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Perelli M, Abundo R, Semenza M, Centracchio M, Chiara SD, Monaco A, Arduino PG. Preliminary Evaluation of a NitrAdine-Based Brushing Solution for Patients Suffering from Gingivitis: A Prospective Clinical Case-Control Study. Eur J Dent 2022; 16:612-618. [PMID: 34875712 PMCID: PMC9507566 DOI: 10.1055/s-0041-1741120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This article aimed to evaluate the clinical efficacy of a nonantibiotic biofilm-removal formulation based on NitrAdine (PerioTabs), combined with a regular home oral hygiene regimen, in Caucasian patients with gingivitis. MATERIALS AND METHODS A sample of 60 patients were included in this clinical prospective study. All selected subjects underwent regular prophylaxis and professional oral hygiene at baseline; 30 days later, they were recalled for the measurements of the reference parameters about bleeding on probing (full-mouth bleeding upon probing score [FMBS]) and plaque index (full-mouth plaque score [FMPS]); no other clinical procedure was performed. Consequently, half of the patients (n = 30) were instructed to use PerioTabs for 10 days. The remaining patients (n = 30) were used as the negative control, only instructed to continue with their usual oral hygiene regimen. Fifteen days after, the clinical parameters of FMBS and FMPS were re-evaluated in both groups. RESULTS Changes in the scores of clinical indices FMBS and FMPS were calculated and compared. A significant difference between pre- and post-values, for both FMBS and FMPS, was noticed in the test group; in particular, the bleeding index value demonstrated the more significant changes: 22 participants showed a clinically meaningful improvement, and 5 had a small improvement. Only three patients had no evidence of change. In addition, 50% of patients had a reduction in plaque levels. No side effects were reported. CONCLUSIONS The adjunctive use of 10-day PerioTabs treatment in the daily oral hygiene routine seemed to be efficient in reducing gingival bleeding and plaque accumulation, with absence of adverse effects. These results should be confirmed in studies with a larger number of participants following a controlled-blinded design.
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Affiliation(s)
- Michele Perelli
- Departemnt of Periodontology, Private Practice, Torino, Italy
| | - Roberto Abundo
- Departemnt of Periodontology, Private Practice, Torino, Italy
| | - Mario Semenza
- Departemnt of Prosthodontist, Private Practice, Sant'Angelo Lodigiano, Italy
| | | | | | - Andrea Monaco
- Departemnt of Dental Hygiene, Private Practice, San Remo, Italy
| | - Paolo Giacomo Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Torino, Torino, Italy
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2
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de Carvalho MM, Hidalgo MAR, Scarel-Caminaga RM, Ribeiro Junior NV, Sperandio FF, Pigossi SC, de Carli ML. Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis. Clin Oral Investig 2022; 26:3949-3964. [PMID: 35024960 PMCID: PMC8755514 DOI: 10.1007/s00784-021-04362-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/29/2021] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Milena Moraes de Carvalho
- School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 - Centro, Alfenas, MG, 37130-001, Brazil
| | - Marco Antonio Rimachi Hidalgo
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, School of Dentistry at Araraquara, FOAr/UNESP), UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Raquel Mantuaneli Scarel-Caminaga
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, School of Dentistry at Araraquara, FOAr/UNESP), UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Noé Vital Ribeiro Junior
- School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 - Centro, Alfenas, MG, 37130-001, Brazil
| | - Felipe Fornias Sperandio
- Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.,Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Suzane Cristina Pigossi
- School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 - Centro, Alfenas, MG, 37130-001, Brazil
| | - Marina Lara de Carli
- School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 - Centro, Alfenas, MG, 37130-001, Brazil.
