Prevention and management of dental erosion and decay

The 2017 Global Disease Study revealed 2.3 billion untreated cavities and 139 million other oral conditions like dental erosion. Modern treatments prioritise controlling etiological factors and preventing related diseases. This Editorial invites researchers to contribute to the collection, 'Prevention and management of dental erosion and decay'.

Clinical Oral Condition Analysis and the Influence of Highly Active Antiretroviral Therapy on Human Salivary Microbial Community Diversity in HIV-Infected/AIDS Patients

The purpose of this study was to assess the clinical oral status and investigate the effect of highly active antiretroviral therapy (HAART) on oral flora diversity in human immunodeficiency virus (HIV)-infected/acquired immune deficiency syndrome (AIDS) patients. We first recorded and analyzed the demographic indicators of 108 HIV-infected patients and assessed their periodontal health, dental health and oral lesion status by oral examination. Besides, we compared the changes in salivary microbial communities of healthy controls, before and after treatment of HAART-processed AIDS patients by Roche 454 sequencing and RT-qPCR. In HIV-infected/AIDS patients, age, sex, marital status, income level, smoking and oral health behaviors had an effect on periodontal clinical indicators; age and marital status were correlated with dental clinical indicators; most of them were accompanied by oral manifestations, mainly including candidiasis albicans, salivary gland disease, AIDS-associated periodontitis, and oral ulcers. Besides, a total of 487 species were detected in the saliva of AIDS patients. The microbial communities of HAART-unprocessed AIDS patients significantly differed from those processed patients, with 112 unique microbial species. More importantly, a large number of conditioned pathogens were also detected in the saliva samples of AIDS patients, which may be associated with opportunistic infections. Therefore, HAART might have a crucial role in salivary microecological balance in AIDS patients. And these patients should pay attention to the maintenance of oral health, and the early initiation of HAART may be important for the development of oral lesions.

[Oral microbiome dysbiosis triggers gestational periodontal disease and adverse pregnancy outcomes]

Oral microbiome dysbiosis, triggered by increased oral pathogens or decreased commercial bacteria, leads to oral and systemic diseases. Recent ecological events suggest that periodontal disease is a risk factor of adverse pregnancy outcomes. The oral microbiome dysbiosis is believed to be associated with oral disease and adverse pregnancy outcomes (APO). However, the pathogenic mechanisms have not yet been elucidated. In this review, we summarize the recent literature on how pregnancy associated pathogenic oral microbiome dysbiosis can trigger gestational periodontal diseases and poor birth outcomes, especially the role of periodontal pathogenic bacteria in the mechanisms of how gestational periodontal diseases cause APO, and the effect of periodontal therapy during pregnancy on birth outcomes.

[Research progress in ecological prevention of dental caries]

Dental caries is one of the most common oral diseases around the world. Dental plaque attached to the surfaces of teeth is the main biological factor leading to caries. Although fluoride is still one of the most commonly used methods to prevent caries, with the change of epidemiological characteristics of caries and the update of the understanding of caries etiology, it is necessary to use other ecological methods such as antimicrobial peptides, arginine, probiotics and natural products, etc. to enhance the effect of fluoride in preventing dental caries. The present article reviews the research progress on the ecological approaches for caries prevention in recent years.

[Morphological and functional assessment of the oral mucosa in children with dystrophic epidermolysis bullosa]

THE AIM OF THE STUDY

To validate modified oral index (MOI) for the assessment of the oral mucosa in children with dystrophic epidermolysis bullosa (DYB).

MATERIALS AND METHOS

The study comprised 27 DYB children aged 4 to 18 years. Morphological component of MOI was documented by an intraoral camera with the registration of pathological elements in various of the oral cavity and differentiated scoring. Functional component included registration of ankyloglossia and microstomia measured by Bristol assessment system and orthodontic caliper, correspondingly, and then referred to normal age-matched values.

RESULTS

Oral mucosa condition deteriorates in DYB children with age both in morphological and functional aspects. MOI values more than 40 should be seen as prognostically unfavorable as they are always associated with severe functional restrictions. These restrictions are always present in children older than 6. If present in younger age they may indicate poor functional status in future.

CONCLUSION

The MOI may be a useful tool for the assessment of the efficacy of the pharmacological agents' impact on the oral mucosa and disease prognosis. Correlation of MOI and general condition of DYB children needs further investigation.

