Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease

Background:  The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD).
Methods:  Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 ± 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 ± 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices.
Results:  No significant difference was found in OHIP-14 scores between patients from UK (22.7 ± 14.4) and Turkey (20.4 ± 14.3) ( P  = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK ( r  = 0.4, P  = 0.04) and the number of oral ulcers in Turkey ( r  = 0.4, P  = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 ± 2.8) compared with that in Turkey (1.5 ± 2.5) ( P  = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK ( P  = 0.000). Similarly, the duration since the last dental visit (5.1 ± 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 ± 23.7 months) ( P  = 0.000).
Conclusions:  Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey.     

The close association between dental and periodontal treatments and oral ulcer course in behcet's disease: a prospective clinical study

Objective:  The aim of the study was to evaluate the influence of dental and periodontal treatments to the course of oral ulcers in patients with Behcet's disease (BD).
Methods:  Fifty-eight consecutive BD patients with oral ulcers were studied. Twenty-nine patients were in the intervention group (F/M: 15/14, mean age: 39.6 ± 6.9 years) and 29 (F/M: 15/14, 39.4 ± 10.6 years) were followed with a conventional treatment approach. In addition to oral hygiene education, dental and periodontal treatments were carried out in the intervention group, whereas the control group was only given oral hygiene education. Patients were evaluated in the pre-treatment observation period (1 month), treatment period (1 month) and 6 months after treatment.
Results:  An increase in the number of new oral ulcers (4.1 ± 3.5) was observed within 2 days during the treatment compared with 3–30 days during treatment month (2.3 ± 1.2) ( P  = 0.002). However, 6 months after the treatment, the number of oral ulcers (1.9 ± 1.5) was significantly lower compared with the pre-treatment observation (4.8 ± 3.2) ( P  = 0.000) and treatment periods (6.4 ± 2.3) in the intervention group ( P  = 0.05), whereas a similar oral ulcer presence was observed in the control group (2.8 ± 2.4, 3.7 ± 2.3 and 4.8 ± 4.3, respectively) ( P  > 0.05). Dental and periodontal indices were also better in the intervention group during the 6-month follow-up.
Conclusion:  Our results suggest that, in BD patients, dental and periodontal therapies could be associated with a flare-up of oral ulcers in the short term, but may decrease their number in longer follow-up. They also lead to a better oral health.     

The assessment of oral health-related quality of life by factor analysis in patients with Behcet''s disease and recurrent aphthous stomatitis

BACKGROUND: The aim of the study was to test multidimensional properties of oral health impact profile-14 (OHIP-14) in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS) patients with active oral ulcers. METHODS: Ninety-six BD patients, 28 patients with RAS and 117 healthy controls (HC) were included in this study. In patients with active oral ulcers, the frequency and healing time of ulcers were recorded. Multidimensional properties of OHIP-14 were examined by factor analysis. RESULTS: Factor analysis revealed three subscales and explained 66.49% of overall variance in these patients with active oral ulcers. The score of Subscale 1 was positively correlated with the recurrence of oral ulcers per month (P = 0.037). Subscale 3 scores of the patients treated with colchicine were worse than those treated with immunosuppressives (P = 0.035). CONCLUSIONS: The factor structure of OHIP-14 was found to be reliable and sensitive to clinical parameters and treatment modalities in active patients.     

Relationship between periodontal parameters and Behçet's disease and evaluation of different treatments for oral recurrent aphthous stomatitis

