Association of cheek-biting and depression

OBJECTIVE

To determine the association between cheek-biting and depression in patients visiting dental clinics for routine check-up..

METHODS

The case-control study was conducted at Ameen Medical and Dental Centre, Karachi, from July 2016 to January 2017, and comprised patients coming for routine dental check-up with complaint of pain and burning in oral cavity. The subjects were divided into two equal groups of cases with cheek-biting and controls without cheekbiting. Data was collected with the help of a self-administered questionnaire and depression was assessed using the Patient Health Questionnaire-9scale. Those with score>19 were labelled as depressed. Data was analysed using Stata 11.

RESULTS

There were 70 subjects in two groups of 35(50%) cases and as many controls. The mean age for the cases was 32.86}12.68 years and for the controls it was 34.23}14.47 years. Among the cases, there were 23(65.7%) females and there were 19(54.3%) among the control. Multivariate logistic regression showed depression was significantly associated with cheek-biting (p<0.05).

CONCLUSIONS

Depression and cheek-biting were found to be significantly associated.

Current Understanding of the Pathophysiology of Osteonecrosis of the Jaw

PURPOSE OF REVIEW

Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ.

RECENT FINDINGS

The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.

Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma

INTRODUCTION

The knowledge of the anatomy surrounding Bichat's fat pad, as well as its clinical applications, is essential to indicate and to safely perform its removal. This surgery is indicated not only for esthetic purposes, but also for functional reasons. When used properly, Bichat's fat pad is composed of stem cells that have a similar phenotype to adipose stem cells, useful in the treatment of pathologies and/or complications, such as maxillary sinus membrane perforation, oroantral/oronasal communications, peri-implantitis, ulcers, fibrosis of the oral mucosa, soft tissue reconstruction, among others. Due to its location, it is prone to suffer clinically significant pathologies, as well as constant trauma.

AIM

The aim of this study is to report two clinical cases and subsequent follow-ups, where bichectomy was performed to avoid dental trauma to mucosal tissues during the masticatory function. Also, literature review on the application of Bichat's fat pad in dentistry is provided.

CASE REPORT

Two female patients (20 and 24 years) reported discomfort and constant pain in the oral mucosa caused by dental trauma. At the clinical examination, patient presented augmented and injured mucosa. The surgical sequence of Bichat's fat pad removal, as well as the extra-/intraoral photographic follow-up (8, 15, 30, and 180 days) of the patients is described.

CONCLUSION

In order to indicate and/or accomplish surgical procedures involving Bichat's fat pad, it is fundamental to know its anatomy and possible applications, not only for esthetic purposes, but also for functional purposes. The patients showed evident improvements following the removal of Bichat's fat pad.

CLINICAL SIGNIFICANCE

Application of Bichat's fat and its removal should be evaluated, being an alternative in patients who constantly undergo mucosal injury during masticatory function.

Anti-inflammatory and wound healing effects of an essential oils-based bioadhesive gel after oral mucosa biopsies: preliminary results

Post-operative management of patients receiving oral biopsy includes the control of edema, pain, infection, and re-epithelization at the surgical site. This clinical study investigates the topical use of a bioadhesive gel, containing essential oils, to promote wound healing and prevent post-operative pain and infection, avoiding the need for surgical suture and chlorhexidine applications. Ten patients, who needed to receive oral biopsies (≤6 mm in diameter) for the diagnosis of mucosal oral lesions, were enrolled. The bioadhesive gel successfully controlled the post-surgical pain; at 1-week follow-up visit, no signs of infection nor side effects were reported and the surgical sites were completely healed. The bioadhesive gel resulted in a very promising agent for the post-operative management of oral biopsy site, without the need for surgical suture and chlorhexidine applications.

Incidental finding of upper lip Warthin tumor

AIM

This report shows an incidental finding of Warthin tumor in upper lip mucosa during hospitalization for a biting lesion of cheek mucosa MATERIALS AND METHODS: A 32-year-old male affected by a biting lesion of cheek mucosa was presented at Maxillo- Facial Unit of Federico II University. Clinical examination showed as an incidental finding a solid mass in the superficial layer of upper lip mucosa. We performed mini-invasive surgical treatment to obtain a radical excision of the cheek lesion at the same time as excision of Warthin tumor.

RESULTS

a follow up of 12 months was performed. The complete healing of the two wounds was achieved, with no recurrence of any of the pathologies.

DISCUSSION

The location of this Warthin tumor of minor salivary glands is very unusual. The role of imaging in diagnosis of Warthin tumor of minor salivary glands is to define localization, shape and dimension, contour, malignant features, nodal involvement. The role of fine needle aspiration cytology (FNAC) is critical in the diagnosis and therapy of minor salivary gland tumors. The surgical treatment in patients affected by Warthin tumour of minor salivary glands is local excision with a wide tumor free margin to prevent potential recurrence.

