Oral care in the intensive care unit: a review

Oral care for patients in the hospital's Intensive Care Unit (ICU) is important, but this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow. The problems of maintaining oral care with oral intubation, performing oral assessment, guidelines for oral hygiene care, frequency of oral care needed, and suggested mouth care protocol followed by recommendations are presented and discussed in this paper.     

Contemplations on responsibility for oral healthcare

The academic dental education in The Netherlands has been extended to 6 years, among other reasons in order to make it possible for responsibility for oral healthcare to be borne in a wide medical context. It is the job of the 3 national dental schools to make this happen. The new dentist should know and recognize all (peri-)oral disorders and oral symptoms of systemic diseases, and he should be able to deliver oral healthcare to medically compromised patients. Accepting this responsibility is required for dentistry to be transformed into medical oral healthcare and for dentists to be upgraded to oral physicians.     

口腔黏膜黏附材料的研究进展

基于口腔黏膜结构的独特性和给药的方便性，局部药物递送在口腔黏膜疾病的治疗中得到广泛应用。但由于口腔是一个有开放、湿润及运动的特殊微环境，口腔黏膜给药面临着巨大挑战。针对这一困境，近年来黏附材料得以深入研究，以期延长药物局部停留时间，从而达到药物缓释和提高生物利用度的目的，具有广泛的应用前景，本文将针对口腔黏膜黏附材料的特点和现状简要总结。     

Neoplastic transformation of oral lichen planus. I: Review of the literature

Lichen planus is described like a well-characterized dermatological condition affecting the skin and the oral and genital mucosa. Over the years, different authors have expressed the possible oral lichen planus premalignant nature, but this is still controversial. This criticism is due to the insufficiency of the clinical and histopathological data to support the initial diagnosis of oral lichen planus, the occurrence of some wrong diagnostic criteria for this pathology, the contemporary presence in the same region of the oral lichen planus lesions and of neoplasia. The malignant transformation of oral lichen planus rate varies, according to authors, from 0.4 to 3.7%. The aim of this study is to review the literature from 1910 to 1999, focusing on the suggested possible premalignant nature of oral lichen planus.     

Immunohistochemical expression of Skp2 protein in oral nevi and melanoma

Objective: The aim of this study was to analyze the immunohistochemical expression of Skp2 protein in 38 oral nevi and 11 primary oral melanomas. Study Design: Expression of this ubiquitin protein was evaluated by immunohistochemistry in 49 oral melanocytic lesions, including 38 intramucosal nevi and 11 primary oral melanomas. The labeling index (LI) was assessed considering the percentage of cells expressing nuclear positivity out of the total number of cells, counting 1000 cells per slide. Results: Skp2 protein was rarely expressed in intramucosal nevi, in contrast to oral melanomas, which showed high levels of this protein. Conclusion: These results indicate that Skp2 protein may play a role in the development and progression of oral melanomas, and it also could be useful as an immunohistochemical marker for differential diagnosis of oral benign and malignant melanocytic lesions. Key words:Oral melanoma, oral nevi, Skp2, cell cycle, immunohistochemistry.     

Intraoral ultrasonic scanning as a diagnostic aid

Since ultrasonographic examination has the advantages of being non-invasive, rapid and easily reproducible, this technique can be a valuable aid in diagnosing oral lesions. However, the relatively large size of commercially available transducers and the acoustic attenuation by the air space within the oral cavity have been deterrents to the intraoral application of this technique. To resolve these problems a small intraoral transducer was developed and employed clinically in the diagnosis of oral soft tissue lesions. Performance tests reveal that this transducer provides 1mm axial resolution and 2 mm lateral resolution with a 30 mm focus. It can be easily employed within the oral cavity, using a small water bag or polymer gel as an acoustic coupling agent to the oral mucosa. Clinical application of this technique to oral soft tissue lesions allows definition of margins, size and location of lesions, and their relationship to adjacent structures, as well as discrimination between cystic, benign or malignant nature, by the sonic character. These results suggest that intraoral ultrasonic scanning can be useful in the diagnosis of oral soft tissue lesions.     

