1
|
Parlatescu I, Tovaru S, Tofan C, Perlea P, Milanesi E, Dobre M, Mihai LL. Gingival Manifestations in Oral Chronic Autoimmune Bullous Diseases: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:167. [PMID: 38256427 PMCID: PMC10818461 DOI: 10.3390/medicina60010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Desquamative gingivitis (DG) is a clinical term indicating "peeling gums" and is associated with different oral manifestations. In this study, we aimed to assess the association between DG and autoimmune blistering mucocutaneous diseases (ABMD) with oral manifestations. Materials and Methods: A retrospective study including 88 patients diagnosed between 1998 and 2019 with ABMD (intraepithelial and subepithelial autoimmune blistering diseases) was performed at the Oral Medicine Department, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest. For each patient, the sociodemographic and anamnestic data, as well as clinical features of oral lesions (location), histological evaluation, and direct immunofluorescence data were collected. Results: Most of the patients involved in the study were female (78.4%). In total, 34 patients (38.63%) were diagnosed with subepithelial autoimmune diseases (SAD) and 54 (61.36%) had intraepithelial autoimmune diseases (IAD). Differences in the anatomic distribution of oral involvement were found between SAD and IAD. The presence of DG was significantly more common in patients with SAD compared to those with a diagnosis of IAD. Conclusions: Specific anatomical locations of the oral lesions are significantly associated with different subtypes of ABMD, with gingiva and hard palate mucosa being more involved in SAD and the soft palate and buccal mucosa in IAD. Desquamative gingivitis is a clinical sign that raises diagnostic challenges for several conditions in oral medicine.
Collapse
Affiliation(s)
- Ioanina Parlatescu
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.P.); (S.T.); (P.P.)
| | - Serban Tovaru
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.P.); (S.T.); (P.P.)
| | - Cristina Tofan
- Private Dental Practice, Dimitrie Cantemir Street, no 11, bl. 8, ap. 46, 040233 Bucharest, Romania
| | - Paula Perlea
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.P.); (S.T.); (P.P.)
| | - Elena Milanesi
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Victor Babeș National Institute of Pathology, 050096 Bucharest, Romania;
| | - Maria Dobre
- Victor Babeș National Institute of Pathology, 050096 Bucharest, Romania;
| | - Laurenta Lelia Mihai
- Faculty of Dental Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania;
| |
Collapse
|
2
|
Hassona Y, Altoum D, Alqaisi D, Taimeh D, Sawair F. Management of auto-immune blistering disease in an older patient with severe intellectual disability. SPECIAL CARE IN DENTISTRY 2024; 44:117-123. [PMID: 37016562 DOI: 10.1111/scd.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
Management of chronic oral mucosal diseases might be challenging in older individuals with intellectual disability because of associated comorbidities, variable clinical presentations, and various barriers imposed by the intellectual disability. This report describes the presentation and management of pemphigus vulgaris in an older female with severe intellectual disability.
Collapse
Affiliation(s)
- Yazan Hassona
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dana Altoum
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dua'a Alqaisi
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dina Taimeh
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- School of Dentistry, The University of Jordan, Amman, Jordan
| |
Collapse
|
3
|
Petruzzi M, Della Vella F, Squicciarini N, Lilli D, Campus G, Piazzolla G, Lucchese A, van der Waal I. Diagnostic delay in autoimmune oral diseases. Oral Dis 2023; 29:2614-2623. [PMID: 36565434 DOI: 10.1111/odi.14480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Autoimmune diseases (ADs) affect about 5% of the general population, causing various systemic and/or topical clinical manifestations. The oral mucosa is often affected, sometimes as the only involved site. The misdiagnosis of oral ADs is an underreported issue. This narrative review focuses on diagnostic delay (DD) in oral ADs (oral lichen planus [OLP], oral Pemphigus Vulgaris, mucous membrane pemphigoid, oral lupus erythematosus, orofacial granulomatosis, oral erythema multiforme [EM], and Sjogren syndrome). Extensive literature research was conducted via MEDLINE, Embase and Google Scholar databases for articles reporting the time spent to achieve the correct diagnosis of oral ADs. Only 16 studies reported DD in oral ADs. Oral autoimmune vesiculobullous diseases are usually diagnosed after 8 months from the initial signs/symptoms, the Sjogren Syndrome diagnosis usually requires about 73 months. No data exist about the DD in OLP, oral lupus erythematosus, orofacial granulomatosis, and oral EM. The diagnosis of oral ADs can be difficult due to the non-specificity of their manifestations and the unawareness of dentists, physicians, and dental and medical specialists about these diseases. This can lead to a professional DD and a consequential treatment delay. The delay can be attributed to the physicians or/and the healthcare system (Professional Delay) or the patient (Patient's Delay).