Oral conditions in the community patient: part 2-systemic complications of poor oral health

Oral health has a symbiotic relationship with general health, with oral disease recognised to have an adverse effect on the overall systemic health of a patient. Deterioration in oral health has been shown to have an impact on the severity of chronic systemic diseases, nutrition, hydration and psychological and social wellbeing. Part 1 of this mini-series explored the common oral conditions that community patients may present with, and the role of the nursing team in aiding the prevention, diagnosis and management of these conditions. Following on from that, this article discusses the links between oral and general health, and preservation of a patient's quality of life. This article also aims to support nurses' knowledge on how to assess the oral health needs of patients, support oral care provision, how to access acute and elective dental services and signpost to additional supportive resources.

Coexistence of Lack of Clinical Manifestation of Oral Mycosis and Systemic Diseases in Edentulous Patients Using Removable Prosthetic Restorations

OBJECTIVE

It is believed that oral infections can increase the risk of systematic diseases, such as atherosclerosis and coronary heart disease, stroke, chronic obstructive pulmonary disease, diabetes, cancer, rheumatoid arthritis, etc. It seems that oral invasive pathogens induce a systemic inflammatory response via mediators released by the cardiovascular system and liver, which increases the risk to the patient of these systematic infections, such as hypertension. On the basis of previous studies of the stomatognathic system, investigating the coexistence of systemic diseases and inflammation in the oral cavity, it can be expected that there is a connection between inflammation of the denture-bearing area in patients using acrylic removable dentures and the presence of systemic diseases, and that patients with inflammation in oral mucosa are more likely to have systemic diseases.

MATERIAL AND METHOD

A retrospective study was carried out on a group of patients seeking prosthetic treatment at the Prosthetic Department of the University Dental Clinic (UKS) from March 2012 to February 2013. All data were collected using a UKS electronic database with KS-SOMED. The minimum period of use for removable prostheses was five years.

RESULTS

According to anamnesis, the most common systemic diseases in our study group were hypertension disease. In total, 58% of patients with hypertension disease had no inflammation in the oral cavity.

CONCLUSIONS

The occurrence of systemic diseases in edentulous people using removable prosthetic restorations, and the subsequent use of medications for these diseases, may result in a lack of clinical symptoms of concomitant fungal infection of the oral mucosa.

Oral Transmission of Sexually Transmissable Infections: A Narrative Review

Over the last few decades, behavioral changes in sexual practices have made oral transmission of traditional sexually transmissible infections increasingly recognized. Patients harboring a sexually transmissible infection may first present lesions on the oral cavity, as these may be visible and interfere with basic functions such as speech or swallowing. Moreover, the oral cavity may function as a reservoir for future spread of these infections. In order to successfully control this problem, a greater focus on oral sex should be persued, along with promotion of the use of condom and education on safe oral sex practices. Furthermore, examination of the oral cavity should is essential when evaluating any patient suspected of harboring a sexually transmissible infection. In this article, oral transmission of several viral and bacterial infections is reviewed, including human papillomavirus infection, genital herpes, syphilis and gonorrhea, among others.

Association between oral diseases and impact on daily performance among male Saudi schoolchildren

Objective

Little is known about exploring the oral health related quality of life (OHRQoL) of school children in Saudi Arabia. The importance of examining this topic has centred on its ability to measure associations between the oral symptoms, impacts and clinical measures. This study aims to explore associations between the (OHRQoL) based on the children's Oral Impacts on Daily Performance (Child-OIDP) index and oral diseases of Saudi school children living in Albaha region.

Materials and methods

A cross-sectional study was conducted between November 2017 to January 2018 using two-stage randomised sampling technique. The oral diseases and impacts were examined using the World Health Organization's (1997) guidelines and the Child-OIDP index, respectively. Data analysis was conducted using the SPSS software version 20.0. Chi-squared, bivariate and multivariate logistic regression tests were used, as appropriate.

Results

In total 349 Saudi male school children, 12 to 15 years old, were recruited. The Child-OIDPrate was significantly high (75.1%). The participants reported minor, moderate and major (severe) oral impacts (29.4%, 50%, and 20.6% respectively). The overall mean of the Child-OIDP score was 2.15±1.40.

Conclusions

The high overall Child-OIDP score was in accordance with the participants' dental status. Further research should focus on improving knowledge and implementing education programmes to advance the community's oral diseases and practices.

