Pg Arduino

Human papillomaviruses in oral carcinoma and oral potentially malignant disorders: a systematic review

OBJECTIVES Human papillomavirus (HPV) in oral carcinoma (OSCC) and potentially malignant disorders (OPMD) is controversial. The primary aim was to calculate pooled risk estimates for the association of HPV with OSCC and OPMD when compared with healthy oral mucosa as controls. We also examined the effects of sampling techniques on HPV detection rates. METHODS Systematic review was performed using PubMed (January 1966-September 2010) and EMBASE (January 1990-September 2010). Eligible studies included randomized controlled, cohort and cross-sectional studies. Pooled data were analysed by calculating odds ratios, using a random effects model. Risk of bias was based on characteristics of study group, appropriateness of the control group and prospective design. RESULTS Of the 1121 publications identified, 39 cross-sectional studies met the inclusion criteria. Collectively, 1885 cases and 2248 controls of OSCC and 956 cases and 675 controls of OPMD were available for analysis. Significant association was found between pooled HPV-DNA detection and OSCC (OR = 3.98; 95% CI: 2.62-6.02) and even for HPV16 only (OR = 3.86; 95% CI: 2.16-6.86). HPV was also associated with OPMD (OR = 3.87; 95% CI: 2.87-5.21). In a subgroup analysis of OPMD, HPV was also associated with oral leukoplakia (OR = 4.03; 95% CI: 2.34-6.92), oral lichen planus (OR = 5.12; 95% CI: 2.40-10.93), and epithelial dysplasia (OR = 5.10; 95% CI: 2.03-12.80). CONCLUSIONS The results suggest a potentially important causal association between HPV and OSCC and OPMD.

Course of oral lichen planus: a retrospective study of 808 northern Italian patients

OBJECTIVES To undertake a retrospective inspection of the general features, clinical presentation and outcome of 808 Italian patients with oral lichen planus (OLP), followed up from 6 months to 17 years. RESULTS The mean age was 61 years for women (n = 493) and 58 years for men (n = 315). More than 20% of the total cases had liver abnormalities (n = 164) of which 83.5% infected with hepatitis C virus (n = 137). The reticular and plaque form were the predominant type, affecting almost 60% of patients. 12.3% of patients had also extraoral manifestation, taking into account the skin (n = 63) and genital (n = 24). Symptoms were present in 40% of the total patients. Only less than 2.47% of patients underwent remission, whereas 78% still had oral lesions at the end of the follow-up period. Treatment was directed towards almost 42% of the patients, mainly using topical corticosteroids. Oral squamous cell carcinoma developed in 15 patients, commonly arising on the lateral border of the tongue. CONCLUSION This is one of the largest groups of OLP patients with such long a follow-up ever reported. We confirm the chronic nature of this disorder, rarely remissive and the treatment intend for alleviating symptoms. OLP is established to be a disease with small frequency of malignant transformation.

Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: a double-blind, randomized controlled trial

Background  Oral lichen planus (OLP) is a chronic inflammatory disease that can be painful, especially in the atrophic and erosive forms. Several drugs have been used with varying results, but most treatments are empirical, and do not have adequate control groups or correct study designs.

Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: a randomized controlled trial to compare two preparations with different concentrations.

Oral lichen planus (OLP) is a chronic inflammatory disease that can be painful, mainly in the atrophic and erosive forms. Numerous drugs have been used with dissimilar results, but most treatments are empirical and do not have adequate control groups or correct study designs. However, to date, the most commonly employed and useful agents for the treatment of LP are topical corticosteroids. A randomized, double-blind, placebo-controlled trial has been designed to compare the efficacy and safety of two different formulations of clobetasol, a very potent topical steroid, in the topical management of OLP and to evaluate which gives the longest remission from signs and symptoms. Thirty-five consecutive patients were divided into two groups: the first received clobetasol propionate 0.025% and the second was given clobetasol propionate 0.05%. Both drugs were placed in 4% hydroxyethyl cellulose bioadhesive gel. Anti-mycotic prophylaxis was also added. After the end of therapy, patients received a 2-month follow-up. In all, 14 of the 15 clobetasol 0.025% patients (93%) and 13 of the 15 clobetasol 0.05% patients (87%), had symptoms improvement after 2 months of therapy (P = 0.001 in both groups). Also, 13 of the 15 clobetasol 0.025% patients (87%) and 11 of the 15 clobetasol 0.05% patients (73%) had clinical improvement after 2 months of therapy (P < 0.05 in both groups). No statistical differences were found in comparing the two different formulations. A larger concentration of the active molecules cannot further improve the therapeutic findings or optimize the obtained results in a significant manner.