Collapse
Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Squicciarini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Lilli
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
- School of Dentistry, Sechenov University, Moscow, Russia
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine "G. Baccelli", University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, Naples, Italy
| | | |
Collapse
|
4
|
Kianfar N, Dasdar S, Mahmoudi H, Daneshpazhooh M. Burden of pemphigus vulgaris with a particular focus on women: A review. Int J Womens Dermatol 2022; 8:e056. [PMID: 36204194 PMCID: PMC9529034 DOI: 10.1097/jw9.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/28/2022] [Indexed: 11/05/2022] Open
Abstract
Pemphigus vulgaris is a chronic autoimmune mucocutaneous blistering disorder. Apart from the disease itself, other aspects of patients' life, including psychological, social, and financial, can be affected. Women are particularly more disposed to the impact of the disease due to their physiological characteristics, the specific periods of pregnancy and lactation as well as their social and familial role. In this review, we summarized the burden of pemphigus vulgaris on various aspects of women's lives. It is essential to understand these problems and provide appropriate support for patients with such a burdensome disease.
Collapse
Affiliation(s)
- Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Pemphigus for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
6
|
Balighi K, Shams-Davatchi C, Ghobadi S, Daneshpajooh M, Lajevardi V, Mahmoodi H, Aryanian Z, Teymourpour A, Seirafi R, Beigmohammadi F, Tavakolpour S. Retrospective study of gingival involvement in pemphigus: a difficult to treat phenomenon. Dermatol Ther 2022; 35:e15475. [PMID: 35352853 DOI: 10.1111/dth.15475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus is a group of autoimmune diseases characterized by flaccid lesions on the skin and mucous membranes. In pemphigus vulgaris, the most common subtype of pemphigus, lesions might be appeared anywhere on the oral mucosa, mostly in the buccal mucosa. However, the gingiva is a less frequently affected site. METHODS Here, we performed a retrospective study at Tehran University of Medical Sciences, covering a two-year period to identify pemphigus patients with active lesions confined to the gingiva. RESULTS Considering 1787 initially evaluated pemphigus cases, 512 (28.6%) were found to have a history of gingival involvement. Among them, 31 patients had only gingival involvement during their last visit, including 29 (93.5%) women and only two (6.5%) men. The mean of disease duration in this group was 5.29±3.46 years, and they had gingival involvement for a mean of 23.9±19.3 months. Of 28 patients, nine were negative for anti-Dsg3 and 24 were negative for anti-Dsg1. In 24 patients, who received rituximab, the mean PDAI specifically for gingiva was 4.76±0.74 at baseline, which had changed to 4.13±0.75 and 3.26±0.63 three and six months after rituximab administration, respectively. After three months, gingival lesions were either entirely resolved (n=3), partially resolved (n=11), remained unchanged (n=2), or progressed (n=7). CONCLUSIONS Gingiva-confined presentation of lesions in pemphigus could be non-anti-Dsg1/3 dependent in some patients. Such patients do not respond well to conventional treatments and rituximab therapy. More studies on the pathogenesis of gingiva-confined presentation of pemphigus are required. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Cheida Shams-Davatchi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Salar Ghobadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpajooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahide Lajevardi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoodi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teymourpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramtin Seirafi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Beigmohammadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Hassona Y, Salim NA, Tarboush N, Sartawi S, Alrashdan M, Rajab L, Sawair F. Knowledge about oral manifestations of systemic diseases among medical and dental students from Jordan: An interdisciplinary educational gap. SPECIAL CARE IN DENTISTRY 2022; 42:383-389. [PMID: 34984709 DOI: 10.1111/scd.