Clinical trial of oral malodor treatment in patients with periodontal diseases

Pham TAV, Ueno M, Zaitsu T, Takehara S, Shinada K, Lam PH, Kawaguchi Y. Clinical trial of oral malodor treatment in patients with periodontal diseases. J Periodont Res 2011; 46: 722–729. © 2011 John Wiley & Sons A/S Background and Objective: Only a few clinical research studies have assessed different therapeutic approaches to oral malodor in subjects affected by periodontal diseases. The aim of this study was to evaluate the effects of periodontal treatment and tongue cleaning on oral malodor parameters in periodontitis and gingivitis patients. Material and Methods: The subjects were 102 periodontitis and 116 gingivitis patients with oral malodor. Oral malodor was measured by organoleptic test and Oral Chroma™. Oral health status, including tooth conditions, periodontal health, tongue coating and proteolytic activity of the BANA test in tongue coating were assessed. Subjects in each periodontal disease group were randomly assigned into two subgroups depending on the sequence of treatment: periodontal treatment and tongue cleaning. Oral malodor and oral health parameters were compared by groups and sequence of treatment. Results: For subjects in the periodontitis group, there were statistically significant reductions in oral malodor after periodontitis treatment or tongue cleaning; however, major reductions were found after periodontitis treatment. For those in the gingivitis group, there were also statistically significant reductions in oral malodor after gingivitis treatment or tongue cleaning, but the most marked reductions were observed after tongue cleaning. At the completion of treatment, all oral malodor parameters fell below the threshold levels in all subgroups. Conclusion: The present study indicated that periodontal treatment played an important role and tongue cleaning contributed to a lesser extent to reduction in oral malodor in periodontitis patients. In contrast, tongue cleaning alone can be the primary approach to reduce oral malodor in gingivitis patients.     

Comparative study of homeopathic remedies clinical efficacy in comprehensive treatment of inflammatory periodontal diseases in patients with burdened allergic status

Comparative analysis of clinical efficacy of 3 antihomotoxic homeopathic preparations (Traumeel S, Engistol and Echinacea compositum S) with non-specific immunostimulating and anti-inflammatory effects was performed. The study showed that Traumeel S had maximal anti-inflammatory effect. In proportion as destructive process weighting the efficacy of homeopathic preparations was decreased. The preparations are indicated for comprehensive treatment of inflammatory periodontal diseases in patients with burdened allergic status or heavy concomitant pathology.     

Prednisolone clearance: a possible determinant for glucocorticoid efficacy in patients with oral vesiculo-erosive diseases

The pharmacokinetics of prednisolone were determined in 12 patients with oral vesiculo-erosive diseases. The bioavailability of prednisone in these patients exhibited a low intersubject variability, while the metabolic clearance rate of total and of unbound prednisolone varied considerably from patient to patient.     

Implant treatment in patients with oral lichen planus: a prospective-controlled study

Objectives: The main aim of this prospective‐controlled study was to evaluate the implant survival rate in patients diagnosed with oral lichen planus (OLP). The secondary goals were to analyze the presence of implant‐ and patient‐dependent variables. Material and methods: Two groups, including 18 patients diagnosed with OLP and 18 controls, received 56 and 62 implants during the years 2003–2008. Pain and wound healing were evaluated after the procedure. After a mean follow‐up of 53.5 and 52.3 months, clinical and radiographic assessments were used to evaluate implant survival and patient‐ and implant‐dependent parameters. Results: The implant survival rate was 100% for the OLP group. Immediate postsurgical complications were similar in both groups. Peri‐implant mucositis (PIM) was detected in 44.6% of the implants and 66.6% of the patients with OLP. The presence of desquamative gingivitis (DG) was associated with a higher rate of PIM on those implants of the OLP group (P=0.004). Peri‐implantitis (PI) appeared in 10.7% of the implants and 27.7% of the patients with OLP (P=NS). Conclusion: Despite the limitations of the small sample size, it seems that lichen planus is not a prominent local player in the genesis of implant failure. Patients with DG should be carefully examined during follow‐up care.     