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Schmidt E, Rashid H, Marzano A, Lamberts A, Di Zenzo G, Diercks G, Alberti‐Violetti S, Barry R, Borradori L, Caproni M, Carey B, Carrozzo M, Cianchini G, Corrà A, Dikkers F, Feliciani C, Geerling G, Genovese G, Hertl M, Joly P, Meijer J, Mercadante V, Murrell D, Ormond M, Pas H, Patsatsi A, Rauz S, van Rhijn B, Roth M, Setterfield J, Zillikens D, C.Prost, Zambruno G, Horváth B, Caux F. European Guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology - Part II. J Eur Acad Dermatol Venereol 2021; 35:1926-1948. [PMID: 34309078 PMCID: PMC8518905 DOI: 10.1111/jdv.17395] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 01/21/2023]
Abstract
This guideline has been initiated by the task force Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology, including physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline that systematically reviewed the literature on mucous membrane pemphigoid (MMP) in the MEDLINE and EMBASE databases until June 2019, with no limitations on language. While the first part of this guideline addressed methodology, as well as epidemiology, terminology, aetiology, clinical presentation and outcome measures in MMP, the second part presents the diagnostics and management of MMP. MMP should be suspected in cases with predominant mucosal lesions. Direct immunofluorescence microscopy to detect tissue-bound IgG, IgA and/or complement C3, combined with serological testing for circulating autoantibodies are recommended. In most patients, serum autoantibodies are present only in low levels and in variable proportions, depending on the clinical sites involved. Circulating autoantibodies are determined by indirect IF assays using tissue substrates, or ELISA using different recombinant forms of the target antigens or immunoblotting using different substrates. The major target antigen in MMP is type XVII collagen (BP180), although in 10-25% of patients laminin 332 is recognized. In 25-30% of MMP patients with anti-laminin 332 reactivity, malignancies have been associated. As first-line treatment of mild/moderate MMP, dapsone, methotrexate or tetracyclines and/or topical corticosteroids are recommended. For severe MMP, dapsone and oral or intravenous cyclophosphamide and/or oral corticosteroids are recommended as first-line regimens. Additional recommendations are given, tailored to treatment of single-site MMP such as oral, ocular, laryngeal, oesophageal and genital MMP, as well as the diagnosis of ocular MMP. Treatment recommendations are limited by the complete lack of high-quality randomized controlled trials.
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Fuschetto T, Kurtz KS, Delgado-Ruiz RA. Implant and prosthetic rehabilitation of a patient with mucous membrane pemphigoid. J Prosthet Dent 2021; 127:22-26. [PMID: 33390271 DOI: 10.1016/j.prosdent.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 10/22/2022]
Abstract
Mucous membrane pemphigoid (MMP) is an autoimmune condition characterized by subepithelial separation and deposition of autoantibodies and complement along the basement membrane zone. The disease results in the development of vesiculobullous lesions of the mucous membranes and skin. This report discusses the surgical treatment and management and the prosthetic implant rehabilitation of a patient with mucous membrane pemphigoid. The rationale for this treatment was to fabricate a prosthesis that was stable and did not rub against the gingival tissues and that was easily cleaned. The overdenture attachment system used provides more stability than other attachment systems while allowing the prosthesis and abutments to be easily cleaned.
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Affiliation(s)
- Thomas Fuschetto
- Prosthodontic Resident, Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY; Private practice, Westchester County, NY.
| | - Kenneth S Kurtz
- Clinical Professor of Prosthodontics and Director, Division of Maxillofacial Prosthetics, Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
| | - Rafael A Delgado-Ruiz
- Associate Professor, Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
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5
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Garcia-Pola MJ, Rodriguez-López S, Fernánz-Vigil A, Bagán L, Garcia-Martín JM. Oral hygiene instructions and professional control as part of the treatment of desquamative gingivitis. Systematic review. Med Oral Patol Oral Cir Bucal 2019; 24:e136-e144. [PMID: 30818305 PMCID: PMC6441599 DOI: 10.4317/medoral.22782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/22/2018] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this present article was to evaluate the scientific evidence on the efficacy of daily hygiene and professional prophylaxis for treatment of desquamative gingivitis. Material and Methods The present systematic review was conducted following the PRISMA protocol. Searches were carried out in Pubmed, Embase, Web of Science and Cochrane Library up to July 2018, randomized clinical trials and cohort studies on desquamative gingivitis (DG), and oral diseases joined to DG. Results After screening, we found that nine publications met the eligibility criteria eight cohort studies and one randomized control trial. The diagnosis of the diseases corresponded to oral lichen planus (n=185), mucous membrane pemphigoid (n=13); plasma cell gingivitits (n=15) and pemphigus vulgar (n=11). The follow-up was between a week and a year after instructing patients. Dental daily hygiene and professional prophylaxis, at least with supragingival scaling and polishing have significantly improved the extension of the lesion and reduced the activity of DG, and gingival bleeding in all patients. Furthermore, these techniques have also reduced pain and gingival plaque. Conclusions In conclusion the studies presented support the efficacy of maintaining personal and professional oral hygiene in patients with GD, reducing the clinical signs of the disease, regardless of its pathogenesis. Key words:Desquamative gingivitis, oral hygiene, oral lichen planus, mucous membrane pemphigoid; pemphigus, plasma cell gingivitis.