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the ability of medical students to recognize oral manifestation of selected systemic diseases and compare their performance with dental students. MATERIALS AND METHODS A total of 400 senior medical and dental students were approached to participate. The study protocol involved two parts; a self-administered survey and a direct interview involving clinical photographs for oral signs of systemic diseases. RESULTS A total of 283 (70.8%) agreed to participate and completed the two- part study. The study population was made of 110 (38.9%) [82 females and 28 males] dental students, and 173(61.1%) [98 females and 75 males] medical students. The knowledge score regarding questions about the normal mouth and oral structures was 15.7 ± 6 out of 22. Dental students had a significantly higher knowledge score about normal mouth and oral structures (20.9 ± 4; range from 17 to 22) compared to medical students (10.6 ± 7; range from 4 to 21) (p = .029). The knowledge score regarding questions about oral manifestations of systemic diseases was 26.8 ± 6 out of 40. Dental students had a significantly higher knowledge score about oral manifestations of systemic diseases (30.8 ± 7; range from 15 to 37) compared to medical students (22.9 ± 4; range from 10 to 36) (p = .031). Only 24.3% (n = 42) medical students reported having adequate training to be able to distinguish between normal mouth and diseases. Nearly all medical students (91.3%; n = 158) felt that it is important to have more formal training in oral examination and disease diagnosis. CONCLUSION Medical students lack adequate knowledge, diagnostic ability, and confidence with regard to diagnosis of oral signs of systemic diseases. To ensure that medical students have necessary skills in assessing oral diseases, curricula revisions and modifications are required, and specific oral health-related learning outcomes should be introduced and reinforced through clinical training.
Collapse
Affiliation(s)
- Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Nesreen A Salim
- Department of Prosthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Nafez Tarboush
- Department of Biochemistry and Physiology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Samiha Sartawi
- Department of Prosthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Mohammad Alrashdan
- Department of Oral Surgery and Oral Medicine, School of Dentistry, Jordan University for Science and Technology, Amman, Jordan
| | - Lamis Rajab
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| |
Collapse
|
8
|
Diagnostic Concordance between Optical Coherence Tomography and Histological Investigations for Immune-Mediated Desquamative Gingivitis: Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179095. [PMID: 34501683 PMCID: PMC8430736 DOI: 10.3390/ijerph18179095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
Desquamative gingivitis (DG) denotes a heterogeneous immune-mediated disease for which early diagnosis represents a great challenge. The main aim of this study is to validate diagnostic concordance between specific Optical Coherence Tomography (OTC) patterns for DG related to oral Lichen Planus (OLP), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP) and definitive histological diagnosis. Forty-three patients with suspected immune-mediated DGs, were progressively recruited. Before biopsy, an OCT preliminary evaluation was performed using specific pre-determined OCT diagnostic patterns (i.e., morphology and localization of blisters, status of the basal membrane, epithelial thickness, presence/absence of acantholytic cells into blister and/or inflammatory infiltrate) related to OLP, PV and MMP. After histological confirmation, OCT and histological diagnoses were compared. Using pre-determined patterns, OCT diagnoses of DGs were: 22 (51%) OLP, of which 11 (26%) were with the bullous variant, 4 (9%) PV and 6 (14%) MMP. The same diagnoses were found by histological investigations (with the main OCT discriminatory potential for the bullous variant of OLP). The concordance between the two diagnostic methods was confirmed by the Fisher exact test (p-value < 0.01). These specific OCT patterns show a diagnostic reliability in 100% of the cases investigated, suggesting their accuracy to support the complex diagnosis and management of immune-mediated DGs.
Collapse
|
9
|
Panzarella V, Bartolone A, Rodolico V, Capocasale G, Maniscalco L, Matranga D, Di Fede O, Campisi G. Immune-Mediated Desquamative Gingivitis and Optical Coherence Tomography Diagnostic Patterns: Clinical Implication from a Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11081453. [PMID: 34441387 PMCID: PMC8394405 DOI: 10.3390/diagnostics11081453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022] Open
Abstract
Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions.
Collapse
Affiliation(s)
- Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (A.B.); (O.D.F.); (G.C.)
- Correspondence:
| | - Alessia Bartolone
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (A.B.); (O.D.F.); (G.C.)
| | - Vito Rodolico
- Department ProMISE, University of Palermo, 90127 Palermo, Italy;
| | - Giorgia Capocasale
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, 37134 Verona, Italy;
| | - Laura Maniscalco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | - Domenica Matranga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy;
| | - Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (A.B.); (O.D.F.); (G.C.)
