Evaluation of different diagnostic criteria of diseases manifesting the oral cavity - A review. Part-1

Single session of laser photobiomodulation for symptom management of oral lichen planus: a retrospective study

This study aimed to evaluate the effectiveness of a single session of laser photobiomodulation (PBM) with flat top handpiece in reducing painful symptoms in patients with Oral Lichen Planus (OLP). The clinical charts of 20 patients of the Dental Clinic of University of Padua (Italy) who underwent a single laser PBM to manage OLP symptomatology were retrospectively analyzed. A 980 nm diode laser and a flat top handpiece with a 1-cm2 spot area were employed to perform the PBM with a single session protocol. VAS pain scores were assessed before and after the laser PBM, the day after, and on the 7th and 30th days after the treatment. No adverse effects occurred within 30 days after treatment. The mean VAS-pain score was 3.8 (SD 2.3) before PBM; 2.6 (SD 2.0) after PBM; 1.9 (SD 2.2) on day 1; 2.0 (SD 2.3) on day 7; and 1.5 (SD 2.2) on day 30. VAS pain decreased significantly over time (p < 0.0001). A single session of laser PBM may be safe and effective in reducing pain for symptomatic OLP patients. Further investigations are required to include placebo or topical corticosteroids as comparators.

Comparative evaluation of prevalence and phenotypic variations of Candida species in patients of oral lichen planus and oral lichenoid lesions with healthy individuals - A prospective microbiological study

Context

Candida isolates might exaggerate the development and advancement of oral lichen planus (OLP) alone or together with other factors. There is a differing pathogenic potential of various Candida species. Since Candida species isolated from OLP and oral lichenoid lesions (OLL) have shown to be resistant to commonly used antifungal agents, identification of Candida species may play a pivotal role in its successful clinical management.

Aim

The aim of the study was to evaluate and compare the prevalence and phenotypic variations of Candida species in patients of OLP and OLL with healthy controls.

Subjects and Methods

This prospective microbiological study was conducted in the institution using indirect microscopic examination. The sample comprised of 40 clinicohistopathologically diagnosed cases of the study group (OLP and OLL) and 40 cases of control group (healthy individuals).

Statistical Analysis Used

The data collected was statistically analyzed using the Chi-square test and Fisher's exact test with the SPSS 20.00 software.

Results

The prevalence of Candida albicans was higher in the control group (28.10%) as compared to the study group (24.60%) and this difference was statistically significant. An increased frequency of non C. albicans species was seen in the study group, in decreasing order of Candida glabrata (40.70%), Candida tropicalis (22.20%), Candida krusei (22.20%) and Candida guilliermondii (3.70%), as compared to the control group.

Conclusion

Non C. albicans species were the predominant pathogens associated with the study (OLP + OLL) group. It is important to identify the infecting strains of Candida because isolates of Candida species differ widely, both in their ability to cause infection and also in their susceptibility of resistance to antifungal agents. Thus, phenotypic speciation of Candida is emerging as a necessary trend to highlight the need of administering appropriate antifungal therapy.

Oral lichen planus identification by mid-infrared spectroscopy of oral biofluids: A case-control study

BACKGROUND AND AIMS

This study aims to access the effectiveness of mid-infrared (MIR) spectroscopy on the identification of the reticular form of OLP, following the assessment of gingival crevicular fluid (GCF) and oral mucosa transudate (OMT).

MATERIAL AND METHODS

The trial follows a case-control design. Samples were characterized through MIR spectroscopy and chemometric tools were applied to distinguish between case and control participants, further identifying the spectral regions with the highest contribution to the developed models.

RESULTS

MIR spectroscopy was capable to discriminate between OLP patients and controls with 95.1% and 85.4% of correct predictions, regarding GCF and OMT samples, respectively. Additionally, the spectral regions mostly contributing to the successful prediction were identified, and possibly related with the distinctive presence of amino acids/proteins and oxidative stress mediators in oral biofluids, supporting the role of the immune-inflammatory activation on OLP etiology and disease course.

CONCLUSION

MIR spectroscopy analysis of GCF and OMT may be regarded as an innovative, non-invasive, low cost and sensitive technique, contributing to the identification of the reticular from of OLP.

Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis

Objectives

To evaluate the effects of photobiomodulation (PBM) in gingival lesions resulting from autoimmune diseases; to compare PBM and topical corticosteroid (CS) treatment; and to assess PBM outcome over time of follow-up.