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Affiliation(s)
- M-J Garcia-Pola
- Department of Oral Medicine, Faculty of Medicine and Sciences of the Health, Julian Clavería, 33006 Oviedo, Spain,
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6
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Effect of a structured plaque control on MMP-1 and MMP-9 crevicular levels in patients with desquamative gingivitis associated with oral lichen planus. Clin Oral Investig 2018; 23:2651-2658. [PMID: 30327948 DOI: 10.1007/s00784-018-2704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES No data are available in the literature on the extent to which the immune host-response and bacterial-elicited inflammation separately contributes to the increase in gingival crevicular fluid (GCF) levels of inflammatory biomarkers in patients affected by desquamative gingivitis (DG) secondary to oral lichen planus (OLP). The aim of this study was to investigate the effect of a structured plaque control intervention on GCF levels of MMP-1 and MMP-9 in OLP patients with DG and to compare them with those of non-OLP patients. MATERIALS AND METHODS The study population consisted of 18 unrelated Caucasian patients with DG, while 18 periodontally healthy subjects were recruited for the control group. Periodontal parameters and GCF biomarker amounts were evaluated at baseline and 2 months after a structured plaque control intervention, comprising professional oral hygiene sessions, manual toothbrushing, and interdental cleaning advice, only for DG patients. Determination of MMP-1 and MMP-9 levels was carried out by means of an enzyme-linked immunosorbent assay. RESULTS Plaque control program led to improvement in all examined clinical parameters and resulted in significant decrease in GCF total amount and concentration of MMP-1 and MMP-9 in comparison to baseline (p < 0.001). However, MMP-1 and MMP-9 levels in DG patients were still significantly higher than those in the healthy control group (p < 0.01). CONCLUSIONS These findings would seem to support an intrinsic upregulated expression of MMPs in DG patients that is exacerbated by bacterial plaque. CLINICAL RELEVANCE The present outcomes provide further scientific grounds for the importance of strict professional oral hygiene sessions in DG patients.
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7
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Maderal AD, Lee Salisbury P, Jorizzo JL. Desquamative gingivitis. J Am Acad Dermatol 2018; 78:839-848. [DOI: 10.1016/j.jaad.2017.05.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022]
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8
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Gambino A, Carbone M, Broccoletti R, Carcieri P, Conrotto D, Carrozzo M, Arduino PG. A report on the clinical-pathological correlations of 788 gingival lesion. Med Oral Patol Oral Cir Bucal 2017; 22:e686-e693. [PMID: 29053652 PMCID: PMC5813986 DOI: 10.4317/medoral.21845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. MATERIAL AND METHODS A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. RESULTS The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. CONCLUSIONS This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases.
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Affiliation(s)
- A Gambino
- Department of Surgical Sciences, University of Turin, CIR - Dental School, Oral Medicine Section, Via Nizza 230, 10126 Turin, Italy,
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9
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Affiliation(s)
- Paolo G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Via Nizza 230, Turin 10100, Italy.