CONCLUSIONS

Warthin tumor of minor salivary glands is a rare disease. We report a singular case of Warthin tumor localized in the upper lip mucosa, found as an incidental finding during a recovery for a biting lesion of cheek mucosa.

KEY WORDS

Incidental finding, Minor salivary glands, Warthin tumor.

A treatment algorithm for the management of intraoral burns: A narrative review

Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm. The algorithm was initially subdivided into the four primary etiologies of intraoral burns - thermogenic, cryogenic, chemical, electrical. Our findings emphasize the importance of conservative modalities of intra-oral burn treatment.

[Comparison of two shaping methods for double-lumen endotracheal tube intubation by Shikani optical stylet laryngoscope]

OBJECTIVE

To compare the efficacy and safety of two different shaping methods for double-lumen endotracheal tube (DLT).DLT was shaped with the rod of a Shikani optical stylet (SOS) with the tracheal orifice aligned with the convex aspect of the distal curvature or the concave aspect of the distal curvature.

METHODS

Patients scheduled for elective thoracic surgery and required intubation with a left-sided DLT were enrolled in this study. They were randomized into two groups. They were intubated with a DLT, which was shaped with the rod of a SOS with its tracheal orifice aligned with the convex aspect of the distal curvature (group T) or the concave aspect of the distal curvature (group U). Time for SOS manipulation, intubation attempts, intubation resistance score, malposition of bronchial intubation, time for fiberoptic bronchoscope (FOB) identification of bronchial placement, total intubation time and oral mucosal or dental injury were recorded. Hoarseness and throat sore of the patients were evaluated 1 hour and 24 hours after surgery.

RESULTS

A total of 136 patients completed the study, with 68 in each group. Time for SOS manipulation was significantly shorter in group U [(35.1±6.1) s vs. 39.6±11.8) s, P=0.007]. First attempt success rate did not differ between the groups (92.6% vs.88.2%, P=0.561). Intubation resistance score was significantly lower in group U. Group T had fewer patients who suffered malposition of bronchial intubation than group U (4 vs.13, P=0.020) and cost less time for FOB identification of bronchial placement [(44.1±20.9) s vs.(53.6±29.2) s, P=0.032]. Total intubation time and the incidence of oral mucosal or dental injury did not differ between the groups. The severity and incidence of hoarseness were lower in group U than in group T 1 hour after surgery. The severity and incidence of sore throat were lower in group U than in group T 1 hour and 24 hours postoperatively.

CONCLUSION

When lacing a left-sided DLT using a SOS, shaping the DLT with the tracheal orifice aligned with the concave aspect of the distal curvature saves SOS manipulation time, decreases the severity and incidence of postoperative hoarseness and sore throat. However, this modified shaping method increases the incidence of malposition of bronchial intubation and time for FOB identification of bronchial placement.

Distinct Patterns of Angiogenesis in Oral and Skin Wounds

Clinical observation suggests that oral mucosal wounds heal faster than skin; however, little is known about the site-specific differences. Since fetal skin wounds heal rapidly, but are less vascular than adult wounds, we hypothesized that less robust wound angiogenesis might be observed in healing oral mucosa. This study investigated angiogenesis in equivalent-size oral and skin murine wounds. Change in wound bed vascularity was significantly lower in oral wounds than in skin. Also, vascular endothelial growth factor (VEGF) levels were less in oral than cutaneous wounds. Because keratinocytes are a prominent source of VEGF in wounds, we compared VEGF production by oral and epidermal keratinocytes in vitro. Significantly higher levels of VEGF protein and mRNA were observed in epidermal keratinocytes than in oral keratinocytes after 18 hrs of hypoxia. This study demonstrates distinct angiogenesis patterns in oral and skin wounds and intrinsic site-specific differences in VEGF production by keratinocytes.