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (A.B.); (O.D.F.); (G.C.)
| |
Collapse
|
10
|
DALTABAN Ö, ÖZÇENTİK A, AKMAN-KARAKAŞ A, ÜSTÜN K, HATİPOĞLU M, UZUN S. Clinical Analysis of Desquamative Gingivitis Related Oral Mucocutaneous Diseases. CUMHURIYET DENTAL JOURNAL 2020. [DOI: 10.7126/cumudj.779519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
11
|
Shaqman M, Hamdan A, Karadsheh O, Sawair F, Hassona Y. Desquamative gingivitis: a challenging diagnosis for clinicians. Br Dent J 2020; 229:26-30. [PMID: 32651518 DOI: 10.1038/s41415-020-1848-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction Diagnosis of underlying causes for desquamative gingivitis (DG) is often delayed in clinical settings, but little is known about factors influencing its delayed diagnosis. We investigated the diagnostic patterns and associated factors in a cohort of patients presenting primarily with DG.Materials and methods A total of 41 patients presenting primarily with DG were interviewed to evaluate professional and patient diagnostic delays. Severity of DG was evaluated using the desquamative gingivitis clinical score (DGCS) proposed by Arduino <i>et al.</i> (2017).Results The study sample was composed of 29 females and 12 males. On average, patients waited 10.8 ± 10 months (range 4-20 months) before seeking their first professional consultation (that is, patient delay). Less severe disease and female gender were significantly associated with longer patient delay. Patients consulted an average of 4.1 ± 2 healthcare professionals (range two to six) before a definitive diagnosis was reached, with an average professional delay of 7.3 ± 5 months (range 2-11 months). Professional delay was positively correlated with the number of professional consultations (r = 0.69) and absence of other oral mucosal lesions or extraoral involvement.Conclusions Considerable diagnostic delay is a feature of the natural history of DG. Increased patient knowledge and professional awareness regarding DG symptoms and diagnostic measures is needed to reduce diagnostic delay and improve patients' experience with this disease.
Collapse
Affiliation(s)
- Murad Shaqman
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontics, School of Dentistry, The University of Jordan, 11942, Jordan.
| | - Ahmad Hamdan
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontics, School of Dentistry, The University of Jordan, 11942, Jordan
| | - Omar Karadsheh
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontics, School of Dentistry, The University of Jordan, 11942, Jordan
| | - Faleh Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontics, School of Dentistry, The University of Jordan, 11942, Jordan
| | - Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontics, School of Dentistry, The University of Jordan, 11942, Jordan
| |
Collapse
|
12
|
Daltaban Ö, Özçentik A, Akman Karakaş A, Üstün K, Hatipoğlu M, Uzun S. Clinical presentation and diagnostic delay in pemphigus vulgaris: A prospective study from Turkey. J Oral Pathol Med 2020; 49:681-686. [PMID: 32516514 DOI: 10.1111/jop.13052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND To evaluate the diagnostic patterns and factors that may influence delays in the diagnosis of pemphigus vulgaris (PV) with oral involvement. MATERIALS AND METHODS In this prospective cohort study, 36 newly diagnosed PV patients with oral involvement were clinically examined and interviewed about the natural history of the oral lesions, number of medical consultations (Med consultation), medical treatment history, and diagnostic delay time (DD time). RESULTS Thirty (83%) PV patients presented initially with oral mucosal involvement (OMI) and 6 (17%) presented initially with skin involvement (SI). The mean DD time was 6.19 ± 3.82 months, and the mean number of Med consultation was 5.8 (n = 36). The means of all the parameters were significantly higher for the OMI patients than for the SI patients (P < .05). All of the patients with OMI had been misdiagnosed. The DD time was significantly longer in patients who presented initially with desquamative gingivitis (8.25 ± 3.81) than patients who presented with ulcers and erosions (4.78 ± 1.11) (P < .05). There was a statistically significant positive correlation between DD time and Med consultation (r = 0.91). CONCLUSION Even with the high frequency of oral involvement and easy access to the oral cavity, diagnostic delays are still common for patients with oral PV. This underlines the need for education to improve healthcare providers' awareness and knowledge of the clinical oral presentation of PV.