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10
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Arduino PG, Romano F, Sasia D, Broccoletti R, Ricceri F, Barbui AM, Brossa S, Cipriani R, Cricenti L, Cabras M, Aimetti M. Subgingival Microbiota in White Patients With Desquamative Gingivitis: A Cross-Sectional Study. J Periodontol 2017; 88:643-650. [DOI: 10.1902/jop.2017.160745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Paolo G. Arduino
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Danilo Sasia
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Roberto Broccoletti
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Fulvio Ricceri
- Unit of Epidemiology, Regional Health Service Azienda Sanitaria Locale Torino 3, Grugliasco, Italy
| | - Anna Maria Barbui
- Division of Microbiology and Virology, Azienda Ospedaliero University, Città della Salute e della Scienza – Molinette Hospital, Turin, Italy
| | - Silvia Brossa
- Division of Microbiology and Virology, Azienda Ospedaliero University, Città della Salute e della Scienza – Molinette Hospital, Turin, Italy
| | - Raffaella Cipriani
- Division of Microbiology and Virology, Azienda Ospedaliero University, Città della Salute e della Scienza – Molinette Hospital, Turin, Italy
| | - Luca Cricenti
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Marco Cabras
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, Center for Interdepartmental Research – Dental School, University of Turin, Turin, Italy
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11
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Jascholt I, Lai O, Zillikens D, Kasperkiewicz M. Periodontitis in oral pemphigus and pemphigoid: A systematic review of published studies. J Am Acad Dermatol 2017; 76:975-978.e3. [DOI: 10.1016/j.jaad.2016.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
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12
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Arduino PG, Broccoletti R, Carbone M, Conrotto D, Pettigiani E, Giacometti S, Gambino A, Elia A, Carrozzo M. Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series. Med Oral Patol Oral Cir Bucal 2017; 22:e149-e152. [PMID: 28160581 PMCID: PMC5359700 DOI: 10.4317/medoral.21431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/23/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The oral cavity has been frequently described as the only site of involvement or as the first manifestation of mucous membrane pemphigoid (MMP), being the gingival tissues often involved, but usually this has been effusively detailed in limited case series. This is a retrospective evaluation of the gingival involvement in 182 Italian patients with oral MMP. MATERIAL AND METHODS The diagnosis of MMP was established by both clinical morphology and direct immunofluorescence finding. Patient information (age, gender, risk factors and medical status) and parameters of manifestation (lesions' distribution, site and type) were detailed. RESULTS The mean age was 62 years for women (n=137) and 67 years for men (n=45). Patients had several sites of oral involvement; the gingiva was the most common one, affecting 151 patients (82.96%; 119 f - 32 m). Female subjects had more possibilities to develop gingival lesions than male patients (P = 0.005). Sixty-five patients (35.7%; 58 f - 7 m) had pure gingival involvement. Patients with lower gingival involvement statistically had more complaints (P = 0.006). CONCLUSIONS This report is one of the largest about predominantly oral MMP cases, detailing the very frequent gingival involvement; this could be crucial not only for oral medicine specialists but also for primary dental healthcare personnel and for periodontists.
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Affiliation(s)
- P-G Arduino
- Department of Surgical Sciences; CIR - Dental School, School of Medicine, University of Turin, Via Nizza 230, 10126 Turin, Italy,
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13
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Sobocinski V, Dridi SM, Bisson C, Jeanne S, Gaultier F, Prost-Squarcioni C, Bernard P, Pascal F, Lefevre B, Weber P, Abasq C, Agbo-Godeau S, Joly P, Ingen-Housz-Oro S, Duvert-Lehembre S. [Oral care recommendations for patients with oral autoimmune bullous diseases]. Ann Dermatol Venereol 2016; 144:182-190. [PMID: 28011091 DOI: 10.1016/j.annder.2016.09.680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 08/14/2016] [Accepted: 09/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Autoimmune bullous diseases (AIBD) may cause chronic oral lesions that progress insidiously. AIMS To provide recommendations for optimal oral-dental management of patients presenting AIBD with oral involvement. PATIENTS AND METHODS In the absence of scientific studies with high levels of proof, these recommendations have been drawn up at two meetings by a committee of experts on AIBD comprising 7 dermatologists, 1 stomatologist, 1 maxillofacial surgeon, 2 odontologists and 4 parodontologists. RESULTS The oral lesions associated with AIBD may be classified into three grades of severity: severe (generalised erosive gingivitis affecting at least 30% of dental sites), moderate (localised erosive gingivitis affecting less than 30% of dental sites) and controlled (no erosive oral lesions). Good oral-dental hygiene suited to the severity of the oral lesions, must be practised continually by these patients so as to avoid the formation of dental plaque, which aggravates symptoms. Dental and parodontal care must be considered in accordance with the severity grade of the oral lesions: in severe cases, the dental plaque must be eliminated manually with a curette, but several types of care (descaling, treatment for tooth decay, non-urgent extractions, etc.) must be suspended until the grade of severity is moderate or until the disease is stabilised.
