Vlaho Brailo

Salivary and serum interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in patients with leukoplakia and oral cancer

Objectives: The aim of study was to compare salivary and serum concentrations of interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral leukoplakia, oral cancer and healthy controls. Study design: Eighty eight patients (28 with oral cancer, 29 leukoplakia, and 31 healthy controls) were included in this study. Cytokine concentrations were measured by commercial enzyme linked immunoassay. Results: Salivary IL-1β and IL-6 were significantly higher in oral cancer patients than in patients with leukoplakia and control group (p<0.05). No differences in concentrations of salivary TNF-α between either of the groups were observed. Serum concentrations of IL-1β were below level of detection in all but two participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in oral cancer patients. Conclusions: Patients with oral cancer have elevated levels of inflammatory cytokines in their saliva. Whether this elevation can be used for monitoring the malignant transformation of oral leukoplakia remains to be answered by further follow up studies. Key words: Cytokines, oral, leukoplakia, cancer.

Oral lichen planus – retrospective study of 563 Croatian patients

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study Design: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, histology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asymptomatic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly affected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transformation all patients should be regularly monitored. Key words:Oral lichen planus, malignant transformation, epidemiology, retrospective study.

Evaluation of pretreatment serum interleukin-6 and tumour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma

Background Oral squamous cell carcinoma (OSCC) constitutes 3 percent of all cancers with predominant occurrence in middle aged and elderly males. Tumour recurrence worsens disease prognosis and decreases quality of life in patients with OSCC. Proinflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) have been suggested to play a certain role in variety of tumours. The aim of this study was to investigate the relationship of pretreatment serum IL-6 and TNF-α levels on tumour recurrence in patients with OSCC in order to identify potential biomarkers for the early detection of disease recurrence. Material and Methods The patients with newly diagnosed OSCC were treated and followed from the first visit from November 2006 until January 2008. Serum IL-6 and TNF-α concentrations were measured. The records of the patients were re-examined in July 2012 and data were recorded about cancer characteristics and tumour recurrence. Disease free survival was analyzed by Kaplan-Meier survival curves, log rank test and Cox proportional hazards regression. Results Serum IL-6 was shown as an independent risk factor for tumour recurrence. Conclusions Pretreatment serum IL-6 concentration may be a useful biomarker for identification of OSCC patients with increased risk of the disease recurrence. Key words: Serum IL-6, serum TNF-α, oral cancer, recurrence.

Is Effect of Low-Level Laser Therapy in Patients with Burning Mouth Syndrome Result of a Placebo?

Forty female participants were included in this study. All had BMS and their average age was 68 years (range 57-85 years). Participants were randomly allocated. In 20 BMS patients, red diode laser with emission of 685nm was applied five times a week during 2 weeks. Another 20 patients with BMS served as a control group and were treated by the same laser, which was switched off. This investigation was single-blinded placcebo-controlled. Burning intensity was recorded by use of visual analogue scale (VAS) every day during 10 days of therapy. LLLT decreased symptom intensity in BMS patients as seen by VAS, but also the symptom intensity decreased in the same manner in the placebo group as wel, where device was switched off.

Laser acupuncture in the treatment of burning mouth syndrome: a pilot study

According to the definition of the International Headache Society, burning mouth syndrome (BMS) is an intraoral burning sensation for which no dental or medical cause could be identified.1 Recently, various authors suggested that acupuncture might be effective in patients with BMS.2–4 In ancient acupuncture texts, it was stated that ‘the Spleen opens in the mouth and the Heart in the tongue’, so the organs Spleen and Heart are traditionally involved in BMS. Spleen and Heart are also the organs that are most involved in depression, hence the traditional connection between BMS and depression, stress and anxiety.5 The aim of this study was to evaluate whether laser acupuncture was effective in patients with burning mouth syndrome, as no satisfactory treatments for this condition are available and patients with the condition may experience substantial disturbance to everyday life. The Ethical Committee of …

grading the intensity of nondental orofacial pain: identification of cutoff points for mild, moderate, and severe pain