Background and Objective:  The highest prevalence of Behçet's disease (BD) has been reported in Turkey, and therefore research of relations between BD and other disorders have become important in the Turkish population. Since oral aphthous ulcers impair tooth brushing, reducing complaints about aphthous ulcers will motivate the patient to maintain better oral hygiene performance and will thus reduce plaque accumulation and periodontal scores. The purpose of this controlled case study was to evaluate the relationship between the severity of periodontal scores and Behçet's disease, and to compare the treatment modalities with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and medication on the recurrent aphthous ulcers in BD patients by considering the degree of pre- and post-treatment pain, discomfort and functional complications.
Material and Methods:  The periodontal status of 28 BD patients was evaluated according to periodontal indices. The BD patients were also assessed for clinical severity score as described previously. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4 and 7.
Results:  Periodontal indices, the number of oral ulcers and the daily frequency of tooth brushing were related to the severity scores of BD ( p  < 0.001). The results indicated that BD patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications and reported immediate relief of pain and faster healing ( p  < 0.001).
Conclusion:  Our results suggest that periodontal status is worse in BD patients and is associated with disease severity; also, the Nd:YAG laser has better patient acceptance, shorter treatment time and lower rates of pain and post-treatment adverse events among BD patients with oral recurrent aphthous stomatitis.     

Recurrent aphthous stomatitis in Behçet''s disease: clinical featueres and correlation with systemic disease expression and severity

Behçet's disease (BD) is a multisystem disease, in which recurrent aphthous stomatitis (RAS) is a universal finding. We studied the expression of RAS in patients with BD, and the correlation between major or minor RAS and systemic expression and severity of the disease. Thirty-five patients with BD were studied, of whom 13 (37%) had major, 21 (60%) had minor and one (3%) had herpetiform RAS. The frequency of major RAS was significantly higher compared with a control group of patients with idiopathic RAS (37% vs 9%, P<0.05). The BD patients with major RAS had significantly more relapses of oral ulceration in a year, higher numbers of oral ulcers per relapse, and longer duration of aphthous episodes, compared with patients with minor RAS. Oral ulcers also appeared at a significantly younger age in patients with major than with minor RAS. However, the systemic expression of the disease, as well as the disease severity score, were similar in patients with major and minor RAS. The results of this study indicate that major RAS is common in patients with BD, and is associated with a more severe, repeated and prolonged oral disease. Nevertheless, the presence of major RAS in BD does not predict a more severe systemic illness.     

Expression of hypoxia-inducible factor-1α is significantly associated with the progression and prognosis of oral squamous cell carcinomas in Taiwan

Background:  Overexpression of hypoxia-inducible factor-1α (HIF-1α) has been found to be significantly associated with the tumor invasion, lymph node metastasis, clinical stage, and prognosis of a variety of human cancers.
Methods:  This study examined the expression of HIF-1α in 57 specimens of oral squamous cell carcinoma (OSCC), 41 specimens of oral epithelial dysplasia (OED, 12 mild, 17 moderate, and 12 severe OED cases), and 14 specimens of normal oral mucosa (NOM) by immunohistochemistry.
Results:  We found that the mean nuclear HIF-1α labeling indices (LIs) increased significantly from NOM (9 ± 6%) through mild OED (25 ± 18%), moderate OED (41 ± 27%), and severe OED (42 ± 22%) to OSCC samples (55 ± 23%, P  < 0.001). A significant correlation was found between the higher mean nuclear HIF-1α LI and OSCCs with larger tumor size ( P  < 0.001), regional lymph node metastasis ( P  < 0.001), or more advanced clinical stages ( P  < 0.001). Only larger tumor size ( P  = 0.002) and nuclear HIF-1α LI ≥ 60% ( P  = 0.048) were identified as independent unfavorable prognosis factor by multivariate analyses with Cox regression model. Kaplan–Meier curve showed that OSCC patients with a nuclear HIF-1α LI ≥ 60% had a significantly poorer cumulative survival than those with a nuclear HIF-1α LI < 60% (log-rank test, P  = 0.022).
Conclusions:  We conclude that the expression of HIF-1α is an early event in oral carcinogenesis. The nuclear HIF-1α LI in OSCC samples can predict the progression of OSCCs and the survival of OSCC patients.     