[Internal medicine, seen from the mouth]

Many diseases affect the oral cavity. Therefore, the mouth is an organ that internists should observe carefully. Hereafter we present five illustrations of oral semiology that reflect a systemic condition: a strawberry tongue, an ulceration, a labial lesion, a gingival hyperplasia and a gingival hyperpigmentation. Each time, a differential diagnosis is to be considered, potentially allowing the identification of severe diseases.

Oral health of adults with intellectual disabilities: a systematic review

BACKGROUND

There have been several past reports that adults with intellectual disabilities experience poor oral health (tooth loss, periodontal health and untreated dental caries). Loss of a functional dentition has serious consequences, including problems with chewing, swallowing, nutrition, speech, temporomandibular joint osteoarthritis and pain and systemic health conditions. Poor oral health is largely preventable through proactive oral care support. In recent years, social care provision for adults has changed, with deinstitutionalisation and home-based personalised care now being the typical provision in high income countries. Hence, oral health inequalities might be reducing. However, there is limited recent evidence-synthesis on the topic. We aimed to address this.

METHOD

PROSPERO registration number: CRD42018089880. We conducted a preferred reporting items for systematic reviews and meta-analyses systematic review of publications since 2008. Four databases were searched with a clear search strategy, strict inclusion criteria for selection of papers, double scoring (two raters), systematic data extraction and quality appraisal of included papers.

RESULTS

A total of 33/3958 retrieved articles were included, of which 14 were drawn from dental service users and 10 from Special Olympic athletes, therefore not necessarily being representative of the wider population with intellectual disabilities. Despite this limitation, adults with intellectual disabilities were still shown to experience poor oral health. High levels of poor oral hygiene and gingivitis were found, with many also affected by periodontitis and untreated dental decay. There is clear unmet need relating to both periodontal (gum) and tooth health, leading to tooth loss.

CONCLUSIONS

Despite reports in the past of poor oral health amongst adults with intellectual disabilities, and despite it being preventable, there remains a high burden of poor oral health. This highlights the need to raise awareness, and for polices on effective daily oral care, and appropriate service provision. The importance of oral health and its possible negative sequelae needs to be elevated amongst carers and professionals.

Syphilitic Cervicitis with Cervical Cancer Presenting as Oropharyngeal Syphilis

We herein report a patient with syphilitic cervicitis and cervical cancer presenting as oropharyngeal syphilis. A 31-year-old Japanese woman with a history of unprotected vaginal and oral sex visited our hospital with right submandibular adenomas and erythema in the extremities. The fornix uteri was red, with a nodule noted. The rapid plasma reagin ratio was 1:3. She was diagnosed with syphilitic cervicitis and treated with amoxicillin for four weeks. Initial cervical cytology showed cells with mild nuclear enlargement, which was thought to be metaplasia associated with syphilis. Repeated cytology a month later showed a high-grade squamous intraepithelial lesion. A punch biopsy of the lesion led to the pathological diagnosis of cervical carcinoma in situ. We performed cervical conization, and no recurrence occurred. Human papillomavirus (HPV) immunostaining was positive in the lesion. Mucosal lesions are an infrequently reported symptom of syphilis. When oropharyngeal lesions are found, the sexual history should be ascertained, and the patient should be screened for sexually transmitted diseases. HPV is especially significant because of its association with cervical cancer. Coinfection of HPV with cervical cancer must be ruled out during follow-up for women when oropharyngeal syphilis involves genital lesions.

Oral diseases: a global public health challenge

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

Oral health practitioners routinely perform oral health assessments for the dental patient to determine if oral disease is present. Systemic health is often a contributor to oral health concerns. One area in particular that has a direct effect on oral structures and oral health is poor sleep quality and open mouth breathing. Sleep is a fundamental process of the human body, which regulates core biological functions. Sleep quality reflects a person's ability to fall asleep, stay asleep, and enter into the various rejuvenating sleep cycles for the full duration. A person who does not obtain quality sleep can exhibit a wide range of oral, systemic, and cognitive health problems. Obstructive sleep apnea, which historically has been considered an adult male disease, is being recognized more often in women children. Research suggests various oral malformations found in newborns and young children can manifest as obstructive sleep apnea in adults. Oral health professionals are in a position to recognize the relationship between sleep and health, identify sleep quality concerns in relation to oral health assessments, administer sleep quality assessments, and determine appropriate referrals for further sleep quality evaluation.

