Behçet's disease

Beh?et's disease is a multisystem inflammatory disorder, characterized by recurrent oral and genital ulceration and uveitis. Additionally, skin lesions, vasculitis, and arthritis may occur. The disease is chronic, with exacerbations and remissions. Treatment of Behcet's disease is symptomatic depending on the symptoms and their severity. Oral ulcers are seen in 98% of patients with Beh?et's disease. Some aspects of oral health, such as the amount of plaque and the presence of periodontal disease, and possibly also caries, are more prevalent in patients with the disease when compared to healthy persons. All oral health aspects will probably benefit from good oral health care. Medications which can be employed for treatment of the various symptoms of the disease are colchicine, corticosteroids, immunosuppressives, cyclosporine, pentoxyfylline, anticoagulants, and thalidomide.     

Relationship between periodontal findings and Behçet's disease: a controlled study

Background: Behçet's disease (BD) is a chronic, relapsing, systemic vasculitis of unknown aetiology. The involvement of oral mucosal surfaces represents the onset feature of the disease in the majority of patients. Objective: The aim of this study was to evaluate the periodontal status of BD patients and then compare with recurrent aphthous stomatitis (RAS) patients and healthy controls. We also determined the relationship between the periodontal condition and the clinical severity of the disease in BD patients. Methods: Eighty‐six patients with BD, 63 patients with RAS and 82 healthy subjects were included in the study. The periodontal status of all subjects was evaluated according to the community periodontal index of treatment needs (CPITN). BD patients were also assessed for clinical severity score (CSS) as described previously. Results: The mean CPITN were observed to be higher in BD patients (1.79 ± 0.96) compared with RAS patients (1.22 ± 0.87) and healthy controls (1.18 ± 0.98) (p<0.001). There was a positive association between CSS and CPITN (p=0.017) in BD patients. Conclusion: Our results showed that periodondal status is worse in BD patients and associated with disease severity. We can speculate that periodontitis may induce a systemic inflammatory process that may contribute to the development and/or progression of BD.     

Behçet's syndrome

A dentist referred a 35-year-old woman to the department of oral and maxillofacial surgery because of recurrent aphtous-like changes of the oral mucosa and persisting pain. She also experienced similar complaints about her eyes and genitals. This combination of symptoms was suspect for Beh?et's disease.     

Behçet's disease: recent findings. Review of the literature

In this work the author reviews the clinical literature and the pathogenetic hypotheses, with particular attention to the correlations of the HLA, for Beh?et disease. Beh?et's syndrome is a multisystem disorder presenting with recurrent oral and/or genital ulcerations, chronic relapsing uveitis that may cause blindness, and neurologic impairments. Although it has a worldwide distribution, the Beh?et's disease is rare in the Americas and Europe and is more prevalent in Turkey and the Middle and Far East. It affects mainly young adults, with men having more severe disease than women. Beh?et syndrome is often diagnosed in late age for the lack of a correct diagnostic protocol and for the different symptoms that can be present. The need to follow the criteria made by the International Group of study on the disease of Beh?et is underlined.     

Number VII Behçet's disease (Adamantiades syndrome)

Behçet's syndrome (BS; Adamantiades syndrome) is the association of the triple symptom complex of recurrent aphthous stomatitis (RAS) with genital ulceration, and eye disease (especially iridocyclitis) though a number of other systemic manifestations may also be seen. BS mainly affects young adult males, and there is an association with HLA‐B5 and HLA‐B51 (B5101). Features such as arthralgia and leucocytoclastic vasculitis suggest an immune‐complex mediated basis, which is supported by finding circulating immune complexes and, although the antigen responsible is unidentified, heat shock proteins have been implicated. An inflammatory disorder, BS is now considered as a systemic vasculitis, characterised by a very wide spectrum of clinical features and by unpredictable exacerbations and remissions.     

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.     

Oral health related quality of life is affected by disease activity in Behçet's disease

Objectives: This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behçet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires. Subjects and methods: Ninety‐four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile‐14 (OHIP‐14), oral health related quality of life (OHQoL) and short form‐36 (SF‐36) questionnaires. Results: OHQoL, OHIP‐14 and SF‐36 subscale scores were significantly worse in patients with BD compared with those in HC (P < 0.05). Both OHIP‐14 and OHQoL scores were significantly worse in active patients compared with inactives in BD and RAS (P < 0.05). Scores of SF‐36 Role physical, Role emotional and Vitality were also lower in active patients than in inactives in BD (P < 0.05). Scores of OHIP‐14 and OHQoL were significantly worse in patients treated with colchicine compared with those treated with immunosuppressives (P < 0.05). Conclusions: Both oral and general QoL was impaired in BD and associated with disease activity and treatment modalities. Translated Turkish versions of OHIP‐14 and OHQoL were also observed to be valid and reliable questionnaires for further studies.     