Background When assessing pain in clinical practice, clinicians often label pain as mild, moderate, and severe. However, these categories are not distinctly defined, and are often used arbitrarily. Instruments for pain assessment use more sophisticated scales, such as a 0–10 numerical rating scale, and apart from pain intensity assess pain-related interference and disability. The aim of the study was to identify cutoff points for mild, moderate, and severe nondental orofacial pain using a numerical rating scale, a pain-related interference scale, and a disability measurement. Materials and methods A total of 245 patients referred to the Facial Pain Unit in London were included in the study. Intensity and pain-related interference were assessed by the Brief Pain Inventory. Pain-related disability was assessed by the Chronic Graded Pain Scale. Average pain intensity (0–10) was classified into nine schemes with varying cutoff points of mild, moderate, and severe pain. The scheme with the most significant intergroup difference, expressed by multivariate analysis of variance, provided the cutoffs between mild, moderate, and severe pain. Results The combination that showed the greatest intergroup differences for all patients was scheme 47 (mild 1–4, moderate 5–7, severe 8–10). The same combination provided the greatest intergroup differences in subgroups of patients with temporomandibular disorder and chronic idiopathic facial pain, respectively. Among the trigeminal neuralgia patients alone, the combination with the highest intergroup differences was scheme 48 (mild 1–4, moderate 5–8, severe 9–10). Conclusion The cutoff points established in this study can discriminate in pain intensity categories reasonably well, and showed a significant difference in most of the outcome measures used.

World Workshop on Oral Medicine VI: Utilization of Oral Medicine–specific software for support of clinical care, research, and education: current status and strategy for broader implementation

OBJECTIVES To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. STUDY DESIGN An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. RESULTS Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. CONCLUSIONS The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed.

Applications of Low Level Laser Therapy

Principles of biostimulation via therapeutic lasers was introduced more than 20 years ago when they were used in dermatology for wound healing. According to Genovese, biological effects caused by low level lasers are due to low energy deposited into tissues where deposited energy results in primary, secondary and general therapeutic effects. This results in the analgesic and anti-inflammatory effects as well as in improvement in healing. LLLT acts according to the Arndt-Schulz principle which states that if the stimulus is too weak, no effect is seen. Increased stimulation and optimal dose leads to the optimal effect ; while, further dose increase leads to a decreased effect. Additional stimulation leads to the inhibition of stimulation. It seems that LLLT act analgesically since they improve endorphin release and therefore inhibit nociceptive signals and control pain mediators. They can also act analgesically by inhibiting pain signals which partially leads to the transient varicosities along the neurons which decrease impulse transmission.

Elektroliti u slini pacijenata s metalnim i keramičkim ortodontskim bravicama

Objectives It is known from the existing literature that metal ions within orthodontic appliances are prone to corrosion due to the salivary and bacterial interplay in the oral cavity. The results from the most studies show that levels of salivary nickel and chromium do not increase after the installment of orthodontic appliances. Material and methods However, there are no studies on salivary levels of titanium, cobalt, copper and zinc in these patients. Salivary levels of nickel (Ni), titanium (Ti), chromium (Cr), cobalt (Co), copper (Cu) and zinc (Zn) were measured in 42 patients with ceramic brackets and in 42 patients with metal conventional brackets prior to insertion of orthodontic appliances and six months after insertion of orthodontic appliances by means of inductive coupled plasma/mass spectrometry. Statistical analysis was performed by use of Wilcoxon signed rank test and Mann Whitney test with level of significance set at 0.05. Results The results showed that salivary level of titanium increased significantly six months after installment of orthodontic appliances. Salivary level of chromium and zinc significantly decreased after installment of orthodontic appliances. There were no significant differences in salivary levels of nickel, titanium, chromium, copper, cobalt and zinc between the patients with metallic and those with ceramic brackets. Conclusion We might conclude that the salivary level of titanium increased significantly six months after installment of orthodontic appliances unlike salivary levels of chromium and zinc which significantly decreased after installment of orthodontic appliances, regardless of bracket type which was used.

Mapping Electrical Impedance Spectra of the Healthy Oral Mucosa: a Pilot Study.

OBJECTIVE Electrical impedance is the resistance to the electric current flow through a tissue and depends on the tissues structure and chemical composition. The aim of this study was to map electrical impedance spectra for each region of the healthy oral mucosa. MATERIALS AND METHODS Electrical impedance was measured in 30 participants with healthy oral mucosa. Measurements were performed in 14 points on the right and the left side of the oral cavity, and repeated after 7 and 14 days respectively. RESULTS The lowest values were measured on the tongue dorsum and the highest values were measured on the hard palate. No significant differences were found between the right and the left side. Significantly higher values were found in females on the upper labial mucosa, tongue dorsum and the ventral tongue. Significant difference between smokers and non-smokers on the lower labial mucosa and floor of the mouth was found. Electrical impedance was negatively correlated with salivary flow on the upper labial mucosa, hard palate, tongue dorsum and sublingual mucosa. Higher variability of measurements was found at low frequencies. CONCLUSIONS Electrical impedance mostly depends on the degree of mucosal keratinization. Demographic and clinical factors probably affect its values. Further studies with bigger number of participants are required.