Smokeless tobacco (shamma) and oral cancer in Saudi Arabia

Oral use of smokeless tobacco has been associated with the development of oral cancer. Shamma is a preparation of smokeless tobacco. Previous investigators in the Kingdom of Saudi Arabia (KSA) have reported a relationship between their patients with oral cancer and a history of using shamma. The purpose of this study was to explore the possible relationship between a smokeless tobacco preparation (shamma) and oral cancer, among the provinces of the KSA. Tumor Registry (TR) data from the King Faisal Specialist Hospital and Research Centre (KFSH&RC) were reviewed for the period from 1976 to 1995. A total of 26510 Saudi cancer patients were referred over this 20-year period. The frequency of oral cancer was investigated, specifically for those primary sites located near the habitual placement of this smokeless tobacco product. Notably, 35.4% of these oral cancers were referred from one province - Jizan. The percentage of oral cancer cases from this province is significantly higher than the percentage of total malignant cases referred to KFSH&RC from this province, and the Saudi population of this province when compared to the whole of the KSA. These data suggest that there is a relationship between the factors smokeless tobacco product (shamma), frequency of oral cancer, and Jizan province: oral cancer appears to be more common in this province where shamma is also common.     

Influence of mouse prolactin-inducible protein in saliva on the aggregation of oral bacteria

Introduction:  Mouse prolactin-inducible protein (mPIP) is secreted in mouse saliva and has been found to bind oral bacteria, showing the highest affinity for streptococci. Comparisons between the oral flora of mPIP knockout mice and their wild-type controls showed differences in the genera colonizing the two groups of mice. These findings suggested a role for mPIP in the colonization of the mouse oral cavity, possibly modulating the oral flora. In this in vitro study, we focused on the contribution of this protein to aggregation of oral bacteria, a process thought to promote the clearance of bacteria from the oral cavity, and one that could influence the composition of the oral bacterial community.
Methods:  The aggregation of selected human and mouse oral streptococci was measured spectrophotometrically. The aggregation of oral bacteria by saliva from mPIP knockout mice, which lack mPIP, was compared with that of saliva from wild-type mice.
Results:  Both wild-type saliva and mPIP knockout mouse saliva induced aggregation of human strain Streptococcus gordonii SK120 and mouse streptococci strains M105/6 and M106/2. Bacterial aggregation induced by the saliva of wild-type mice was significantly higher than the aggregation induced by saliva from mPIP knockout mice for all the bacterial strains.
Conclusion:  In this study it was confirmed that mPIP plays a role in the aggregation of oral bacteria. The salivary components promoting aggregation of oral bacteria are considered to be part of the oral defense mechanisms so these findings provide insight into a possible function of mPIP in host defense by promoting aggregation of oral bacteria.     

器官型口腔黏膜感染模型在宿主-微生物关系研究的应用与展望

构建体外口腔黏膜感染模型有助于研究口腔黏膜感染性疾病的发病机制与防治策略。器官型口腔黏膜感染模型以组织工程化口腔黏膜为基础,通过引入病原体提取物、接种浮游微生物或与细菌生物膜、唾液共培养,在体外模拟口腔微生物与宿主的相互作用。近年来,学者们通过该技术研究微生物对口腔黏膜疾病和牙周疾病的发生、发展作用及致病机理。本文将对器官型口腔黏膜感染模型的建立、研究进展与应用前景等进行阐述。     

Neoplastic transformation of oral lichen planus. II: association with risk co-factors

The possible malignant transformation of oral lichen planus is still controversial. It is not clear if this is in fact due to the premalignant nature of oral lichen planus or to the presence of some risk-factors in patients with this pathology. The risk co-factors that may he involved in this malignant transformation are numerous. Some authors suggested a correlation between oral lichen planus and HCV or HGV, or with the presence of some oncogenic viruses (EBV, HSV, HPV). Cases of this malignant transformation on oral and genital mucosa with lichen are reported, hut none on the skin lesions. The aim of this study is to investigate, through the literature, these correlations that may have a role in the malignant transformation of oral lichen planus.     