Oxidant/antioxidant status in recurrent aphthous stomatitis

Objective:  Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The study was performed to evaluate the involvement of oxidant toxicity in this disorder.
Methods:  Patients with RAS ( n  = 26) and age- and sex-matched healthy control subjects ( n  = 20) were included in this study. Following an overnight fast, blood specimens were obtained. Plasma malondialdehyde concentrations and erythrocytes glutathione peroxidase activities were determined. Also, plasma vitamin E and selenium levels were detected. Mann–Whitney U -test was performed for statistical evaluation.
Results:  Oxidative stress was confirmed by the significant elevation in plasma malondialdehyde levels and by the significant decrease in glutathione peroxidase activities, vitamin E and selenium levels ( P  < 0.001).
Conclusions:  Our results indicated that lipid peroxidation and the inadequacy of the defense system seem to play a crucial role in the pathogenesis of recurrent aphthous stomatitis.     

Decreased expression of Ep-CAM protein is significantly associated with the progression and prognosis of oral squamous cell carcinomas in Taiwan

Background:  The epithelial cell adhesion molecule (Ep-CAM) is involved in cell signaling, migration, proliferation, cell-cycle regulation, and cancer metastasis.
Methods:  This study used an immunohistochemical technique to examine the expression of Ep-CAM protein in 84 specimens of oral squamous cell carcinoma (OSCC), 98 specimens of oral epithelial dysplasia (OED, 31 mild, 41 moderate, and 26 severe OED cases), and 15 specimens of normal oral mucosa (NOM).
Results:  We found that the mean Ep-CAM labeling indices (LIs) decreased significantly from NOM (80 ± 18%) and mild OED (76 ± 14%) through moderate OED (66 ± 22%) and severe OED (55 ± 20%) to OSCC samples (46 ± 16%, P <  0.001). A significant correlation was found between the lower mean Ep-CAM LI and OSCCs with larger tumor size ( P =  0.003), positive lymph node metastasis ( P =  0.022), more advanced clinical stages ( P <  0.001), cancer recurrence ( P =  0.021), or extracapsular spread of lymph node ( P =  0.015). However, only Ep-CAM LI  <  50% ( P  < 0.0001) was identified as an independent unfavorable prognosis factor by multivariate analyses with Cox proportional hazard regression model. Kaplan–Meier curve showed that OSCC patients with an Ep-CAM LI < 50% had a significantly poorer cumulative survival than those with an Ep-CAM LI ≥ 50% ( P  < 0.00001, log-rank test).
Conclusions:  We conclude that the decreased expression of Ep-CAM protein is an early event in oral carcinogenesis. The Ep-CAM LI in OSCC samples can predict the progression of OSCCs and the survival of OSCC patients.     

Oral manifestations of HIV infection in adult patients from the province of Sancti Spiritus, Cuba

Background:  Studies on the prevalence of HIV-related oral lesions (HIV-OL) have shown great variations among different countries. The aim of this study was to describe the prevalence of HIV-OL in adults infected with HIV in the province of Sancti Spiritus, Cuba, and to determine the factors associated with the presence of HIV-OL.
Methods:  A cross-sectional observational study was performed between November 2006 and August 2007 at the Hospital General Universitario 'Camilo Cienfuegos', Sancti Spiritus. One hundred and fifty-four HIV-infected patients were included. Patients were examined and interviewed by a periodontal specialist. Diagnosis of HIV-OL was based on clinical criteria. Demographical, clinical and laboratory data were obtained. Independent association of each factor with HIV-OL was assessed by logistic regression modelling.
Results:  The prevalence of HIV-OL was 40.9%. The commonest manifestation was oral hairy leucoplakia ( n  = 19; 12.3%); oral candidiasis ( n  = 17; 11%); herpes simplex virus infection ( n  = 11; 7.4%); and aphthous ulcer ( n  = 9; 5.8%). Principal factors associated with the presence of HIV-OL were CD4⁺ lymphocytes <500 cells/mm³ (OR: 2.06; 95% CI: 1.019–4.195) and smoking (OR: 2.03 CI: 1.037–3.982).
Conclusion:  This study described the prevalence of HIV-OL in 154 HIV-infected patients which represent about 80% of those known to be infected in the province of Sancti Spiritus. The prevalence of HIV-OL was lower than those reported from developing countries. Oral hairy leucoplakia and oral candidiasis were the most prevalent HIV-OL. Smoking and CD4⁺ cells count <500 cells/mm³ were the two factors independently associated with the presence of HIV-OL.     

