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Torrezani A, Gallo CDB, Motta ACF, Siqueira CS, Rabelo GD, Júnior CAL. Desquamative gingivitis treatment with topical tacrolimus applied to a custom tray: an open trial regarding its efficacy on patients' symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:30-36. [PMID: 37919196 DOI: 10.1016/j.oooo.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To evaluate the efficacy of topical tacrolimus offered on a custom tray to treat desquamative gingivitis (DG). STUDY DESIGN Eighteen patients with symptomatic DG related to oral lichen planus (OLP) or mucous membrane pemphigoid (MMP) were selected, of which 13 completed the study. Periodontal treatment was followed by the fabrication of a custom silicone tray to apply a tacrolimus gel formulation (0.1%). Clinical evaluation (complaint of pain and burning - visual analog scale from 0 to 10; and the presence of erythema, desquamation, vesicle/blister, erosion, ulcer, and bleeding) was performed by the same examiner on day 1, and every 15 days for 90 days. RESULTS Total remission was found in 4 patients (30.76%). Partial remission was found in 69.24% of the patients, classified with an excellent (30.76%), good (30.76%), and regular (7.69%) recovery, respectively. There was a reduction of about 60% in pain and 65% in burning sensation complaints. Wilcoxon test revealed significant differences between pre- and post-treatment pain and burning sensation symptoms (P < .01). CONCLUSION Topical application of 0.1% tacrolimus gel was effective in the treatment of DG in controlling pain and burning sensation, leading to the clinical remission of gingival lesions in patients with OLP and MMP.
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Affiliation(s)
- Anna Torrezani
- Stomatology Department, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.
| | - Camila de Barros Gallo
- Stomatology Department, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Carolina Fragoso Motta
- Stomatology, Public Health & Forensic Department, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Gustavo Davi Rabelo
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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González-Serrano J, Serrano J, Sanz M, Torres J, Hernández G, López-Pintor RM. Efficacy and safety of a bioadhesive gel containing propolis extract, nanovitamin C and nanovitamin E on desquamative gingivitis: a double-blind, randomized, clinical trial. Clin Oral Investig 2023; 27:879-888. [PMID: 35900605 PMCID: PMC9889524 DOI: 10.1007/s00784-022-04653-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG). MATERIALS AND METHODS A randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks. RESULTS Twenty-two patients were randomly assigned to test (n = 11) or control group (n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported. CONCLUSIONS Test gel may alleviate DG and improve quality of life without side effects. CLINICAL RELEVANCE A gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects. CLINICAL TRIAL REGISTRATION The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.
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Affiliation(s)
- José González-Serrano
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Julia Serrano
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Mariano Sanz
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Jesús Torres
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Gonzalo Hernández
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Rosa María López-Pintor
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Departamento de Especialidades Clínicas Odontológicas. Facultad de Odontología, Universidad Complutense de Madrid. Plaza Ramón Y Cajal S/N, 28040 Madrid, Spain
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Arduino PG, Campolongo MG, Sciannameo V, Conrotto D, Gambino A, Cabras M, Ricceri F, Carossa S, Broccoletti R, Carbone M. Randomized, placebo-controlled, double-blind trial of clobetasol propionate 0.05% in the treatment of oral lichen planus. Oral Dis 2018; 24:772-777. [PMID: 29297958 DOI: 10.1111/odi.12821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To perform a randomized, placebo-controlled, double-blind study, with a follow-up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP). SUBJECTS AND METHODS Thirty-two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow-up. RESULTS Symptoms improved in all clobetasol-treated patients during the first 2 months of therapy, while only 50% of placebo control group (p = .005) displayed similar results; of the remaining half, 12.5% did experienced a worsening while 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol-treated patients improved, while only 62.5% of the placebo-treated patients had a positive response (p = .229). CONCLUSIONS It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic-erosive oral lesions.
