weeks in all animals that received 4NQO for 16 weeks.