Role of saliva in oral dryness,oral feel and oral malodour

Patients who believe they have oral malodour often have a dry mouth condition instead. Here we have examined its relation to oral malodour, real or perceived. A direct relationship between the thickness of the film of residual saliva on mucosal surfaces throughout the mouth and perception of a dry mouth was observed. On the hard palate, the thickness of this film proved to be diagnostic for a dry mouth and corresponded to lower resting saliva flow and pH levels (P< 0.001). Intra-muscular administration of the anti-sialogogue, Robinul, accurately produced the dry mouth condition. Using a sulphide monitor, loss of volatile sulphur compounds into mouth air progressively occurred as the mouth became drier. Mouth pH and Eh on the dorsum of the tongue correspondingly fell. Mouth breathing led to tongue and palate moisture loss thus enabling escape of malodour volatiles into mouth air. Measurement of oral dryness should make it possible to differentiate genuine malodour from dry mouth related pseudo-malodour subjects, and in turn, the latter from patients that are halitophobic. This should facilitate identification of such patients and avoid error in their clinical management.     

Detection of survivin mRNA in healthy oral mucosa, oral leucoplakia and oral cancer

Background:  Survivin is involved in modulation of cell death and cell division processes. Survivin expression in normal adult tissues has not been fully understood, although it is markedly lower than in cancer, where it is over-expressed.
Objective:  To investigate survivin expression in normal, potentially malignant and cancerous oral mucosa.
Methods:  We measured survivin mRNA levels by real-time RT-PCR in specimens of oral mucosa (15 from normal mucosa, 17 from potentially malignant lesions, 17 from neoplasms). Scores were compared using Kruskal–Wallis test and post hoc according to Conover. Chi-squared test was used for dichotomous data.
Results:  The median relative levels of survivin mRNA resulted six for normal mucosa, eight for potentially malignant lesions, 13 for cancers: differences among these three groups were statistically significant, as between cancer and potentially malignant lesions. Expression in normal mucosa and potentially lesions group showed no significant difference. Low, but not marginal expression of survivin in normal mucosa is a new finding, and it could be explained with the higher sensibility of our methods.
Conclusions:  Survivin expression in oral potentially malignant lesions might indicate a progressive deregulation of expression paralleling oncogenesis, particularly during the first stages of process, suggesting a putative predictive role for survivin.     

Evidence-based practice of oral pathology and oral medicine

Oral pathology is the specialty area of dentistry that deals with the diagnosis and management of oral diseases and more specifically, diseases other than dental caries, periodontal disease, restorative dentistry, and orthodontic therapy. Oral medicine represents the clinical arm of oral pathology and deals with diagnosis and treatment of soft-tissue lesions, whereas oral histopathology is the specialty area that focuses on the microscopic diagnosis of soft- and hard-tissue lesions of the head and neck area. The diagnosis and treatment of oral pathologic conditions is often based on empirical decision-making and many approaches to treatment have not been well-supported by clinicopathologic studies. The need for evidence-based, scientifically documented approaches to both diagnosis and treatment is eminent. Specific diagnostic criteria are lacking for many oral diseases, and therapeutic strategies have not been assessed by the gold standard of placebo-controlled, double-blind trials. Additionally, there are scientific data in the published literature that continue to be ignored by dental practitioners who manage patients with oral pathologic conditions. In this article, specific disease entities that are commonly managed by oral pathologists and oral medicine practitioners will be discussed with recommendations for future scientific studies that can serve as a framework for evidence-based diagnostic and therapeutic approaches.     

Effect of oral anticipatory guidance on oral health and oral hygiene practices in preschool children

Thirty children (6 to 18 months), enrolled in a dental program since birth, make up the intervention group. Control group consisted of thirty children who were of similar age and gender but had never been to a dental office. The presence of visible dental plaque and the performance of oral hygiene differed statistically between both groups. The dental program was effective in reducing visible dental plaque, and in establishing oral health habits among parents and young children.     

Relationship between chronic trauma of the oral mucosa,oral potentially malignant disorders and oral cancer

J Oral Pathol Med (2010) 39 : 513–517 Background: Oral cancer represents 2%–5% of all cancers, being one of the 10 most frequent ones. Apart from oral cancer risk factors already described in literature, such as tobacco and alcohol consumption, others emerging risk factors have been proposed, such as chronic irritation from dental factors. The aim of this work was to assess the influence of chronic trauma of the oral mucosa (CTOM) in patients with oral potentially malignant disorders (OPMD) and cancer. Methods: A retrospective study of 406 patients (both sexes; aged between 18 and 80 years; with OPMD and cancer) who attended the Department of Clinical Stomatology A of the National University of Cordoba was performed by non‐probabilistic sampling. The association of variables and outcome variable diagnosis, with levels control, OPMD, oral cancer, was evaluated by multinomial regression model. Results: Population under study was represented by 72% of control patients, 16% patients with OPMD and 11% of patients with oral cancer. It was observed a significant association between diagnosis and CTOM (P = 0.000), after adjustment of confounding factors (smoking and drinking habits, sex, cancer inheritance and denture use). Conclusions: Our results suggest that CTOM is, together with other factors, an important risk factor in patients with oral cancer diagnosis, but not for patients with OPMD.     