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Affiliation(s)
- V Sobocinski
- Clinique dermatologique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - S-M Dridi
- Service d'odontologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Bisson
- Service d'odontologie, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - S Jeanne
- Service d'odontologie, CHRU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - F Gaultier
- Service d'odontologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Prost-Squarcioni
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - P Bernard
- Service de dermatologie, hôpital Robert-Debré, rue du général-Koening, 51100 Reims, France
| | - F Pascal
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - B Lefevre
- Service d'odontologie, hôpital Robert-Debré, rue du général-Koening, 51100 Reims, France
| | - P Weber
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - C Abasq
- Service de dermatologie, hôpital Morvan, 2, avenue maréchal-Foch, 29200 Brest, France
| | - S Agbo-Godeau
- Service de stomatologie et chirurgie maxillo-faciale, hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - P Joly
- Clinique dermatologique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S Duvert-Lehembre
- Service de dermatologie, hôpital de Dunkerque, 130, avenue Louis-Herbeaux, 59240 Dunkerque, France
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14
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Arduino PG, Broccoletti R, Sciannameo V, Scully C. A practical clinical recording system for cases of desquamative gingivitis. Br J Dermatol 2016; 177:299-301. [PMID: 27639053 DOI: 10.1111/bjd.15075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- P G Arduino
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - V Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Turin, Italy
| | - C Scully
- WHO Collaborating Centre for Oral Health-General Health and University College London, London, U.K
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Taylor J, McMillan R, Shephard M, Setterfield J, Ahmed R, Carrozzo M, Grando S, Mignogna M, Kuten-Shorrer M, Musbah T, Elia A, McGowan R, Kerr A, Greenberg M, Hodgson T, Sirois D. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:161-71.e20. [DOI: 10.1016/j.oooo.2015.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 01/06/2023]
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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Conservative approach in patients with pemphigus gingival vulgaris: a pilot study of five cases. Int J Dent 2014; 2014:747506. [PMID: 25505912 PMCID: PMC4258340 DOI: 10.1155/2014/747506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/10/2014] [Accepted: 11/05/2014] [Indexed: 11/17/2022] Open
Abstract
Objectives. The aim of this pilot study was to describe the clinical efficacy of a conservative oral hygiene protocol in patients affected by gingival pemphigus vulgaris (PV) applied in a case series. Methods. Subjects suffering from PV with gingival localisation and slightly responsive to conventional treatment with systemic corticosteroids and immunosuppressive drugs were selected among individuals treated in the Unit of Oral Medicine Section of the University of Turin. Five subjects received nonsurgical periodontal therapy, over a 7-day period, including oral hygiene instructions; patients were instructed about domiciliary oral hygiene maintenance and instructions were reinforced at each visit and personalised if necessary. Clinical outcome variables were recorded at baseline (before starting) and 16 weeks after intervention, including full mouth plaque score (FMPS), bleeding scores (FMBS), probing pocket depth (PPD), oral pemphigus clinical score (OPCS), and patient related outcomes (visual analogue score of pain). Results. Five patients were treated and, after finishing the proposed therapy protocol, a statistical significant reduction was observed for FMBS (P = 0.043) and OPCS (P = 0.038). Conclusions. Professional oral hygiene procedures with nonsurgical therapy are related to an improvement of gingival status and a decrease of gingival bleeding in patients affected by PV with specific gingival localization.
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Topical tacrolimus and periodontal therapy in the management of a case of oral chronic GVHD characterized by specific gingival localization. Case Rep Dent 2014; 2014:127219. [PMID: 24639902 PMCID: PMC3930030 DOI: 10.1155/2014/127219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022] Open
Abstract
Background. Chronic graft versus host disease (cGVHD) is a complication following bone marrow transplantation. The oral lesions are difficult to control with a systemic pharmacological therapy. Case Description. A 63-year-old female patient, who underwent an allogeniec transplantation for acute myeloid leukemia, developed a chronic oral and cutaneous GVHD. The patient was treated with topical tacrolimus 0.1%, twice daily for two months, and underwent a protocol of oral hygiene characterized by 3 appointments of scaling, root planning, and daily oral hygiene instructions. The patient showed marked resolution of gingival lesions and a significant improvement of related pain and gingival inflammatory indexes. Clinical Implications. This case report suggests that treatment with topical tacrolimus and professional oral hygiene may be helpful in the management of chronic oral GVHD with severe gingival involvement.