HMGB1 Promotes Intraoral Palatal Wound Healing through RAGE-Dependent Mechanisms

High mobility group box 1 (HMGB1) is tightly connected to the process of tissue organization upon tissue injury. Here we show that HMGB1 controls epithelium and connective tissue regeneration both in vivo and in vitro during palatal wound healing. Heterozygous HMGB1 (Hmgb1^+/-) mice and Wild-type (WT) mice were subjected to palatal injury. Maxillary tissues were stained with Mallory Azan or immunostained with anti-HMGB1, anti-proliferating cell nuclear antigen (PCNA), anti-nuclear factor-κB (NF-κB) p50 and anti-vascular endothelial growth factor (VEGF) antibodies. Palatal gingival explants were cultured with recombinant HMGB1 (rHMGB1) co-treated with siRNA targeting receptor for advanced glycation end products (RAGEs) for cell migration and PCNA expression analysis. Measurement of the wound area showed differences between Hmgb1^+/- and WT mice on Day 3 after wounding. Mallory Azan staining showed densely packed of collagen fibers in WT mice, whereas in Hmgb1^+/- mice weave-like pattern of low density collagen bundles were present. At three and seven days post-surgery, PCNA, NF-κB p50 and VEGF positive keratinocytes of WT mice were greater than that of Hmgb1^+/- mice. Knockdown of RAGE prevents the effect of rHMGB1-induced cell migration and PCNA expression in gingival cell cultures. The data suggest that HMGB1/RAGE axis has crucial roles in palatal wound healing.

The practical evaluation and management of patients with symptoms of a sore burning mouth

There are many etiologic factors to consider in a patient who presents with symptoms or sensations of a sore burning mouth. These range from local causes within the oral cavity to underlying systemic disease, including psychologic factors. This paper aims to describe the different clinical presentations and to outline a systematic approach to the evaluation and management of such patients. The clinician will be directed to the relevant diagnosis by following the traditional medical model of taking a focused history, performing a thorough clinical examination, considering the potential differential diagnoses, and requesting pertinent and appropriate investigations. The various differential diagnoses and broad treatment options will also be discussed and outlined. This paper will not, however, discuss burning mouth syndrome (oral dysesthesia), which is a diagnosis of exclusion, whereby the oral mucosa is clinically normal and there are no identifiable medical or dental causes to account for the patient's symptoms.

Clinical-pathological study of the healing of wounds provoked on the dorso-lingual mucosa in 186 albino rats

OBJECTIVE: To evaluate wound healing of incisions created in the upper aerodigestive tract.

STUDY DESIGN AND SETTING: In this prospective and blind study, 186 adult rats were assigned to six groups to create incisions in the tongue. In the first three groups, the wounds were made with a steel scalpel; no substance was applied to the wound in the first group, but N-butyl-2-cyanoacrylate was applied in the second group, and trichloroacetic acid at 50 percent in the third group. In the fourth, fifth, and sixth groups, the wounds were caused by cryosurgery, electrocautery, and CO2 laser. Hemostasis, postoperative oral intake, and wound healing were measured. Statistical analysis was performed with analysis of variance.

RESULTS: The wounds to which N-butyl-2-cyanoacrylate was applied showed no hemorrhaging and faster reepithelialization and resolution of the inflammatory response.

CONCLUSIONS: N-butyl-2-cyanoacrylate is a good hemo-static for managing wounds in the oral mucosa provoked by steel scalpel.

© 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Traumatic Herniation of the Buccal Fat Pad Into the Oral Cavity of a 3.5-Year-Old Boy: A Case Report

The buccal fat pad represents a specialized type of tissue that is distinct from subcutaneous fat. Its primary function is to serve as a cushioning tissue and as a sucking pad. In this case report, we present an interesting lesion and its management, wherein a tiny traumatic perforation of the buccal mucosa caused a large portion of the buccal fat pad to extrude into the oral cavity.

[Comparison of Shikani optical stylet and Macintosh laryngoscope for double-lumen endotracheal tube intubation]

OBJECTIVE

To compare the efficacy and safety of Shikani (S)optical stylet and Macintosh(M) laryngoscope for double-lumen endotracheal tube intubation.

METHODS

In the study, 60 patients undergoing elective thoracic surgery were randomly allocated to group S(n=30) and group M (n=30). After general anesthesia induction, the patients in group S and group M were intubated double-lumen endotracheal tube (DLT) by Shikani optical stylet (SOS) and macintosh laryngoscope respectively. Intubation time, intubation attempts, cuff broken and oral mucosal or dental injury were recorded; Blood pressure and heart rate at baseline (T0), at the time of intubaiton onset (T1), 1 minute after intubaiton (T2), 3 minutes after intubation (T3) and 5 minutes after intubation (T3) were also recorded; Hoarseness and throat sore of the patients 24 hours after surgery were evaluated.

RESULTS

The intubaiton time with the SOS was faster than with the Macintosh [(37.4±9.7) s vs. (43.9±13.7) s, P=0.039] and the first attempt success rate (87% vs. 80%, P=0.488) did not differ between the groups; No tube cuff broke in both the groups; Group S had fewer patients who suffered oral mucosal or dental injury than group M (8 vs.2, P=0.038); The blood pressure and heart rate at T0,T1,T2,T3 and T4 did not differ between the groups; Throat sore (7 vs.10, P=0.390) and hoarseness (5 vs.7, P=0.519) incidence did not differ between the groups.