Histomorphometric Analysis of Human Maxillary Sinus Lift with a New Bone Substitute Biocomposite: A Preliminary Report

Purpose: To analyze radiographic and histological outcomes of maxillary sinus floor augmentation using a calcium-sulfate based allograft containing demineralized bone matrix particles.
Materials and Methods: Fifteen maxillary sinus lift procedures with simultaneous placement of titanium implants were performed in 12 patients of both genders aged 36–71 years. Each sinus cavity was filled by the biocomposite. After 3 months of healing, all surgical sites were uncovered and bone biopsies were retrieved for undecalcified histology and histomorphometry. The ratio between the original and the grafted sinus height (GSH/OSH) was computed using a panoramic radiography taken immediately after surgery and at 3 months of healing, and the two ratios were compared by Wilcoxon signed-rank test.
Results: By 3 months, all implants were stable without clinical and radiographic signs of infection. Significant changes in GSH/OSH during healing were seen (2.7 ± 0.6 initially vs. 2.6 ± 0.5 after healing; p  = 0.01). Histologic findings showed newly formed bone surrounding the residual grafted particles without inflammation. At 3 months, mean regenerated bone density was 33.8 ± 8.6%; marrow spaces amounted to 32.3 ± 10.3%; residual graft was 33.9 ± 9.0%. Similar histomorphometric and radiographic results were obtained independently from patient age or sex.
Conclusions: The analysed putty seems to be a safe and effective graft material for maxillary sinus floor augmentation by accelerating bone regeneration and thus reducing the healing time.     

Treatment with levamisole and colchicine can result in a significant reduction of IL-6, IL-8 or TNF-α level in patients with mucocutaneous type of Behcet's disease

Background:  Mucocutaneous type of Behcet's disease (MCBD) is a multisystemic inflammatory disease with oral and genital ulcers with or without skin lesions.
Methods:  A solid phase, two-site sequential chemiluminescent immunometric assay was used to measure serum levels of interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-α in 54 normal control subjects and in 64 MCBD patients before and after treatment with levamisole plus colchicine.
Results:  We found that 67%, 83% or 67% of MCBD patients had a serum IL-6, IL-8 or TNF-α level greater than the upper normal limit of 4.7, 8.7 or 7.4 pg/ml, respectively. The mean serum level of IL-6 (9.9 ± 2.4 pg/ml, P  < 0.005), IL-8 (107.5 ± 21.4 pg/ml, P  < 0.001) or TNF-α (22.5 ± 4.1 pg/ml, P  < 0.001) in 64 MCBD patients was significantly higher than that (2.1 ± 0.2, 5.7 ± 0.2 or 3.8 ± 0.2 pg/ml for IL-6, IL-8 or TNF-α level, respectively) in normal control subjects. In 43 MCBD patients with all the serum IL-6, IL-8 and TNF-α levels higher than their upper normal limits, treatment with levamisole plus colchicine for a period of 0.5–11.5 (mean, 3.2 ± 2.4) months could significantly reduce the mean serum IL-6, IL-8 and TNF-α levels from 9.0 ± 1.7 to 1.6 ± 0.2 pg/ml ( P  < 0.001), 134.6 ± 28.2–6.0 ± 0.4 pg/ml ( P  < 0.001) and 25.7 ± 5.6–3.5 ± 0.4 pg/ml ( P  < 0.001), respectively.
Conclusions:  Treatment with levamisole and colchicine can result in a significant reduction of serum IL-6, IL-8 or TNF-α level in MCBD patients.     