Influence of mouse prolactin‐inducible protein in saliva on the aggregation of oral bacteria

Introduction: Mouse prolactin‐inducible protein (mPIP) is secreted in mouse saliva and has been found to bind oral bacteria, showing the highest affinity for streptococci. Comparisons between the oral flora of mPIP knockout mice and their wild‐type controls showed differences in the genera colonizing the two groups of mice. These findings suggested a role for mPIP in the colonization of the mouse oral cavity, possibly modulating the oral flora. In this in vitro study, we focused on the contribution of this protein to aggregation of oral bacteria, a process thought to promote the clearance of bacteria from the oral cavity, and one that could influence the composition of the oral bacterial community. Methods: The aggregation of selected human and mouse oral streptococci was measured spectrophotometrically. The aggregation of oral bacteria by saliva from mPIP knockout mice, which lack mPIP, was compared with that of saliva from wild‐type mice. Results: Both wild‐type saliva and mPIP knockout mouse saliva induced aggregation of human strain Streptococcus gordonii SK120 and mouse streptococci strains M105/6 and M106/2. Bacterial aggregation induced by the saliva of wild‐type mice was significantly higher than the aggregation induced by saliva from mPIP knockout mice for all the bacterial strains. Conclusion: In this study it was confirmed that mPIP plays a role in the aggregation of oral bacteria. The salivary components promoting aggregation of oral bacteria are considered to be part of the oral defense mechanisms so these findings provide insight into a possible function of mPIP in host defense by promoting aggregation of oral bacteria.     

Nursing home executive directors' perception of oral care in long-term care facilities

Oral health in long‐term care (LTC) facilites has been repratdly documented as less than ideal. The complex nature of this enviroment has made it difficult to understand and improve the oral health status of residents through education and training. The purpose of the study was to investigate how the executive directors (EDs) of LTC facilites value oral health and to determine facility variables. which may infulunce how oral care is deliverd. A mail survey of the EDs of all LTC facilities in Ohio (n = 1018) was conducted with 338 responses received after secondary follow‐up (33.2%response rate). The 30‐item survey inculuded information concerning the nursing facility, the EDs, the EDs' perception of the level of oral health care, and value statements rated on a Likert‐like scale. The results of the survey showed that more than two‐third of the EDs were female and that most facilities were proprietary (70.3%). ED gender was not statistically associated with any of the oral health variables. Fifty‐three percent of the EDs rated their residents' oral health as fair of poor but were still satisfied with the oral care proveded at their facilites. The apparant discontinuity between perceived lebvels of oral health and satisfaction with oral care suggests that EDs are distanced form the oral care of thir residents or they do not acknowledge oral health care needs. While the survey results revealed inmpotant facility characteristics and administrators' perceptiosn about oral health, the most important aspect of this project was the low response rate despite secondary follow‐up. That, coupled with the negativity expressed upon follow‐up, suggests a larger issue that may affect oral health in nursing facilities: oral health continues to have a low priority in this setting. Continuing efforts to improve oral health and educate LTC professionals about oral health's influence on general health is critical for managing the oral health or future generatiosn of aging aduts.     

The evolutionary history of the human oral microbiota and its implications for modern health

Numerous biological and cultural factors influence the microbial communities (microbiota) that inhabit the human mouth, including diet, environment, hygiene, physiology, health status, genetics, and lifestyle. As oral microbiota can underpin oral and systemic diseases, tracing the evolutionary history of oral microbiota and the factors that shape its origins will unlock information to mitigate disease today. Despite this, the origins of many oral microbes remain unknown, and the key factors in the past that shaped our oral microbiota are only now emerging. High throughput DNA sequencing of oral microbiota using ancient DNA and comparative anthropological methodologies has been employed to investigate oral microbiota origins, revealing a complex, rich history. Here, I review the current literature on the factors that shaped and guided oral microbiota evolution, both in Europe and globally. In Europe, oral microbiota evolution was shaped by interactions with Neandertals, the adaptation of farming, widespread integration of industrialization, and postindustrial lifestyles that emerged after World War II. Globally, evidence for a multitude of different oral microbiota histories is emerging, likely supporting dissimilarities in modern oral health across discrete human populations. I highlight how these evolutionary changes are linked to the development of modern oral diseases and discuss the remaining factors that need to be addressed to improve this embryonic field of research. I argue that understanding the evolutionary history of our oral microbiota is necessary to identify new treatment and prevention options to improve oral and systemic health in the future.     