Systemic sclerosis and its oral health implications

Systemic sclerosis (SSc) is a chronic, generalized disorder of the connective tissue. It is characterized by immune disorders, abnormalities of morphology and functions of small blood vessels, and the presence of inflammatory process. The pathogenesis of this disorder has not yet been fully understood. The classification criteria were established by The American College of Rheumatology (ACR). A number of clinical types are distinguished due to the diversity of the clinical picture. These types are characterized by a different course, presence of organ complications and prognosis. Connective tissue disorders are interdisciplinary conditions and, therefore, the subject of interest of different medical specialties, including dentistry. The oral cavity may be the place of pathological manifestations within soft and hard tissues. Such manifestations are the results or the primary symptom of systemic diseases. The relationship between the health of the oral cavity and systemic diseases has been frequently reported in the literature. Lesions in the oral cavity in patients with SSc are discussed in detail in the present paper. Management includes the administration of drugs that prevent tissue ischemia and post-ischemic consequences as well as drugs that inhibit inflammatory-immune processes and excessive collagen production.

Oral diseases in diabetic patients

In this paper, the authors summarize current findings on the relationship between diabetes mellitus (DM) and oral tissue diseases. They study the effect of diabetes on the condition of hard dental tissues, oral mucosa and salivary glands and explain how these undesirable changes occur. They focus primarily on the bilateral relationship between diabetes and periodontitis, common pathogenetic traits of both diseases and on the effect of periodontal treatment on basic metabolic diseases. They show that diabetes not only negatively affects the condition of periodontal tissues, but inflammatory disease of periodontium is also a risk factor for hyperglycemia. The authors point to the emerging closer co-operation between diabetologists and parodontologists (Perio-Diabetes Workshop in 2017) and consider possibilities of effective prevention and better motivation of diabetics for oral health care.

Incidental finding of subgemmal neurogenous plaque upon retrospective evaluation of oral lymphoepithelial cysts

PURPOSE

We aimed to compare the histomorphological features of oral lymphoepithelial cysts (OLC) in different locations of the oral cavity and to verify the association between oral lymphoepithelial cysts and subgemmal neurogenous plaque (SNP) on biopsies from the lateral border of the tongue.

METHODS

All cases diagnosed as OLC from the Oral Pathology Service at the School of Dentistry/University of São Paulo were retrieved. For all the cysts located in the tongue, their association to SNP was analyzed. Immunohistochemical staining against S100 was performed to confirm the diagnosis of SNP.

RESULTS

Thirty-one cases were selected for morphological analysis and SNP was identified in 40% of cases, all of them positive for S100. In these cases, macroscopic analysis demonstrated two independent fragments. Microscopic analysis showed that cysts located in the floor of the mouth and ventral surface of the tongue showed less intense exocytosis, less formation of lymphoid follicles, and predominantly a moderate inflammatory infiltrate.

CONCLUSIONS

OLC have a similar histological pattern regardless the location within the oral cavity and. In some cases, the biopsy specimen may be accompanied by a SNP as an adjacent independent structure.

Oral Health-A Neglected Aspect of Subjective Well-Being in Later Life

Objectives

This study examined whether oral health is a neglected aspect of subjective well-being (SWB) among older adults. The key research question was whether deterioration in oral health among dentate older adults living in England was associated with decreases in SWB, using measures of eudemonic, evaluative, and affective dimensions of well-being.

Methods

This secondary analysis used data from the third (2006-2007) and fifth (2010-2011) waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (ELSA). We fitted multivariable regression models to examine the effects of changes in oral impacts on daily life and edentulism (complete tooth loss) on SWB (quality of life, life satisfaction, and depressive symptomatology).

Results

A worsening in both oral health measures was associated with an increase in depressive symptoms even after adjusting for time-varying confounders including declining health, activities of daily living, and reduced social support. Becoming edentate was also associated with decreases in quality of life and life satisfaction.

Discussion

A deterioration in oral health and oral health-related quality of life increases the risk of depressive symptoms among older adults and highlights the importance of oral health as a determinant of subjective well-being in later life.

Oral Health among Patients with Bipolar Disorder

PURPOSE

To compare the oral health of patients with bipolar disorder (BD) with a control group of subjects.

MATERIALS AND METHODS

The study sample comprised 242 patients with BD and a mean age of 35.8 years. The control group comprised 187 subjects and a mean age of 37.3 years. Oral health was assessed through clinical examination by the Decayed, Missing, and Filled Teeth (DMFT) Index, the Community Periodontal Index (CPI), and the Simplified Oral Hygiene Index (OHI-S).