FOXP3+ T regulatory cells in lesions of oral lichen planus correlated with disease activity

Objective:  The aim of this study was to determine the correlation between the number of FOXP3⁺ T cell in lesions and the disease activity of patients with oral lichen planus (OLP).
Materials and Methods:  The expression of FOXP3 was investigated using immunohistochemical staining and real-time RT-PCR in 23 OLP lesions and 12 controls. Changes of FOXP3⁺ Treg in peripheral blood from three patients' pre and post-treatment were assessed using flow cytometry.
Results:  Few FOXP3⁺ cells were detected in controls, but an increased number of FOXP3⁺ cells were observed in lesions ( n  = 20, 40.99 ± 24.68 cells per high-power field – hpf). Furthermore, the frequency of FOXP3⁺ Treg in reticular OLP ( n  = 7, 63.6 ± 23.2 cells per hpf) was significantly higher than that in erythematous/erosive OLP ( n  = 13, 28.8 ± 16.8 cells per hpf, P  = 0.001). In addition, negative correlation was found between the number of FOXP3⁺ Treg and disease activity (correlation oefficient = −0.557, P  = 0.013). The proportion of FOXP3⁺ Treg showed remarkable increase in peripheral blood from patients after treatment (1.39 ± 0.71% vs 4.91 ± 1.59%).
Conclusions:  These data indicated that FOXP3⁺ Treg were involved in the pathogenesis of OLP and correlated with disease's subtype and activity.     

Humoral immunity to cow’s milk proteins and gliadin within the etiology of recurrent aphthous ulcers?

Objectives:  The goal of this study was to determine the incidence of serum antibodies to gliadin and to cow's milk proteins (CMP) using ELISA test, within patients who have recurrent aphthous ulcers (RAU).
Subjects and Methods:  Fifty patients with recurrent aphthous ulcers and fifty healthy people were included in this research. Levels of serum IgA and IgG antibodies to gliadin and IgA, IgG and IgE to CMP were determined using ELISA.
Results:  The levels of serum antigliadin IgA and IgG antibodies were not significantly higher in patients with RAU in comparison with the controls ( P  = 0.937 and P  = 0.1854 respectively). The levels of serum anti-CMP IgA, IgG and IgE antibodies were significantly higher in patients with RAU in comparison with the controls ( P  < 0.005, P  < 0.002 and P  < 0.001 respectively). In general, the increased humoral (IgA or IgG) immunoreactivity to CMP was found in 32 of 50 patients, while 17 of them showed the increased levels of both IgA and IgG immunoreactivity to CMP. At the same time, 16 out of 50 patients had IgA, IgG and IgE immunoreactivity to CMP.
Conclusion:  These results indicate the strong association between high levels of serum anti-CMP IgA, IgG and IgE antibodies and clinical manifestations of recurrent aphthous ulcers.     

New mouthwash: an efficacious intervention for oral ulceration associated with Behçet's disease

Topical interventions to treat oral ulcers in Behçet's disease (BD) are crucial to control disease activity and improve patients’ quality of life. Our aim was to evaluate the effectiveness of a new BD mouthwash (BD MW) for oral ulceration. A retrospective cross-sectional study was carried out on 261 BD patients (141 women, mean (SD) age 39.9 (11.8) years, and 120 men, mean (SD) age 41.141(3.7) years). All were assessed using the oral ulcer severity score (OUSS), oral health quality of life (OHQoL), and the Behçet's disease current activity form (BDCAF). Patients were divided into three groups: one group used the BD MW, one group used a betamethasone mouthwash, and the other used no therapeutic mouthwash. Patients were assessed at three and six months. The OUSS in those using the BD MW was nine times lower than it was in those using betamethasone mouthwash (p = 0.001), and 12 times lower than it was in the no mouthwash group (p = 0.001). Compared with the baseline data, use of the BD MW during the first three months significantly reduced the OUSS, the BDCAF score, and intraoral scarring, and also improved OHQoL (p = 0.001, 0.019, 0.012, and 0.001, respectively). Ongoing use of the BD MW after six months significantly improved the OUSS, OHQoL, and intraoral scars, and kept oral and systemic disease activity under control. A total of 20/31 patients reported high levels of satisfaction with its use, and a patients’ satisfaction score showed a preference for it. This study confirms the efficacy of the BD MW in patients with recurrent oral ulceration (ROU). It is more efficacious than betamethasone mouthwash used alone.     