人类主要组织相容抗原Ⅰ类分子在口腔白斑中表达的临床意义

目的通过检测人类主要组织相容抗原Ⅰ类分子（MHC-Ⅰ）在伴有不同异常增生程度的口腔白斑中的表达,以探讨MHC-Ⅰ类抗原表达改变后其局部免疫状态的变化,以及与口腔白斑发生的关系。方法应用MHC-Ⅰ特异性单抗通过免疫组织化学方法从蛋白表达水平检测28例正常口腔黏膜、55例口腔白斑、31例口腔鳞癌内MHC-Ⅰ类抗原的表达。结果伴有重度异常增生的口腔白斑与口腔鳞癌内MHC-Ⅰ类抗原的表达显著低于正常口腔黏膜组（P<0.05）。不伴异常增生及伴有轻、中度异常增生的口腔白斑内MHC-Ⅰ类抗原的表达和正常黏膜未见统计学差异（P＞0.05）。结论MHC-Ⅰ在口腔白斑中存在有表达降低的现象,特别在伴有重度异常增生时,其降低与异常增生的程度有关,对判断口腔白斑的预后有一定价值。     

Knowledge, opinions, and practices related to oral cancer: Results of three elderly racial groups

A study of 204 inner-city, senior center participants (ages ranged from 41–96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African-American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.     

口腔黏膜癌前病变和口腔癌动物模型的研究进展

口腔黏膜癌前病变和口腔癌是发展中国家的常见疾病尤其是在南亚地区,其癌变机制尚不明确,目前缺乏有效防治措施,因此口腔黏膜癌前病变及口腔癌动物模型建立显得尤为重要。本文结合相关研究,就近年来口腔黏膜癌前病变及口腔癌动物模型建立方法的进展作一综述。     

Oral health promotion interventions on oral reservoirs of staphylococcus aureus: a systematic review

The oral cavity serves as a reservoir of Staphylococcus aureus for infection of the lower respiratory tract and cross-infection to other patients. This systematic review was designed to examine the effectiveness of oral health promotion interventions on this pathogen. The PubMed, ISI Web of Science, and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral and oropharyngeal carriage of S. aureus. Oral health promotion interventions on oral reservoirs of S. aureus in both systemically healthy and medically compromised groups consisted of oral hygiene interventions only. There was a lack of evidence pertaining to the effectiveness of mechanical oral hygiene interventions against this pathogen. Chlorhexidine delivered in oral hygiene products such as mouthrinses, gels, and sprays appeared to have some utility against S. aureus, although some studies found equivocal effects. There was a dearth of studies investigating the efficacy of other chemical agents. Although many chemical agents contained in oral hygiene products have proven in vitro activity against S. aureus, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remain to be confirmed by further high-quality randomized controlled trials.     

Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior

The aim of this study was to test the efficiency of an extended model of the theory of planned behavior (TPB) in predicting intention to improve oral health behaviors. The participants in this cross-sectional study were 153 first-year medical students (mean age 20.16, 50 males and 103 females) who completed a questionnaire assessing intentions, attitudes, subjective norms, perceived behavioral control, oral health knowledge, and current oral hygiene behaviors. Attitudes toward oral health behaviors and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward oral health behaviors were slightly more important than perceived behavioral control in predicting intention. Oral health knowledge significantly affected affective and cognitive attitudes, while current behavior was not a significant predictor of intention to improve oral health behavior. The model had a slightly better fit among females than among males, but was similar for home and professional dental health care. Our findings revealed that attitude, perceived behavioral control, and oral health knowledge are predictors of intention to improve oral health behaviors. These findings may help both dentists and dental hygienists in educating patients in oral health and changing patients' oral hygiene habits.     

From victim blaming to upstream action: tackling the social determinants of oral health inequalities

The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.