Clinical and histological characterization of oral pemphigus lesions in patients with skin diseases: a cross sectional study from Sudan

Background

Pemphigus is a rare group of life-threatening mucocutaneous autoimmune blistering diseases. Frequently, oral lesions precede the cutaneous ones. This study aimed to describe clinical and histological features of oral pemphigus lesions in patients aged 18 years and above, attending outpatient’s facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan. In addition, the study aimed to assess the diagnostic significance of routine histolopathology along with immunohistochemical (IHC) examination of formalin-fixed, paraffin-embedded biopsy specimens in patients with oral pemphigus.

Methods

A cross-sectional hospital-based study was conducted from October 2008 to January 2009. A total of 588 patients with confirmed disease diagnosis completed an oral examination and a personal interview. Clinical evaluations supported with histopathology were the methods of diagnosis. IHC was used to confirm the diagnosis. Location, size, and pain of oral lesions were used to measure the oral disease activity.

Results

Twenty-one patients were diagnosed with pemphigus vulgaris (PV), 19 of them (mean age: 43.0; range: 20–72 yrs) presented with oral manifestations. Pemphigus foliaceus was diagnosed in one patient. In PV, female: male ratio was 1.1:1.0. Buccal mucosa was the most commonly affected site. Exclusive oral lesions were detected in 14.2% (3/21). In patients who experienced both skin and oral lesion during their life time, 50.0% (9/18) had oral mucosa as the initial site of involvement, 33.3% (6/18) had skin as the primary site, and simultaneous involvement of both skin and oral mucosa was reported by 5.5% (1/18). Two patients did not provide information regarding the initial site of involvement. Oral lesion activity score was higher in those who reported to live outside Khartoum state, were outdoor workers, had lower education and belonged to Central and Western tribes compared with their counterparts. Histologically, all tissues except one had suprabasal cleft and acantholytic cells. IHC revealed IgG and C3 intercellularly in the epithelium.

Conclusions

PV was the predominating subtype of pemphigus in this study. The majority of patients with PV presented with oral lesions. Clinical and histological pictures of oral PV are in good agreement with the literature. IHC confirmed all diagnoses of PV.

     

Oral lesions of lupus erythematosus patients in relation to other chronic inflammatory oral diseases: an immunologic study

Abstract – The nature and distribution of mononuclear cells in non-ulcerated oral lesions of discoid (DLE) and systemic lupus erythematosus (SLE), were investigated and compared to other chronic inflammatory oral diseases (lichen planus (LP), contact lesion (CL), unspecified inflammation (UI), geographic tongue (GT), and leukoplakia (LK). For this purpose an immunoperoxidase technique based on staining with monoclonal antibodies was employed. In most LE specimens examined infiltrating cells consisted predominantly of a mixture of T cells (Leu 3a⁺ and Leu 2a⁺) that were distributed in the lamina propria, the submucosa, and occasionally also in the epithelium. In general, only few B cells were detected while macrophages were more frequent. In all LE specimens examined β₂-microglobulin expression was observed on a large proportion of cells including infiltrating mononuclear cells as well as resident keratinocytes. In addition, most infiltrating cells displayed MHC Class II antigens according to a pattern HLA-DR>DQ>DP. Interestingly, expression of Class II antigens was also observed on epithelial keratinocytes but was restricted to HLA-DR and -DP gene products (DR> >DP). HLA-DQ expression was never observed on keratinocytes. In most LE specimens studied a small proportion (<5%) of inflammatory cells had detectable interleukin-2 receptors (IL-2R) and/or transferrin receptors (transf-R). However, expression of transf-R was also observed on basal epithelial cells, being more pronounced in DLE than in SLE lesions. The above staining patterns observed in LE lesions, when compared to other chronic inflammatory oral lesions, did not disclose any striking differences that could support the specific diagnosis of LE. However, the findings of Class I and II MHC gene products on oral keratinocytes suggest an important accessory role for these cells in directing the migration of activated lymphoid cells in the epithelium in chronic inflammatory lesions of the oral mucosa.     