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Affiliation(s)
- P G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M G Campolongo
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - V Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - D Conrotto
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Cabras
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - S Carossa
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Carbone
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
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Ai R, Tao Y, Hao Y, Jiang L, Dan H, Ji N, Zeng X, Zhou Y, Chen Q. Microenvironmental regulation of the progression of oral potentially malignant disorders towards malignancy. Oncotarget 2017; 8:81617-81635. [PMID: 29113419 PMCID: PMC5655314 DOI: 10.18632/oncotarget.20312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMD) develop in a complex tissue microenvironment where they grow sustainably, acquiring oral squamous cell carcinoma (OSCC) characteristics. The malignant tumor depends on interactions with the surrounding microenvironment to achieve loco-regional invasion and distant metastases. Unlike abnormal cells, the multiple cell types in the tissue microenvironment are relatively stable at the genomic level and, thus, become therapeutic targets with lower risk of resistance, decreasing the risk of OPMD acquiring cancer characteristics and carcinoma recurrence. However, deciding how to disrupt the OPMD and OSCC microenvironments is itself a daunting challenge, since their microenvironments present opposite capacities, resulting in diverse consequences. Furthermore, recent studies revealed that tumor-associated immune cells also participate in the process of differentiation from OPMD to OSCC, suggesting that reeducating stromal cells may be a new strategy to prevent OPMD from acquiring OSCC characteristics and to treat OSCC. In this review, we discuss the characteristics of the microenvironment of OPMD and OSCC as well as new therapeutic strategies.
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Affiliation(s)
- Ruixue Ai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yan Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yilong Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ning Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Reply to: Details of the participants and medical intervention used in the study evaluating the effect of a mouth exercising device on burning sensation in oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:735-737. [PMID: 28412237 DOI: 10.1016/j.oooo.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
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Gupta S, Ghosh S, Gupta S. Interventions for the management of oral lichen planus: a review of the conventional and novel therapies. Oral Dis 2017; 23:1029-1042. [PMID: 28055124 DOI: 10.1111/odi.12634] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This narrative review focuses on the rationale and role of conventional and newer therapies in the management of oral lichen planus (OLP) with emphasis on randomized controlled trials (RCTs) reported over two decades. MATERIALS AND METHODS Literature search was conducted to identify RCTs for the management of OLP from 1 January 1995 to 31 December 2015; Medline and Cochrane databases complemented with manual search were used. Primary outcome as resolution of pain was evaluated with the analysis of clinical resolution of erythema and ulceration as secondary outcome. RESULTS The search provided 260 abstracts, of which 70 full-text articles were included. Majority of trials used topical steroids with very few trials on newer therapies. It was found that topical steroids are effective for symptomatic management of OLP with equal efficacy shown by topical calcineurin inhibitors and retinoids. However, the side effect of transient burning sensation with relapse was more with calcineurin inhibitors. CONCLUSION Although the newer therapies offer advantage over steroids for the management of OLP in recalcitrant cases, extensive lesions, and cases unresponsive to steroids, but sufficient clinical data on their use are still lacking. Hence, more RCTs with large sample size, adequate treatment duration, and long-term follow-up are required for clinical utility.