Influence of oral health and lifestyle on oral malodour

Objective: To assess the influence of oral health and lifestyle on the prevalence of oral malodour among university students. Materials and methods: Self‐administered questionnaires. Chi‐square test was used to detect any significant association between malodour and various variables. Results: 9% of males and 6% of females complained of malodour, while 36% of males and 31% of females did not complain of malodour. Nevertheless, 12% of the males and 6% of females were unable to decide. The highest percentage of respondents not complaining of malodour were non‐smokers (55%). A significant number of respondents were free from caries (48%), gingival disease (55%) and also were not complaining of malodour. Statistically, a significant association was found between malodour and gingival disease (p < 0.05) and between malodour and the use of a toothbrush on a daily basis (p < 0.001). Conclusions: The results highlight the influence of oral self‐care and lifestyle on malodour. Public awareness, diagnosis and treatment of malodour are primarily the responsibility of dentists. Malodour can have a distressing effect and the affected person may avoid socialising.     

Physiotherapeutic treatment improves oral opening in oral submucous fibrosis

Background:  In oral submucous fibrosis (OSF) fibrous bands and burning mucosal pain restrict oral opening to limit speech and eating. The pathogenesis of OSF remains unclear, while surgical and pharmacological treatments have limited success, and are often inaccessible in communities using areca nut where OSF is prevalent. Improved outcomes are reported for surgical treatment when followed by physiotherapy. We tested the hypothesis that physiotherapy alone can modify tissue remodelling in OSF to increase oral opening.
Materials and methods:  Fifty-four Nepali OSF patients were managed for 4 months in three randomly assigned groups receiving either: five times daily physiotherapy by inter-positioning tongue spatulas between teeth and adding a new spatula every 5–10 days; local injection of hyaluronidase with steroids; or no active treatment.
Results:  More males presented with OSF than females ( p  < 0.05). All patients reported reduced opening and 47% had mucosal pain. Progressive mucosal involvement was always in the same order, starting with the soft palate, and then progressing to the fauces, unilateral buccal mucosa, bilateral buccal mucosa, floor of mouth and finally lip mucosa ( p  < 0.006). Physiotherapy improved oral opening ( p  < 0.0005), but not oral pain, while no clear improvement was seen in untreated patients as well as patients managed by injection.
Conclusions:  We conclude OSF in the Nepali population progresses in a predictable pattern, and that physiotherapy is effective for increasing the oral opening. We further suggest physiotherapy can be readily used to improve OSF in communities with otherwise limited health resources.     

Prevention of oral diseases and oral health promotion.

Research and activities, as promoted in 1989 and 1990, in oral disease prevention and health promotion are summarized. Significant syntheses of research findings have occurred, as a result of planning and workship activities, which will direct oral health promotion in the 1990s. Original research on established and new preventive therapies for dental caries, periodontal diseases, oral mucosal alterations, soft-tissue lesions, precancers and cancers, and trauma are reported, opportunities to prevent oral diseases or maintain oral health through changes in individual behaviors, professional orientation, and social and environmental changes are addressed.     

Global oral health inequalities: oral infections-challenges and approaches

Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.     

Bleeding incidence after oral surgery with continued oral anticoagulation

Objectives

The aim of this retrospective study was to assess the incidence of postoperative hemorrhage in patients treated with coumarins without interruption of the anticoagulant treatment undergoing oral surgical procedures, mostly osteotomies for tooth removal, when compared with patients who had never been anticoagulated.

Material and methods

Six hundred thirty-seven patients underwent 934 oral surgical procedures on an outpatient basis. The INR was measured preoperatively being 2.44 in the mean SD 0.61. Local hemostasis was carried out routinely (80%) with collagen fleece, local flap, and acrylic splint.

Results

Of these 637 patients, 47 presented with a postoperative hemorrhage (7.4%), 15 of these 47 cases had to be treated in hospital (2.4%). All patients showed up finally with a good wound healing, no administration of blood was necessary, and local measures revealed to be sufficient in all cases except for two patients, where the preoperative anticoagulant treatment had to be changed for 6?days. The bleeding incidence in 285 patients with comparable oral surgical procedures, who had never been anticoagulated, was 0.7%.