RESULTS

Patients with BD had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than control group subjects. The average DMFT index score was 10.0 (SD = 5.7) in the BD group and 8.1 (SD = 5.2) in the control group (p = 0.002). The mean value of decayed teeth in patients with BD (4.5) was significantly higher than that of the control group (2.3) (p < 0.001). Periodontal diseases were significantly more prevalent among patients with BD (p < 0.001), particularly regarding shallow and deep pockets (47.1% vs. 16.6%). Oral dryness (xerostomia) and severe tooth wear were also more prevalent among patients with BD (p < 0.001). Statistically significant risk factors for higher DMFT scores were: older age and having BD; CPI scores of 3 or 4; having BD, male gender, older age, and lower educational level.

CONCLUSION

Poorer oral health among patients with BD is represented mostly as caries and advanced periodontal disease. The results of this study highlight the necessity to intensify preventive dentistry in this vulnerable population.

Oral verruciform xanthoma and erythroplakia associated with chronic graft-versus-host disease: a rare case report and review of the literature

BACKGROUND

Oral verruciform xanthoma is an uncommon benign lesion. Although oral verruciform xanthoma occurs in healthy individuals, it has been also reported in association with some inflammatory conditions. The aim of this study is to report a case of oral verruciform xanthoma associated with chronic graft-versus-host disease and to review the literature on this topic.

CASE PRESENTATION

A 47-year-old Caucasian male presented to the Sector of Oral Medicine "V. Margiotta", University Policlinic "P. Giaccone" of Palermo complaining of a mass on the gingiva. He first noticed the painless mass 1 year ago. He reported to have undergone allogenic hematopoietic stem cell transplantation 15 years ago for acute lymphoblastic leukaemia. Intraoral examination revealed a well-circumscribed, sessile yellowish and verrucous nodule upon canine, multiple yellowish and verrucous nodules on the hard palate, yellowish and verrucous nodules on left buccal mucosa. In addiction an area of white striae in a reticular pattern with erythema and ulceration was present on the dorsum of the tongue. This lesion was consistent with a known history of oral chronic graft versus host disease. Moreover, we observed a suspected area of oral erythroplakia yet on the dorsum of the tongue. In biopsy specimen of hard palate histopathological examination revealed a diagnosis of verrucous xanthoma of the oral cavity; in addiction in biopsy specimen of the dorsum of the tongue revealed the presence of erythroplakia with high grade dysplasia.

CONCLUSION

Verruciform xanthoma of the oral cavity associated with chronic graft-versus-host disease is a rare condition with a usually benign clinical course but malignant transformation has been described in association with oral potential malignant disorder (e.g. chronic graft versus host disease, erythroplakia). Very rare cases showed association with oral chronic graft versus-host-disease. To date, only eight cases were published in the world literature. Therefore it could be important follow up patients also for oral verruciform xanthoma onset.

[Laugier-Hunziker syndrome in a patient with Sjögren’s syndrome: Report of one case]

Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögren’s syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.

Role of Oral Microbial Infections in Oral Cancer

The role of bacterial and viral carcinogenesis in the oral cavity is increasingly of interest, as a means to provide more methods of cancer prevention. There may be relationships between bacteria and multiple strains of viruses in the progression of malignancy. Cancer cause is closely related to the type of carcinogen, as well as the synergistic or additive actions of combined risk factors, the susceptibility of the host, and duration of interaction between host and exposure to risk factor. Much research is underway to further define the role of microbial and bacterial agents in the progression of malignancy.

Septic Cerebral Venosinus Thrombosis Secondary to an Odontogenic Infection

BACKGROUND

Cerebral venosinus thrombosis (CVT); is an uncommon, potentially fatal disease that is more common in young adults and children. Thrombophilia, elevated estrogenic states, and infections are the most common risk factors in patients who develop CVT.

CASE

A 69-year-old man with a right-sided odontogenic infection presented with fever, headache, opthalmoplegia, and periorbital swelling. Imaging revealed evidence of meningitis and thrombosis of bilateral ophthalmic veins, the cavernous sinus, right internal jugular vein, and sigmoid sinus. The patient was treated with empiric antibiotic therapy and unfractionated heparin. He recovered with only mild impairment in right eye abduction.

DISCUSSION

Early diagnosis and prompt treatment of CVT is vital in reducing the associated morbidity and mortality. Unfractionated or low molecular weight heparin may be safely used in CVT patients. Thrombolytic therapy is an option in clinically severe cases. Treatment also includes addressing the underlying cause and management of early complications.