Varicella zoster virus: review of its management.

Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans. Primary infection causes varicella (chickenpox), after which virus becomes latent. Years later, VZV reactivates and causes a wide range of neurological diseases. The aim of the present report was to critically examine the published literature to evaluate advantages and limitations of therapy of VZV infection in both immunocompetent and immunocompromised patients. Aciclovir (ACV) has been the drug of choice for many years for the treatment of VZV infections. Recently, other antiviral agents have been developed to overcome the low oral bioavailability of ACV, as well as to provide a more flattering dosage regime. Chickenpox is a benign self-limiting disease in the majority of cases and usually no specific treatment is required. Treatment of shingles is indicated to reduce the acute symptoms of pain and malaise, to limit the spread and duration of the skin lesions and to prevent the development of post-herpetic neuralgia. Different classes of drugs have been used for the treatment of post-herpetic neuralgia. The first choice of any of these medications should be guided by the patients medical health, the likely adverse effects of the drug and the patients preference.

Periodontal status in oral mucous membrane pemphigoid: initial results of a case-control study

OBJECTIVE To evaluate the periodontal status of mucous membrane pemphigoid (MMP) patients and compare it with that of healthy controls. METHODS A prospective study was undertaken to examine the impact of gingival MMP lesions on the human periodontium of 29 patients. Parameters evaluated included full mouth plaque score (FMPS), full mouth bleeding upon probing scores, probing depths (PD), gingival recession, clinical attachment level (CAL), mobility score, furcation involvement, number of missing teeth and Machtei criteria. RESULTS All periodontal parameters recorded were increased in cases when compared to controls in univariate statistics. The mean differences between groups in PD (0.8±0.2mm, 95% CI 0.3-1.3), CAL (1.3±0.4mm, 95% CI 0.4-2.2), FMPS (41.0±6.2%, 95% CI 28.7-53.4), FMBS (16.2±6.6%, 95% CI 3.0-29.4) and tooth loss (2±1 teeth, 95% CI 1-3) were all statistically significant (P<0.01 for all). Substantial differences in domiciliary oral hygiene routines were observed (P<0.0001). In multivariate models when FMPS was included as covariate the difference between groups in all clinical periodontal parameters was no longer statistically significant. CONCLUSIONS Our results showed that periodontal status is worse in MMP patients if compared with healthy controls due to a substantial difference in oral hygiene. Oral health should be promoted in MMP.

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients

OBJECTIVES The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. METHODS Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). RESULTS A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). CONCLUSIONS Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization.

Systemic minocycline as a therapeutic option in predominantly oral mucous membrane pemphigoid: a cautionary report.

The aim of this study was to evaluate the therapeutic benefit of minocycline in mucous membrane pemphigoid (MMP) predominantly involving the oral cavity. A descriptive, open clinical study with no control group, including 9 patients, was developed. The diagnosis was confirmed by histopathological examination and direct and salt-split-skin indirect immunofluorescence analysis. Target antigens were sought by immunoblotting. Patients received minocycline (200mg/day) for a variable period. All patients were followed up for at least 2 years after initial diagnosis. Therapeutic response was assessed by clinical improvement in three categories: major response, minor response and no response. A major response was observed in 3 patients (33%), a minor response in 4 (44%) and 2 (22%) patients showed no improvement. Two of the 3 patients with a major response showed no immunoblot reactivity; 80% of patients with circulating autoantibodies (autoAb) against BP180 had a minor or no response. Permanent remission of signs with no relapse was only obtained in one patient. 5 patients (55%) stopped the drug because of adverse effects, such as vertigo and gastralgia. The results revealed temporary clinical benefits in MMP predominantly involving the oral cavity with minocycline, although frequently side effects led to drug withdrawal.

A practical clinical recording system for cases with desquamative gingivitis.