Materials and methods

A comprehensive electronic search was performed in four electronic databases. Treatment effects were measured through visual analog scale of pain (VAS) and clinical evolution of lesion (Thongprasom scale for oral lichen planus (OLP)). Meta-analysis was performed to compare PBM with topical corticosteroid treatment and to evaluate PBM effect over time of follow-up.

Results

Seventeen studies were included in this review, of which six were used for the meta-analysis. Meta-analysis results showed no significant differences between PBM and topical CS in pain reduction at baseline (MD = 0.20, 95% CI =  − 0.92, 1.32, p = 0.72) and 60-day follow-up (MD = 0.63, 95% CI =  − 3.93, 5.19, p = 0.79); however, VAS showed significant pain reduction when compared before and after PBM at 30-day (MD =  − 3.52, 95% CI =  − 5.40, − 1.64, p = 0.0002) and 60-day (MD =  − 5.04, 95% CI =  − 5.86, − 4.22, p < 0.00001) follow-up. Thongprasom clinical scale for OLP also showed significant improvement at 30-day follow-up (MD =  − 2.50, 95% CI =  − 2.92, − 2.08, p < 0.00001) after PBM.

Conclusion

PBM led to significant reduction of pain and clinical scores of the lesions, not having shown significant differences when compared to topical CS.

Clinical relevance

PBM has been used in the treatment of autoimmune gingival lesions, but so far there is little strong evidence to support its use.

Malignant transformation in oral lichen planus and lichenoid lesions: a 14-year longitudinal retrospective cohort study of 829 patients in New Zealand

OBJECTIVE

The aim of this study was to identify the rate of malignant transformation in a longitudinal cohort of patients with oral lichen planus and oral lichenoid lesion (OLP/OLL) and to assess the associations between clinicopathologic aspects and malignant transformation.

STUDY DESIGN

Data were taken from the records of 829 patients histologically diagnosed with OLP/OLL in the years 2005 to 2018.

RESULTS

Of the study patients, 548 (66.1%) were females and 281 (33.9%) were males. The average age at diagnosis was 57.3 years. The hyperplastic type was the most frequent (58.5%). Most patients had multiple sites of involvement, with the buccal mucosa being the most frequent site of biopsy. Oral epithelial dysplasia developed in 5 (0.6%) patients with a previous histologic diagnosis of OLP/OLL and developed oral squamous cell carcinoma (OSCC) in 23 patients (2.8%) during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types (hazard ratio [HR] 25.8; P < .05). The HR increases by 5% with every year of age (HR 1.05; 95% confidence interval; P < .05).

CONCLUSIONS

In our study, oral epithelial dysplasia developed in less than 1% of patients with OLP/OLL, and OSCC in 2.8%during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types. The HR increases by 5% with every year of age.

Clinicopathological Profile and Malignant Transformation in Oral Lichen Planus: A Retrospective Study

OBJECTIVES

The aim of this study was to analyze the histopathologically diagnosed cases of oral lichen planus (OLP) in terms of age, gender, clinical variant, site, hyperpigmentation, systemic illness, grade of dysplasia, and associated malignant transformation. This study also intended to do a review of reported cases of OLP with malignant transformation.

MATERIALS AND METHODS

One hundred and forty-three cases of histopathologically diagnosed OLP between 2010 and 2016 were retrospectively reviewed. Demographic and clinicopathological data including malignant transformation were obtained. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) software for Windows version 20.0 (IBM SPSS, SPSS Inc., Chicago, IL, USA). A review of published literature on OLP with malignant transformation was also done from 1988 to 2017 and tabulated.

RESULTS

OLP in this study showed a male predilection with most of the patients in the third decade. The buccal mucosa (bilateral presentation) was the most common site (79.72%), and reticular type was the most common clinical type (79.02%) followed by erosive type (20.98%). The majority (92.31%) of cases were diagnosed with OLP without dysplasia. The rest (7.69%) of dysplastic cases were predominantly seen in the buccal mucosa of 58 years and above, female patients manifesting mainly as erosive type. Two patients (1.4%) previously diagnosed clinically and histopathologically as OLP developed oral squamous cell carcinoma.

CONCLUSION

The present investigation revealed the predominance of OLP among middle-aged male population and the prevalence of bilateral involvement of buccal mucosa. Two of our cases showed malignant transformation over an average period of 3.5 years. The outcome of this study emphasizes the role of clinical follow-up of patients with OLP.