Oral manifestations of gastrointestinal diseases in children. Part 4: Coeliac disease

Alterations within the oral cavity can be the first sign of systemic diseases and may thus allow for an early diagnosis and treatment. In particular, being the oral cavity part of the gastrointestinal system, oral alterations can be an expression of a gastrointestinal disease. Dental enamel hypoplasia and aphthous ulcers have been found to be more common in children with coeliac disease compared with the general population and to regress after the patient is started on a gluten free-diet. A prompt recognition of systemic diseases through a careful examination of the oral cavity could allow the child to have appropriate investigations and to be treated in a timely fashion.

Oral Lesions in HIV Infection in Developing Countries: an Overview

HIV infection is a major global health problem affecting developing and developed countries alike. Oral lesions that are associated with this disease are important, since they affect the quality of life of the patient and are useful markers of disease progression and immunosuppression. Oral lesions in HIV infection have been well-documented in developed countries, but there are fewer reports on oral lesions from developing countries. Oral candidiasis is the most common opportunistic infection seen in all continents. Kaposi’s sarcoma has been reported only from Africa and Latin America, while histoplasmosis and penicilliosis were reported in patients with advanced disease from Thailand. HIV-associated salivary gland disease has a high prevalence in Africa and Latin America, especially in the pediatric group. It is clear that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. Well-designed and -documented studies are necessary for the correct assessment of the nature and magnitude of the problem in developing countries, if oral health measures are to be effectively formulated for the HIV-infected.

Implications of HIV Disease for Oral Health Services

This paper, by means of a quality framework, reviews health services research in relation to people with HIV infection. The relevance of oral health care services to people’s needs is considered in terms of the goal of health services to reduce the burden of disease on the everyday life of the population. Dental services may therefore have a role in primary prevention in the HIV epidemic, passing on information about HIV and promoting health through the early diagnosis and treatment of oral disease. Effectiveness research of oral health care in HIV assesses the usefulness of oral diagnosis, whether care is safe, and whether treatment is clinically effective. Few data are available on the efficiency of services. People with HIV still have problems accessing dental care, due to the volume of care available in relation to their need and acceptability of care. Access problems in the US are compounded by social inequality. Health services research data are particularly sparse in resource-poor countries, and there is a need to translate the available information into treatment guidelines appropriate to these settings. The research community and funding agencies should place greater emphasis on the quality of oral health services for people with HIV.

(A1) Identification of Oral Health Care Needs in Children and Adults, Management of Oral Diseases

The workshop considered five questions reviewing the identification of international oral health care needs of children and adults, and the management of oral diseases in resource-poor countries: (1) What is the role of the dental profession in the management of the HIV-infected individual? (2) Identifying health care needs-What are the epidemiology and disparities of HIV-associated oral lesions in children from different continents? (3) How effective is HIV treatment in controlling oral diseases? (4) Could we develop basic inexpensive oral and dental care protocols for economically deprived HIV-infected patients? and (5) What is the best method of arranging resources to meet the oral health care needs of people with HIV disease? The consensus of the workshop participants was that there is a need to re-target research efforts to non-established market economy countries and prioritize research in these regions to children with HIV disease. It will be important to assess commonalities and variations in oral health needs across geographical and cultural boundaries, and research efforts should be centralized in resource-poor countries to support multi-center longitudinal standardized studies. It is essential that oral health research be integrated into other health care research programs, to make these research priorities and public health initiatives feasible.

(B3) Markers of Immunodeficiency and Mechanisms of HAART Therapy on Oral Lesions

Highly active anti-retroviral therapy (HAART) has revolutionized the treatment and prognosis of HIV disease and AIDS in those who can take advantage of the treatment. There are currently 20 different anti-retroviral drugs in 4 different classes that are used in specific combinations. Suppression of HIV replication and immune reconstitution are goals of therapy. Since the prevalence of some easily detectable oral manifestations of HIV/AIDS (OMHIV/AIDS) decreases with HAART, it has been suggested that they might be clinically useful surrogate markers of HAART efficacy and immune status. This might be particularly useful if their recurrence presaged or accompanied HAART failure. To date, there has been little work in this area, but its potential value to the clinical management of HIV/AIDS is apparent, especially if frequent measures of viral load and CD4 cell counts are not readily available. However, the usefulness of OMHIV/AIDS as signals for HAART failure is complicated by three phenomena: the immune reconstitution syndrome, the similarity of some adverse reactions of HAART to OMHIV/AIDS, and the direct inhibitory effect of HAART medications on some OMHIV/AIDS ( e.g., inhibition of oral candidosis by protease inhibitors). This workshop considered the current evidence and proposed pertinent research questions.