Oral lesions of lupus erythematosus patients in relation to other chronic inflammatory oral diseases: an immunologic study

The nature and distribution of mononuclear cells in non-ulcerated oral lesions of discoid (DLE) and systemic lupus erythematosus (SLE), were investigated and compared to other chronic inflammatory oral diseases (lichen planus (LP), contact lesion (CL), unspecified inflammation (UI), geographic tongue (GT), and leukoplakia (LK). For this purpose an immunoperoxidase technique based on staining with monoclonal antibodies was employed. In most LE specimens examined infiltrating cells consisted predominantly of a mixture of T cells (Leu 3a+ and Leu 2a+) that were distributed in the lamina propria, the submucosa, and occasionally also in the epithelium. In general, only few B cells were detected while macrophages were more frequent. In all LE specimens examined beta 2-microglobulin expression was observed on a large proportion of cells including infiltrating mononuclear cells as well as resident keratinocytes. In addition, most infiltrating cells displayed MHC Class II antigens according to a pattern HLA-DR greater than DQ greater than DP. Interestingly, expression of Class II antigens was also observed on epithelial keratinocytes but was restricted to HLA-DR and -DP gene products (DR much greater than DP). HLA-DQ expression was never observed on keratinocytes. In most LE specimens studied a small proportion (less than 5%) of inflammatory cells had detectable interleukin-2 receptors (IL-2R) and/or transferrin receptors (transf-R). However, expression of transf-R was also observed on basal epithelial cells, being more pronounced in DLE than in SLE lesions. The above staining patterns observed in LE lesions, when compared to other chronic inflammatory oral lesions, did not disclose any striking differences that could support the specific diagnosis of LE. However, the findings of Class I and II MHC gene products on oral keratinocytes suggest an important accessory role for these cells in directing the migration of activated lymphoid cells in the epithelium in chronic inflammatory lesions of the oral mucosa.     

老年口腔癌患者合并系统性疾病的治疗体会

目的：探讨老年口腔癌患者合并系统性疾病的特点及治疗体会。方法：收集本院口腔颁而外科经冶的老年口腔患者59例，对其合并系统性疾病及围手术期处理，进行回顾性分析。结果：经围手术期处理后，58例患者安全渡过围手术期，完成口腔癌的手术治疗。结论：积极处理纠正老年口腔癌患者的合并症，提高手术耐受力，加强术后的监测和护理，合并系统性疾病老年口腔痛患者可取得满意的治疗效果。     

应用直接数字成像技术诊断口腔内科常见疾病的可行性研究

目的：比较直接数字成像技术和传统Ｅ－ｓｐｅｅｄ牙片诊断口腔常见疾病的缺点,方法：对同一患牙用两法进行诊断比较。结果：与临床诊断相比,直接数字成像技术的诊断符合率略高于传统Ｘ线技术,但两者经无统计学差异（Ｐ〉０．０５）。结论：直接数字成像技术在口腔内科学常见疾病的辅助诊断上有较好的应用前景。     

Psychological problems and quality of life of patients with oral mucosal diseases: a preliminary study in Chinese population

Background

Psychological problems might play important roles in oral mucosal diseases such as recurrent aphthous ulcers (RAU), oral lichen planus (OLP), burning mouth syndrome (BMS), but the relevance to patients’ quality of life remained controversial. The aim of this study was to investigate the psychological problems and oral health-related quality of life in patients with RAU, OLP, and BMS in China, to assess the relationship between psychological problems and quality of life.

Method

Thirty-nine RAU patients, 45 OLP patients, 15 BMS patients and 45 healthy controls were enrolled in the study. Hospital Anxiety and Depression Scale (HADS) were chosen to analyze the patients’ psychological problems. Oral Health Impact Profile (OHIP-14) was used to measure the OHRQoL. The scores of HADS and OHIP-14 were used to analyze the relationship between psychological problems and the quality of life of oral mucosa patients.

Results

Each of OHIP-14 scores and HADS scores in RAU, OLP, BMS was higher than the control group, and there was significant difference in the patients groups with the control cases(P <?0.05). OHIP-14 score of RAU was the highest in three patient groups. Its OHRQoL was lowest in the three groups, which had statistical significance (P <?0.05). Positive correlations existed between the psychological problems and the quality of life of the three patient groups (r_s >?0, P <?0.05), except for the depression of the BMS group (r_s =?0.168, P =?0.395).

Conclusion

Patients with oral mucosal diseases such as RAU, OLP, and BMS had higher levels of anxiety, depression, and lower quality of life. The patient’s psychological problems were related to their quality of life, suggesting that the psychological state of patients with oral mucosal disease need more attention.