DEAR EDITOR, The most frequent autoimmune disorders that involve the oral mucosae are lichen planus, pemphigoid, pemphigus, epidermolysis bullosa acquisita, erythema multiforme, discoid lupus erythematosus and chronic ulcerative stomatitis. Affected individuals present with variable oral lesions, mainly hyperkeratosis, erythema, blisters, erosions and ulcerations. The gingival tissues are commonly involved, not least because of decreases in oral hygiene, but the gingiva can be the site of onset or the first manifestation of the disorder, often as desquamative gingivitis (DG). The aim of gingival treatment should be principally directed towards diminution of pain and discomfort, lessening erosions and ulcers into mild diseases. To date, there is only weak evidence for the superiority of any interventions over placebo in the treatment of DG. One barrier to good studies is the lack of a reproducible gingival clinical score, although a helpful mucosal index for lichen planus has been described. Therefore, we developed a novel scoring system to describe gingival involvement in DG, the Desquamative Gingivitis Clinical Score (DGCS), modified from two previous scoring systems and incorporating the extent and severity of gingival disease. The examination should be performed visually with a good dental light, using a probe calibrated in millimetres (PCPUNC15; Hu-Friedy, Chicago, IL, U.S.A.) to measure lesion size. The DGCS is detailed on both aspects of the gingival tissues (six times vestibular and six times buccal), one for each sextant of the upper and lower gingiva. The criteria are as follows: 0, no detectable gingival lesions present; 1, only white lesions; 2, mild erythema (< 3 mm from gingival margins); 3, one or more bullae, or clinically obvious erythema (> 3 mm from gingival margins); 4, erosion or ulcer. Where different features are present, the clinician chooses the higher index, so the scores can range from 0 to 48 (considering both vestibular and oral sites), with higher results indicating more severe clinical disease. With local ethical committee approval, one of the authors, P.G.A. (a qualified oral medicine specialist of 20 years), conducted a study between January 2015 and December 2015. In this study, every patient attending for regular follow-up of previously histologically confirmed gingival disease associated with one of the abovementioned autoimmune diseases, at the oral medicine unit of the main hospital in Turin, Italy, was enrolled. To determine the interexaminer reproducibility of this score, after evaluation by P.G.A., three other blinded clinicians with different skills in oral medicine examinations (previously instructed using Table 1 as support) reviewed the patients. These clinicians were a trainee with < 1 year of practice in oral medicine, and two graduated physicians, one with

Ipoestesia del nervo mentoniero causata da infezioni odontogene: casi clinici

Riassunto Obiettivi Si descrive una serie di casi nei quali il sintomo piu rilevante era la presenza di “mento addormentato” (Numb Chin Syndrome, NCS) correlato a infezioni odontogene e lesioni cistiche. Questa neuropatia del nervo alveolare e caratterizzata da ipoestesia o parestesia del labbro inferiore e del mento. Materiali e metodi Quando non e associata a cause iatrogene, la sindrome e clinicamente significativa a causa della sua frequente associazione con malattie maligne, soprattutto linfoma e lesioni metastatiche. Tuttavia sono stati riscontrati casi relazionati con patologie dentali, come ascessi dentoalveolari o tumori benigni. Vengono presentati tre casi di NCS. Un paziente maschio di 59 anni (caso 1) accusava dolore violento nella regione premolare destra; dopo pochi giorni compariva ipoestesia del nervo mentoniero destro. L’esame clinico e radiologico confermava la presenza di una lesione osteolitica infettiva originata da 4.5. Una paziente di 45 anni (caso 2) riportava un dolore continuo spontaneo di 3.5 e 3.6 e ipoestesia del territorio mentoniero sinistro; l’ortopantomografia evidenziava una lesione litica espansiva che coinvolgeva il canale mandibolare, suggestiva per lesione cistica in relazione all’elemento 3.6. Un paziente maschio di 63 anni (caso 3) riportava un violento dolore in regione premolare e molare inferiore destra, presto seguita da ipoestesia del territorio mentoniero omolaterale. La TC mandibolare mostrava segni di osteite con sequestro osseo, originato da parodontite apicale di 4.7 e 4.5. Discussione e conclusioni Nonostante la neuropatia del nervo mentoniero sia considerata un sintomo da “codice rosso” per la possibilita di una neoplasia maligna a distanza, si deve comunque valutare l’eventualita di cause infettive odontogene o altre cause benigne.