Cytomegalovirus Co-infection in AIDS-associated Oral Kaposi’s Sarcoma

The increasing appearance of AIDS-associated oral Kaposi’s sarcoma (KS) in South Africa may be ascribed to the later start of the HIV epidemic, more patients reaching stages III and IV, and the inaccessibility of most patients to anti-retroviral therapy. The objective of this study was to demonstrate cytomegalovirus (CMV) co-infection in oral KS and to consider its possible significance. We reviewed 20 cases of oral KS in known HIV-positive patients without active CMV disease. HHV8 PCR and CMV immunohistochemistry were performed. HHV8 DNA was present in all cases. CMV inclusions were detected in five cases. The significance of CMV co-infection in oral KS is unclear. The inclusions suggest active infection, although there is no evidence to support CMV in the pathogenesis of KS. Nonetheless, it is vital that physicians be alerted to active CMV infection, so that timely intervention and careful observation can be instituted, ensuring early diagnosis and treatment.

Oral Lesions of HIV Disease and HAART in Industrialized Countries

The epidemiology of HIV-related oral disease in industrialized nations has evolved following the initial manifestations described in 1982. Studies from both the Americas and Europe report a decreased frequency of HIV-related oral manifestations of 10–50% following the introduction of HAART (highly active antiretroviral therapy). Evidence suggests that HAART plays an important role in controlling the occurrence of oral candidosis. The effect of HAART on reducing the incidence of oral lesions, other than oral candidosis, does not appear as significant, possibly as a result of low lesion prevalence in industrialized countries. In contrast to other oral manifestations of HIV, an increased prevalence of oral warts in patients on HAART has been reported from the USA and the UK. HIV-related salivary gland disease may show a trend of rising prevalence in the USA and Europe. The re-emergence of HIV-related oral disease may be indicative of failing therapy. A range of orofacial iatrogenic consequences of HAART has been reported, and it is often difficult to distinguish between true HIV-related oral disease manifestations and the adverse effects of HAART. A possible association between an increased risk of oral squamous cell carcinoma and HIV infection has been suggested by at least three epidemiological studies, with reference to the lip and tongue. These substantial and intensive research efforts directed toward enhancing knowledge regarding the orofacial consequences of HIV infection in the industrialized nations require dissemination in the wider health care environment.

Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up

Dens invaginatus (dens in dente) is a developmental malformation of permanent or deciduous teeth that has various complex forms. It most commonly affects permanent maxillary lateral incisor teeth, and rarely affects the mandibular teeth. In this report, a rare case of dens invaginatus of a mandibular lateral tooth with an extraoral fistula is presented. A 10-year-old patient was referred to our clinic with extraoral symptoms that could not be diagnosed by medical doctors. Successful treatment with endodontic treatment and periapical surgery is described. Seven-year follow-up of the case is provided.

Oral manifestations of gastrointestinal diseases in children. Part 2: Crohn's disease

Alterations within the oral cavity can be the first sign of systemic diseases and may thus allow for an early diagnosis and treatment. In particular, being the oral cavity a part of the gastrointestinal system, oral alterations can be an expression of a gastrointestinal disease. Diffuse mucosal swelling, cobblestone mucosa, localised mucogingivitis, deep linear ulceration, fibrous tissue tags, polyps, nodules, pyostomatitis vegetans, and aphthous-like ulcers have been described in Crohn's disease. A prompt recognition of systemic diseases through a careful examination of the oral cavity allows for proper investigations and timely treatment.

Human Papillomavirus Infection in Oral Cavity and Oropharyngeal Cancers: Are They the Same Story?

BACKGROUND

Nowadays, human papillomavirus (HPV) infection becomes the main risk factor for head and neck cancer development. In Thailand, the related role of this viral infection to head and neck cancer is still unknown and not well established.

OBJECTIVE

To identify different characteristics of oral cavity and oropharyngeal cancer, and to determine the HPV-associated prevalence of these two tumor types in Thailand, which is unlike the Western countries.

MATERIAL AND METHOD

Between 2010 and 2012, a cross-sectional study was performed in 23 oral cavity and 23 oropharyngeal cancer patients. HPV genome was studied in all of them from pathological confirmed fresh specimens. Risks of HPV infection were collected using self-reported questionnaire.