Collapse
Affiliation(s)
- Özlem Daltaban
- Department of Periodontology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Aslı Özçentik
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ayşe Akman Karakaş
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Kemal Üstün
- Department of Periodontology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Mükerrem Hatipoğlu
- Department of Periodontology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Soner Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
13
|
Dal Prá KJ, de Assis Tristão SDSS, Franco JB, Matias DT, Carrillo CM, de Melo Peres MPS, Ribas PF. Oral management of pemphigus vulgaris in the intensive care unit. SPECIAL CARE IN DENTISTRY 2020; 40:280-284. [PMID: 32162360 DOI: 10.1111/scd.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/13/2023]
Abstract
Pemphigus vulgaris (PV) is a rare and potentially lethal autoimmune disease that affects the skin and mucous membranes. Injuries caused by the disease cause pain, risk of infection, and other complications that result in a high mortality rate. Frequently, management of the PV requires intensive care and a multidisciplinary approach. Oral lesions of PV are usually the first clinical signs of the disease and the last lesions to heal, requiring treatment by a specialized dental team. The aim of this study was to report two clinical cases of PV with involvement of the oral mucosa. The patients were admitted to an intensive care unit, and underwent multidisciplinary management of their condition along with low-level laser therapy. Both cases demonstrated the importance of specialized dental care in improving the quality of life of patients with PV.
Collapse
Affiliation(s)
- Ketelin Juliane Dal Prá
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Juliana Bertoldi Franco
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Diogo Toledo Matias
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Camila Merida Carrillo
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Priscila Fernandes Ribas
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
14
|
Al‐Amad SH, Ghebeh M, Saloum P, Maarouf TB, Moustafa YM, Younis Z. Pharmacists' clinical competency towards oral mucosal diseases: Results from a mystery shopper study. Oral Dis 2019; 26:89-95. [DOI: 10.1111/odi.13208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Maya Ghebeh
- College of Dental Medicine University of Sharjah Sharjah UAE
| | | | | | | | - Zeyad Younis
- College of Dental Medicine University of Sharjah Sharjah UAE
| |
Collapse
|
15
|
Hassona Y, El-Ma'aita A, Amarin J, Taee AA. Diagnostic delay and suboptimal management in persistent idiopathic facial pain and persistent dentoalveolar pain; a cross-sectional study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:498-503. [PMID: 30956081 DOI: 10.1016/j.oooo.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to explore the diagnostic and therapeutic challenges encountered by patients with persistent idiopathic facial pain (PIFP) and to investigate factors influencing its delayed diagnosis. STUDY DESIGN In this cross-sectional study, 34 patients with newly diagnosed PIFP were interviewed. Data about diagnostic delay, number and nature of previous consultations, and previous medical and surgical interventions were recorded. Pearson's correlation and Student t test were used to examine the differences among the variables in relation to diagnostic delay. RESULTS The average time between the onset of symptoms to correct diagnosis was 19.3 ± 11.1 months. Diagnostic delay was significantly longer in patient with pain localized to intraoral sites (22.6 ± 7.4) compared with patients with extraoral pain (16.1 ± 9.3). The average number of health care professionals consulted before correct diagnosis was 3.7 ± 2.3. General dental practitioners were the most commonly consulted health care professionals (n = 27; 79.4%). On average, patients were given 2.3 ± 0.24 misdiagnoses before the correct diagnosis was determined and were prescribed 3.5 ± 2.4 classes of drugs. Twenty-five patients (73.5%) underwent unnecessary surgical/dental interventions. CONCLUSIONS Patients with PIFP are frequently misdiagnosed, leading to prescription of ineffective medications and unnecessary investigations and surgical interventions. Educational efforts should emphasize on improving knowledge and awareness of this condition.
Collapse
Affiliation(s)
- Yazan Hassona
- School of Dentistry, The University of Jordan, Amman, Jordan.
| | | | | | - Anas Al Taee
- School of Dentistry, The University of Jordan, Amman, Jordan
| |
Collapse
|
16
|
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: 9] [Impact Index Per Article: 1.8] [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.
Collapse
Affiliation(s)
- M-J Garcia-Pola
- Department of Oral Medicine, Faculty of Medicine and Sciences of the Health, Julian Clavería, 33006 Oviedo, Spain,
| | | | | | | | | |
Collapse
|