壳聚糖口腔贴膜治疗轻型复发性阿弗他溃疡随机对照临床研究

目的通过壳聚糖口腔贴膜对轻型复发性阿弗他溃疡的临床疗效观察,探讨其有效性和安全性。方法本研究共纳入72例患有轻型复发性阿弗他溃疡的受试者。在6日的试验期间,随机分配受试者至试验组或对照组并告知贴膜使用方法,试验组材料为壳聚糖口腔贴膜,对照组材料为聚乙烯醇膜;比较2组受试者溃疡疼痛值、溃疡面积及不良反应。结果在第4天至第6天,试验组溃疡面积缩小(2.91±3.66)mm^2,对照组溃疡面积缩小(1.10±2.26)mm^2,2组差异具有统计学意义(P<0.05),试验期间初诊及每次复查时,组间溃疡面积、溃疡疼痛值、溃疡疼痛缩小值比较差异均没有统计学意义(P>0.05)。试验过程中无不良反应发生。结论壳聚糖口腔贴膜具有一定的促进轻型复发性阿弗他溃疡愈合的作用。     

Expression of CXCR4 in oral squamous cell carcinoma: correlations with clinicopathology and pivotal role of proliferation

J Oral Pathol Med (2010) 39 : 63–68
Background:  The chemokine SDF-1 and its receptor CXCR4 play active role in the metastasis and proliferation of several malignancies.
Methods:  In this study, we used an immunohistochemical technique in 91 specimens of oral squamous cell carcinoma (SCC), and flow cytometry technique in oral SCC cell line, and then evaluated the role of proliferation of CXCR4 using MTT assay in oral SCC cell line.
Results:  The expression of CXCR4 in 91 specimens of oral SCC was 62.6% and in oral SCC cell line was 68.6%. There was a significant association between the expression of CXCR4 and lymph node metastasis ( P  = 0.012), tumor size ( P  = 0.01), UICC stage ( P  = 0.016), tumor histology grade ( P  < 0.001). SDF-1 stimulated proliferation of oral SCC cell and CXCR4 neutralization by monoclonal antibodies decreased proliferation.
Conclusions:  Our results suggest that CXCR4 might be a novel biomarker to evaluate the biological behavior of oral SCC. CXCR4 inhibitors or antagonists might be potential anticancer agents to suppress tumor proliferation.     

Dimensional ridge alterations following immediate implant placement in molar extraction sites: a six-month prospective cohort study with surgical re-entry

Aim: To assess dimensional ridge alterations following immediate implant placement in molar extraction sites.
Material and methods: Twelve subjects received 12 immediate transmucosal implants in molar extraction sites. Peri-implant defects were treated according to the principles of Guided Bone Regeneration by means of a deproteinized bone substitute and a bioresorbable collagen membrane. Changes in vertical (IS-BD, CREST-BD) and horizontal distances (EC-I, IC-I) of alveolar bony walls to the bottom of the defects (BD) and to the implant surfaces (I) were compared between implant placement and surgical re-entry at 6 months.
Results: The implant survival rate at 6 months was 100%. Statistically significant differences ( P <0.01) were observed in the mean changes in vertical distances IS-BD and CREST-BD between baseline and re-entry. At re-entry, all peri-implant marginal defects assessed from the internal socket wall to the implant surface (IC-I) were healed. The residual combined thickness of the buccal wall with the newly formed peri-implant bone at sites with an initial thickness of 1 mm was statistically significantly smaller ( P <0.05) compared with that of sites with an initial buccal thickness of 2 mm (2.50 ± 0.76 vs. 4±0 mm).
Conclusions: The marginal defects around immediate implants placed in molar extraction sites were completely filled after 6 months of healing through de novo bone formation. Bone resorption was observed from the external aspects of the buccal and oral socket walls. Dimensional changes of the external socket walls were mostly pronounced at the buccal aspects.     