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Lo Russo L, Gallo C, Pellegrino G, Lo Muzio L, Pizzo G, Campisi G, Di Fede O. Periodontal clinical and microbiological data in desquamative gingivitis patients. Clin Oral Investig 2013; 18:917-25. [PMID: 23900791 DOI: 10.1007/s00784-013-1038-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/02/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy,
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Carbone M, Broccoletti R, Gambino A, Carrozzo M, Tanteri C, Calogiuri PL, Conrotto D, Gandolfo S, Pentenero M, Arduino PG. Clinical and histological features of gingival lesions: a 17-year retrospective analysis in a northern Italian population. Med Oral Patol Oral Cir Bucal 2012; 17:e555-61. [PMID: 22322515 PMCID: PMC3476015 DOI: 10.4317/medoral.17809] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/15/2011] [Indexed: 12/02/2022] Open
Abstract
Objectives: Only few studies on gingival lesions considered large enough populations and contemporary literature does not provide a valid report regarding the epidemiology of gingival lesions within the Italian population. The histopathological and clinical appearance of 538 gingival lesions from northern Italians are described and discussed here.
Study Design: The case records of patients referred for the diagnosis and management of gingival lesions, from October 1993 to October 2009, were reviewed. Data regarding the histological type of lesion were also obtained from the biopsy register for each case, and blindly re-examined.
Results: We reported a greater frequency of benign lesions (reactive and/or inflammatory) in non-plaque/non-calculus induced gingival disorders. We confirmed an unambiguous prevalence of oral squamous cell carcinoma above all other malignant neoplasia, and a prevalence of neoplastic malignant lesions in the maxilla, with a slight increase in females and a drift of the incidence peak from the seventh to the eighth decade. There was a prevalence of precancerous gingival lesions in the maxilla, with a higher incidence in females and with a drift from the sixth to the seventh decade. We also reported a prevalence of oral lichen planus and lichenoid lesions as major manifestations of desquamative gingivitis.
Conclusions: The high frequency of gingival involvement of such different diseases emphasizes the importance of histological characterization and differential diagnosis for periodontists, but more prospective studies are needed to better describe the true incidence of the non-plaque related gingival diseases.
Key words:Gingival lesions, clinical appearance, histological analysis.
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Affiliation(s)
- Mario Carbone
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, Lingotto Dental School, University of Turin, Turin, Italy
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Comparison of periodontal status in gingival oral lichen planus patients and healthy subjects. Dermatol Res Pract 2012; 2012:561232. [PMID: 22570646 PMCID: PMC3337596 DOI: 10.1155/2012/561232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/05/2012] [Indexed: 12/02/2022] Open
Abstract
Background and Objective. Oral lichen planus (OLP) is a common chronic mucocutaneous disease. OLP can occur in different oral sites such as gingiva. The purpose of study was to evaluate the periodontal status of OLP patients with desquamative gingivitis (DG) and compare it with that of healthy control. Methods. This study was case-control. 32 patients with gingival OLP as a case group and 32 healthy subjects as a control group were selected. The periodontal status of all subjects including plaque index (PI), bleeding on probing (BOP), and clinical attachment level (CAL) was evaluated in both groups. Finally data were analyzed by t-test. Results. The mean values of periodontal parameters were observed to be higher in case group compared with control group, and this was significant (P < 0.05). Conclusion. Our results showed that periodontal status is worse in gingival OLP if compared with healthy controls.
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Arduino PG, Lopetuso E, Carcieri P, Giacometti S, Carbone M, Tanteri C, Broccoletti R. Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients. Int J Dent Hyg 2011; 10:138-41. [DOI: 10.1111/j.1601-5037.2011.00527.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arduino PG, D'Aiuto F, Cavallito C, Carcieri P, Carbone M, Conrotto D, Defabianis P, Broccoletti R. Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series. J Periodontol 2011; 82:1670-5. [PMID: 21563944 DOI: 10.1902/jop.2011.100663] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG. METHODS All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain). RESULTS A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003). CONCLUSION Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.
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Affiliation(s)
- Paolo G Arduino
- Department of Biomedical Science and Human Oncology, Oral Medicine Section, Lingotto Dental School, University of Turin, Italy.
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