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Affiliation(s)
- S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Ghosh
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Leite FRM, Nascimento GG, Demarco FF, Waechter J, Etges A. Use of Fusidic Acid for Desquamative Gingivitis Treatment: 1-Year Follow-Up. Braz Dent J 2015; 26:422-7. [DOI: 10.1590/0103-64402013x0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 05/22/2015] [Indexed: 11/22/2022] Open
Abstract
<p>This study evaluated retrospectively the effect of fusidic acid on the management of desquamative gingivitis (DG). The study population consisted of 15 patients with DG. Patients were requested to make topical application of 2% fusidic acid ointment 4 times a day for 6 weeks. Clinical assessments were recorded at baseline, at 6 weeks and 12 months after beginning the therapy. Patients' examination involved lesion size area, pain score and impact on daily activities. All patients presented lesions in maxilla; in 9 patients (60.0%) lesions were predominately at the anterior region and 6 (40.0%) at the posterior region of maxilla. Treatment significantly (p<0.05) reduced the pain intensity (from 5.4±1.12 to 1.16±0.97) and its periodicity (from 53.33% with pain>3 x/week to 13.33%), and the lesion size in 72.47% (±4.12) immediately after 6 weeks of treatment. Improvements were sustained for 12 months compared to baseline (p<0.001). It also reduced the impact of disease in daily activities (eating and oral hygiene performance), and improved the emotional condition of patients, who reported better social relationships and habits. Topical application of fusidic acid may be a possible alternative local palliative therapy for desquamative gingivitis treatment.</p>
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Noce CW, Gomes A, Shcaira V, Corrêa MEP, Moreira MCR, Silva Júnior A, Gonçalves LS, Garnica M, Maiolino A, Torres SR. Randomized Double-Blind Clinical Trial Comparing Clobetasol and Dexamethasone for the Topical Treatment of Symptomatic Oral Chronic Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2014; 20:1163-8. [DOI: 10.1016/j.bbmt.2014.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/07/2014] [Indexed: 01/12/2023]
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Kvaal SI, Angell-Petersen E, Warloe T. Photodynamic treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:62-70. [DOI: 10.1016/j.oooo.2012.08.448] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 08/14/2012] [Accepted: 08/20/2012] [Indexed: 01/28/2023]
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López-Jornet P, Camacho-Alonso F. Application of a motivation-behavioral skills protocol in gingival lichen planus: a short-term study. J Periodontol 2011; 81:1449-54. [PMID: 20572768 DOI: 10.1902/jop.2010.100245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main objective of the present study was to assess the efficacy of a motivation–behavioral skills protocol for plaque control in patients with gingival lichen planus. METHODS A pre- and post-test descriptive clinical study was made of 40 consecutive white patients with gingival lichen planus: five males (12.5%) and 35 females (87.5%); mean age: 57 years. A motivation–behavioral skills protocol for oral hygiene was applied, with the determination of gingival scores (gingival index, plaque extension, and Community Periodontal Index of Treatment Needs [CPITN]) and patient evaluation after 4 and 8 weeks. RESULTS The clinical parameters in relation to the different forms of gingival lichen planus showed statistically significant improvements for gingival index, plaque extension, and CPITN (P <0.001) as determined 4 and 8 weeks after starting the program. CONCLUSIONS The application of an active prevention program in patients with gingival lichen planus is important because it offers benefits for periodontal health. However, more long-term studies are needed to confirm the results obtained.
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Affiliation(s)
- Pia López-Jornet
- Department of Oral Medicine, Murcia University Dental School, Murcia, Spain.
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Gagari E, Damoulis PD. Desquamative gingivitis as a manifestation of chronic mucocutaneous disease. J Dtsch Dermatol Ges 2010; 9:184-8. [PMID: 21050381 DOI: 10.1111/j.1610-0387.2010.07543.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Desquamative gingivitis (DG) is a clinical descriptive term indicating "peeling gums". DG is usually the result of a disease process that causes separation of the epithelium from the underlying connective tissue in the oral masticatory mucosa. DG may be a manifestation of several mucocutaneous diseases, most commonly cicatricial pemphigoid, pemphigus vulgaris and lichen planus. Correct diagnosis of the underlying disease in DG patients requires careful clinical observation, detailed examination of medical history, biopsy and histopathological examination of the lesions as well as more specialized tests such as direct and indirect immunofluorescence. Treatment of DG consists of treating the underlying disease and often requires the use of immunosuppressive agents, such as corticosteroids. Elimination of local gingival irritants, such as dental plaque and calculus, can significantly improve the treatment outcome.
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Affiliation(s)
- Eleni Gagari
- Department of Dermatology, National and Kapodistrian University, Athens, Greece.
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