Conclusions

The results suggest that oral surgical procedures can be performed safely without alteration of the oral anticoagulant treatment.

Cinical relevance

Local hemostasis with collagen fleece, local flap, and acrylic splint seems to be sufficient to prevent postoperative bleeding.     

Effects of S-PRG eluate on oral biofilm and oral malodor

ObjectivesThis study evaluated the effects of a surface pre-reacted glass-ionomer (S-PRG) eluate on oral microbiota and dental biofilms in vitro, and on oral malodor and tongue bacterial loads clinically.Study designThe effect of S-PRG eluate on the growth and survival of salivary bacteria was examined under both aerobic and anaerobic conditions; its ability to inhibit new biofilm formation and disrupt mature biofilms was also evaluated. The concentration of volatile sulfur compounds (VSCs) was measured using a portable sulfide monitor before and after rinsing with S-PRG eluate or distilled water. The number of bacteria on the tongue surface was calculated using a portable bacterial counter before and after tongue scraping with S-PRG eluate or distilled water.ResultsNo zone of inhibition was seen for S-PRG eluate against salivary microbiota under either aerobic or anaerobic conditions; however, treatment with ≥20% S-PRG eluate was sufficient to suppress biofilm formation relative to untreated controls. Mature biofilms were significantly disrupted following treatment with ≥60% S-PRG eluate relative to controls. Rinsing with S-PRG eluate significantly reduced the level of VSCs relative to baseline; this effect was not seen with distilled water alone. Waste fluids collected after oral rinsing with S-PRG eluate contained more bacteria than rinsing with distilled water alone. Finally, tongue scraping using S-PRG eluate was shown to significantly reduce the number of bacteria on the tongue surface.ConclusionsS-PRG eluate inhibits biofilm formation and disrupts mature biofilms, although its antibacterial activity is limited. Oral rinsing and tongue cleaning with S-PRG eluate may reduce oral malodor by effectively removing oral bacteria from the oral cavity.     

The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma

BackgroundThe clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC.MethodsThe authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms “oral mucosal lesion screening” and “oral lesions.” They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool.ResultsThe overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1–17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC.Clinical ImplicationsOn the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.     

Characterization of oral lactobacilli as potential probiotics for oral health

INTRODUCTION: Intestinal lactobacilli have been successfully used as probiotics to treat gastrointestinal disorders, but only limited data are available for the probiotic properties of oral lactobacilli to combat oral diseases. We aimed to characterize oral lactobacilli for their potential probiotic properties according to the international guidelines for the evaluation of probiotics, and to select potential probiotic strains for oral health. METHODS: The study included 67 salivary and subgingival lactobacilli of 10 species, isolated from healthy humans. All strains were identified using amplified ribosomal DNA restriction analysis, tested for antimicrobial activity against oral pathogens, tolerance of low pH and bile content. Thereafter, the lysozyme tolerance and antibiotic susceptibility of 22 potential probiotic strains were assessed. RESULTS: The majority of strains suppressed the growth of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Streptococcus mutans, but none inhibited Candida albicans. The lowest pH tolerated by lactobacilli following 4 h of incubation was pH 2.5, but none of the strains grew at this pH. All strains tolerated a high concentration of lysozyme (10 mg/ml) and half of the strains tolerated a high concentration of human bile [5% volume/volume (V/V)]. Four Lactobacillus plantarum and two Lactobacillus oris strains expressed resistance to tetracycline and/or doxycycline. CONCLUSIONS: Strains of L. plantarum, Lactobacillus paracasei, Lactobacillus salivarius, and Lactobacillus rhamnosus expressed both high antimicrobial activity and high tolerance of environmental stress. The absence of transferable antibiotic-resistance genes in L. plantarum strains remains to be confirmed. These results suggest a potential for oral lactobacilli to be used as probiotics for oral health.     

Coaggregation of oral lactobacilli with streptococci from the oral cavity

The ability of oral lactobacilli to coaggregate with streptococci and actinomycetes was investigated. Of the 7 species of lactobacilli studied, only two were capable of Coaggregation and the Coaggregation was restricted to streptococci. Lactobacillus salivarius strains (2/4) coaggregated with Streptococcus salivarius, Streptococcus gordonii, Streptococcus crista and tufted Streptococcus sanguis II strains. Lactobacillus fermentum (2/3) coaggregated with S. gordonii and S. sanguis. The Coaggregation between L. salivarius and S. salivarius, S. gordonii or tufted S. sanguis II strains was mediated by a protein on the surface of the lactobacilli and was not inhibited by lactose. The Coaggregation between L. fermentum and the streptococci was mediated by protein on the surface of the streptococci and was inhibited by lactose.