Periodontal findings and systemic antibody responses to oral microorganisms in Behçet's disease

BACKGROUND: Beh?et's disease is a multisystem disorder of unknown etiology, affecting predominantly the oral mucosa, skin, and eyes. Recurrent and painful episodes of oral ulcerations interfere with regular oral hygiene leading to rapid bacterial plaque accumulation. The aims of this study were to evaluate the periodontal status of patients with Beh?et's disease and determine serum antibody responses to selected oral microorganisms, including major periodontopathogens in these patients. METHODS: Thirty-three patients with Beh?et's disease and 15 healthy subjects were included in the study. Plaque, sulcular bleeding, periodontal index scores, probing depths, and total number of teeth were recorded. Serum IgG antibody levels to a panel of 13 oral microorganisms were determined. RESULTS: Significantly higher values for each of the clinical measures were observed in patients with Beh?et's disease compared to healthy subjects (P <0.0001). Antibody levels to selected members of plaque, including Actinomyces viscosus, Streptococcus mutans, Streptococcus sanguis, Streptococcus oralis, Eikenella corrodens, Campylobacter rectus, and Prevotella intermedia were significantly lower in patients with Beh?et's disease than in controls (P <0.001-0.05). In contrast, these patients exhibited significantly elevated antibody levels to Actinobacillus actinomycetemcomitans Y4 compared to controls (P <0.01). CONCLUSIONS: Our data indicate that the patients with Beh?et's disease generally exhibit clinical findings of established periodontal disease. Decreased antibody responses to early colonizers of both supra- and subgingival plaque were observed along with the elevation in antibody levels to A. actinomycetemcomitans. These results suggest that the bacterial plaque ecology and/or immune responses to these microorganisms may be affected in Beh?et's disease which could lead to changes in the expression of periodontal disease.     

Gorham–Stout disease with involvement of the jaws: a systematic review

The purpose of this study was to systematically review all published cases of Gorham–Stout disease (GSD) involving the jaws and to identify the clinico-radiological and histopathological features associated with persistence of the lesions, as well as the best treatment options available. An electronic search was undertaken in November 2018. Eligibility criteria included publications with sufficient information to confirm the diagnosis. Eighty-six publications reporting 89 cases were included. Features observed included symptomatic disease (51.1%), swelling (34.1%), pathological fracture (31.8%), history of previous trauma (32.1%), high alkaline phosphatase levels (24.3%), and predominance of vascular tissue (72.4%). Nearly a quarter of the patients were only followed up, with no treatment implemented. Most treatments consisted of some type of surgery with/without additional therapies (42.0%), drugs (20.5%), and radiotherapy (14.8%). Half of the cases were found to persist after some treatment modality, and five patients died. Among the variables investigated, only a lesion crossing the midline showed an association with persistence of the disease. There remains much to understand about GSD, a rare condition with no clear consensus on the aetiopathology, an unpredictable clinical course, and no standard treatment. The high rate of persistence after treatment was found to be associated only with the lesion crossing the midline.     

Periodontal disease and occlusal trauma: a still debated controversy? A review of the literature

In the "Glossary of Periodontics Terms" written by the American Academy of Periodontology, the occlusal trauma is defined as "an injury to the attachment apparatus as a result of excessive occlusal forces". Nowadays, the effects of occlusal trauma on tooth support tissues, the onset and the progression of periodontal disease are still debated: many commonplaces have been disproved, but some doubts and not yet clear points remain, even owing to the difficult diagnosis of the presence and the real clinical impact of a traumatic occlusion. Then, ethical reasons prevent researchers from prospective clinical trials. At the beginning of the last century occlusal trauma has been supposed to be an etiologic factor of "alveolar pyorrhea", but several studies attending more strict scientific criteria failed to prove such correlation. On the basis of the bacterial genesis of periodontal disease, researchers started evaluating the possible effects of occlusal discrepancies on incidence, progression and treatment outcomes of periodontitis, but all the results underlined the more relevant role played by micro-organisms. The present review of the literature runs through this controversy again, analysing the most significant studies published.     

Relationship of Porphyromonas gingivalis and Alzheimer’s disease: a systematic review of pre-clinical studies

Clinical Oral Investigations - This study aimed to analyze the following PICO question: Are animals infected with Porphyromonas gingivalis (P. gingivalis) or bacterial lipopolysaccharide (Pg-LPS)...     

Adamantiades-Behçet disease: an enigmatic process with oral manifestations

Adamantiades-Beh?et disease (ABD) is a chronic multisystemic vasculitis that is able to affect any human organ or system. Recurrent oral ulcers are a very important clinical sign. ABD is a worldwide pathology, which prevalence varies according to the population and geographic location. Although ABD has been known for ages, its aetiology remains an enigma. Genetic, immunological and microbiological factors have been associated. A wide spectrum of clinical manifestations (oral, genital, cutaneous, ocular, neurological, vascular and gastrointestinal) and an unpredictable evolution with repeated periods of exacerbation and remission are the most representative aspects of this pathology. The complex treatment of ABD requires a deep multidisciplinary cooperation; therefore, there is an extensive development of new therapeutic agents that have improved the prognosis of ABD. In this review were analysed the main etiological, clinical and therapeutic aspects of the disease.     

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case–control studies

Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case?Ccontrol studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case?Ccontrol studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case?Ccontrol studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.