Human cytomegalovirus as a potential etiologic agent in recurrent aphthous ulcers and Behçet's disease

In a preliminary study on anti-human cytomegalovirus (HCMV) antibody (Ab) by ELISA. the serum anti-HCMV/IgG Ab concentrations in 22 patients with recurrent aphthous ulcers (RAU) in the remission stage were found to be significantly higher than in 22 control subjects (121±42 vs 100±27, P<0.05) and in 39 patients with RAU in the active stage (121±42 vs 88±45, P<0.01). Therefore, the potential of HCMV as an etiologic agent in RAU was proposed and studies using the polymerase chain reaction (PCR) and in situ hybridization (ISH) have been performed to investigate the possible presence of HCMV DNA in pre-ulcerative oral aphthous lesions in patients with RAU or Behçet's disease (BD) of the mucocutaneous type. For this purpose, formalin-fixed biopsy specimens were obtained from 13 pre-ulcerative oral aphthous lesions, 2 samples of normal oral mucosa and 1 ileal mucosal lesion from 9 RAU patients and 4 BD patients. Five specimens of normal oral mucosa from 5 normal control subjects and 12 specimens of oral erosive or ulcerative lesions from 12 patients with erosive lichen planus (ELP) were also included. By PCR, HCMV DNA was detected in 5 of the 13 (38.5%) pre-ulcerative oral aphthous lesions. 3 from RAU patients and 2 from BD patients. The ileal mucosa specimen was also HCMV DNA-positive, whereas HCMV DNA was not demonstrated in any of the 7 specimens of normal oral mucosa from RAU patients and normal control subjects; 12 specimens of oral lesions from ELP patients were similarly negative. ISH did not detect HCMV DNA in any of the biopsy specimens from RAU patients and control subjects. Our findings suggest that HCMV may be an etiologic agent in some cases of RAU and BD.     

Clinical and immunological effects of azithromycin in Behçet''s disease

Background: The aim of this study was to evaluate the effects of azithromycin on mucocutaneous manifestations, oral health and immune response in Behçet's disease (BD). Methods: Eight BD patients with active mucocutaneous symptoms were treated with azithromycin for 4 weeks. Oral health, clinical manifestations and in vitro interleukin (IL)‐12, interferon (IFN)‐γ, IL‐10 and monocyte chemotactic protein (MCP)‐1 responses were evaluated before and after treatment. Results: The number of folliculitic lesions, healing time of oral ulcers and scores of plaque indexes (PLIs) were lower after azithromycin treatment (P < 0.05). Scores of PLIs correlated positively with the healing time of oral ulcers (P = 0.02). Although a trend towards increased stimulated IL‐10 responses with azithromycin was observed, no statistically significant difference was found. Stimulated and unstimulated MCP‐1, IFN‐γ and IL‐12 responses were similar before and after treatment (P > 0.05). Conclusion: Azithromycin was observed to be effective in decreasing folliculitic lesions and fastening the healing time of oral ulcers in BD.     

Association of MTHFR gene C677T mutation with recurrent aphthous stomatitis and number of oral ulcers

Objectives

Recurrent aphthous stomatitis (RAS) is a common ulcerative disease of the oral mucosa. Methylenetetrahydrofolate reductase (MTHFR) gene variants are associated with thrombophilia and vasculopathy that may result in oral ulceration. Oral ulcers are also the most common feature of Behcet’s disease (BD). Association of MTHFR gene C677T mutation with BD has been reported in different populations. The aim of the present study was to investigate the possible association between MTHFR gene C677T mutation and RAS and evaluate if there was an association with clinical features in a relatively large cohort of Turkish patients.

Materials and methods

The study included 188 patients affected by RAS and 200 healthy controls. Genomic DNA was isolated and genotyped using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay for the MTHFR gene C677T mutation.

Results

The genotype and allele frequencies of C677T mutation showed statistically significant differences between RAS patients and controls (p?=?0.002 and p?=?0.0004, respectively). After stratifying RAS patients according to clinical characteristics of oral ulcers, a significant association was observed between C677T mutation and number of oral ulcers of RAS patients (p?=?0.006).

Conclusions

As a result, a high association between MTHFR gene C677T mutation and RAS was observed in the present study. Also number of oral ulcers was found to be associated with MTHFR C677T mutation in RAS patients.

Clinical Relevance

If our observation can be substantiated with further studies, evaluation for MTHFR mutations and perhaps folate supplementation may become necessary in selected patients.