     

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目的    探讨重组人表皮生长因子（rhEGF）凝胶治疗复发性口腔溃疡的临床疗效。方法    采用随机平行对照试验方法,将2007-2009年辽宁省人民医院口腔科收治64例复发性口腔溃疡（ROU）患者随机分为试验组和对照组,试验组用rhEGF凝胶局部涂药,对照组给予2%碘甘油局部涂药,分组观察,2组均治疗至溃疡愈合或2周止。结果    试验组患者溃疡平均愈合时间为（3.52±1.29）d,对照组为（7.58±2.07）d,两组比较,差异有统计学意义（P < 0.05）。试验组总有效率（96.9%）明显高于对照组（62.5%）（P < 0.05）。结论    重组人表皮生长因子凝胶对口腔溃疡创面具有明显的促进愈合作用,应用方便、安全。     

口腔黏膜病患者口腔念珠菌感染情况的分析

目的 分析了解口腔黏膜病患者感染白念珠菌的情况。方法 收集2019年就诊于口腔黏膜科并进行白念珠菌培养的2 289 例患者,收集其基本信息、临床资料及实验室检查情况。按年龄分组:0～16岁(1组,38例),17～29岁(2组,181例),30～39岁(3组,274例),40～49岁(4组,325例),50～59岁(5组,535例),60～69岁(6组,540例),70岁及以上(7组,396例)。结果 白念珠菌总感染率为 30.6%,且女性患者感染率高于男性(33.1% vs.25.1%,P<0.05)。随着年龄的增长,白念珠菌感染率总体是上升的,且第6、7组感染率明显高于第2、3、4、5组(P<0.05)。除了口腔念珠菌病本身,唇舌疾病及口腔斑纹类疾病中最容易检测出白念珠菌,且白念珠菌的阳性检出与唇舌疾病、干燥综合征、口腔斑纹类疾病等相关。在同时进行白念珠菌培养及真菌镜检且白念珠菌培养阳性的患者中,真菌镜检阳性为50例,阳性率为35.5%。对白念珠菌培养阳性患者进行制霉素片及2%～3%碳酸氢钠溶液的局部治疗,其药物有效率为81.36%。结论 口腔念珠菌病更容易发生于60岁以上老年女性;且与系统性疾病、口腔斑纹类疾病相关。制霉素片联合2%～3%碳酸氢钠溶液局部治疗口腔念珠菌病效果尚可。     

Chemokines in oral inflammatory diseases: apical periodontitis and periodontal disease

The inflammatory oral diseases are characterized by the persistent migration of polymorphonuclear leukocytes, monocytes, lymphocytes, plasma and mast cells, and osteoblasts and osteoclasts. In the last decade, there has been a great interest in the mediators responsible for the selective recruitment and activation of these cell types at inflammatory sites. Of these mediators, the chemokines have received particular attention in recent years. Chemokine messages are decoded by specific receptors that initiate signal transduction events, leading to a multitude of cellular responses, including chemotaxis and activation of inflammatory and bone cells. However, little is known about their role in the pathogenesis of inflammatory oral diseases. The purpose of this review is to summarize the findings regarding the role of chemokines in periapical and periodontal tissue inflammation, and the integration, into experimental models, of the information about the role of chemokines in human diseases.     

Keratinocyte expression of calprotectin in oral inflammatory mucosal diseases

Oral mucosal inflammation evolves in response to microbial pathogens and non-infectious antigens which activate humoral and cell-mediated immunologic processes. Most of these disease processes invoke a leukocyte response culminating in cellular infiltration of the submucosa and. to some degree, transmigration into the epithelium itself. Calprotectin, a leukocyte-derived dimeric protein complex that has potent antibacterial and antifungal effects, has recently been identified in skin and mucosal keratinocytes implying that epithelium may biochemically contribute to the overall mechanism of host defense. In this study, the upregulation of calprotectin as assessed immunohistochchemically is pursued for oral diseases of immunopathologic, fungal and viral origin. In lichen planus, candidiasis, herpes virus stomatitis, and oral hairy leukoplakia, calprotectin was found to be expressed to a significantly higher level than in normal control mucosal samples.