RESULTS

The prevalence of HPV-related oropharyngeal cancer was significantly noted in 26.09% (p = 0.009), while no demonstrable HPV-associated prevalence in oral cavity cancer. In addition, the routes of HPV infection were not identifiable.

CONCLUSION

Oral cavity and oropharygeal cancers are not only anatomically distinct, but also greatly differed in their characteristics and pathophysiology. The percentage of HPV-related tumors in Thailand is considerably low when compared to the Western countries. However, the impact on treatment modification cannot yet be universally applied.

Oral Health and Hospital-Acquired Pneumonia in Elderly Patients: A Review of the Literature

The U.S. spends an average of $6.5 billion each year to treat patients who suffer from pneumonia. Pneumonia currently has the highest morbidity and mortality rates of all nosocomial infections, is hypothesized to account for 15% of all hospital-acquired illnesses and is responsible for 13 to 48% of all nursing home-associated illnesses. For years, researchers have tried to develop methods to prevent pneumonia because of its detrimental effects on the body, but only in the last decade have they been able to uncover possible methods to do so. Inadequate oral hygiene care is one of the ways that elderly patients contract hospital-acquired pneumonia (HAP). Proper oral disease prevention could possibly be considered the standard of care in long-term stay facilities to reduce and prevent elderly patients from contracting HAP. The purpose of this literature review is to explore the relationship between oral health care practices and HAP.

Spontaneous Oral Mucosal Bleeding Unmasking Undiagnosed Sarcoidosis: A Case Report

Sarcoidosis is a multisystem, non-caseating, chronic, granulomatous disease affecting any organ. In the head and neck region, salivary glands and lymph nodes are most commonly involved. Oral manifestations are rare but these lesions, occasionally haemorrhagic, may be the first sign of systemic disease. It is important to recognize the oral manifestations of sarcoidosis and to be aware of potential secondary disease-driven processes, such as thrombocytopenia. The purpose of this paper is to present a previously undiagnosed case of sarcoidosis, initially presenting with oral manifestations, including mucosal bleeding, and to review the current literature on oral sarcoidosis. Clinical relevance: Oral lesions can be the first sign of undiagnosed systemic sarcoidosis.

Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports

Inflammatory bowel diseases (IBD) are known as chronic inflammatory disorders of the digestive tract, represented mainly by Crohn's disease (CD) and ulcerative colitis (UC). Among the main oral manifestations of IBD are cobblestoning of the oral mucosa, labial swellings with vertical fissures, pyostomatitis vegetans, angular cheilitis, perioral erythema, and glossitis. In this sense, understanding these nosological entities by dentists would help reach early and differential diagnosis. Thus, two case reports are presented and discussed based on theoretical references obtained by a literature review. The first case report refers to an adult patient whose IBD diagnosis was established after stomatological assessment. The second case was a patient with CD diagnosed in childhood with characteristic oral lesions.

Interdisciplinary nature of oral diseases--clinical implications

Due to the progress in medicine and healthcare as well as the socioeconomic development in industrialised countries we have to deal with the flood of lifestyle diseases. The treatment of such diseases and in particular of complications thereof is the greatest economic burden on contemporary healthcare funding systems. Numerous studies prove the existence of interrelationships and cause-and-effect relationships among oral diseases and systemic illnesses. An analysis of risk factors for the occurrence of numerous systemic illnesses with a society-wide range has shown that the maintenance of oral health is one of essential elements which may considerably influence the modification of treatment outcomes for other general diseases.

An unusual presentation of a lingual dermoid cyst

Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

High Accuracy of Common HIV-Related Oral Disease Diagnoses by Non-Oral Health Specialists in the AIDS Clinical Trial Group

Objective

Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS) like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS.

Methods

A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU) in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta) and Haiti. CTU examiners (non-OHS) received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed.

Results

Among 324 participants, the majority were black (73%), men (66%), and the median CD4+ cell count 138 cells/mm³. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC) was detected in 153 (47%) by OHS, with erythematous candidiasis (EC) the most common type (39%) followed by pseudomembranous candidiasis (PC; 26%). The highest prevalence of OC (79%) was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm³ and HIV-1 RNA > 1000 copies/mL (71%). The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%). Sensitivity and specificity were also high for KS (87% and 94%, respectively), but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse) was ≥ 93% for both PC and EC.

Conclusion

Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings, but detection of less common lesions may require OHS.