CONCLUSION

By comparison of the Macintosh laryngoscope, the SOS provides faster DLT intubation and causes less oral Mucosal or dental injury.

[BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER]

OBJECTIVE

To investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer.

METHODS

Six patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm x 2.5 cm to 6.5 cm x 3.5 cm and the defect of the neck skin was 5.5 cm x 3.5 cm to 7.5 cm x 5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm x 3.5 cm to 17.0 cm x 5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly.

RESULTS

Cervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck.

CONCLUSION

The bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.

Oral mucosal lesions in Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators

The aim of this cross-sectional study was to evaluate the prevalence of oral mucosal lesions, and their risk indicators in adult Kiriri Indians from Northeast Brazil. Clinical oral examination was performed on a representative sample of 223 Indians (age ≥ 19 years). A systematic evaluation of lips, labial mucosa and sulcus, commissures, buccal mucosa and sulcus, gingiva and alveolar ridge, tongue, floor of the mouth, and soft and hard palate was performed. Bivariate analysis was conducted to assess associations between mucosal conditions and age, gender, income, educational level, diabetic status, and smoking status. Mucosal lesions were found in 50 participants (22.4%). The most prevalent lesions were fistulae (6.2%) and traumatic ulcers (4.48%). Oral mucosal was associated with higher age (≥ 35 years; odds ratio [OR] = 1.99, 95% confidence interval [CI]: 1.05-3.76, P = 0.03) and lower education level (<9 years; OR = 2.13, 95% CI: 0.96-4.71, P = 0.06). Mucosal conditions are prevalent in Kiriri Indians and the presence of mucosal lesions is associated with advanced age and lower education. A public health program aimed at preventing and treating mucosal lesions and targeted toward the high-risk group is vital to improve the oral health status of this population.

Lip buccal mucosa traumatic overgrowth due to sucking habit - a 10-year follow-up of a non-surgical approach: a combination of behavioural and myofunctional therapy

OBJECTIVE

Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention.

MATERIAL AND METHODS

56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space.

RESULT

The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment.

CONCLUSION

Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.

Postdischarge events occurring after pediatric sedation for dentistry

PURPOSE

To investigate postdischarge events occurring in children during the 24 hours following sedation for dentistry.

METHODS

A convenience sample of 50 children undergoing sedation with combinations of midazolam, hydroxyzine, and meperidine were included. Parents received a standardized timesheet to record child's behavior, alertness, activity level, motor imbalance, emesis, and soft tissue trauma every two hours from discharge until bedtime. A questionnaire asked about transportation, supervision, and return to normal activity. Families were telephoned after 24 hours to collect the information.

RESULTS

Sixty-six percent of children slept in the car; of these, 30 percent were supervised by only the driver, and 12 percent were difficult to awaken. Agitation was observed in 22 percent, restlessness in 10 percent, withdrawn behavior in 16 percent, and soft tissue trauma in 18 percent. Motor imbalance was significantly associated with midazolam (P=.002), as was restlessness (P=.004). Eighty-two percent slept between discharge and bedtime, with 16 percent sleeping for greater than four hours. Return to normal activity was greater than four hours in 36 percent, and was inversely correlated with age (P=.02).

CONCLUSIONS

Postdischarge sleepiness, drug-specific motor imbalance, sleep during transit, and recovery times greater than four hours were common and warrant vigilant adult supervision.

Prevalence of oral manifestations in soft tissues during early childhood in Brazilian children

This study aimed at assessing the prevalence of soft tissue oral manifestations in children during early childhood, according to age group, gender, and site in the oral cavity, and at correlating these oral manifestations with systemic alterations. A cross-sectional study was conducted involving 586 children from 0 to 3 years of age (12.4 ± 11.8 months), 316 (53.9%) male and 270 (46.1%) female, in the city of Mauá, SP, Brazil. Examination was performed by a single examiner (Kappa Index = 0.90) according to World Health Organization criteria (WHO, 1997).The prevalence of oral manifestations in the soft tissues of children during early childhood was 34.8%. The age group showing statistical significance was 0-1 months old (56.4%). Epstein's pearls were significantly present (43.2%) in 0-1-month-old babies, and gingivitis in 12-24-month-olds (15.9%). The palate was the most affected region (16.7%). Infectious alterations were the most prevalent systemic alteration (20%). An association was observed between the presence of systemic alterations and the occurrence of oral manifestations. The prevalence of oral manifestations was 34.8%, regardless of gender, and was manifested mostly in 0-1-month-old babies. The palate was the most prevalent region, and the majority of oral manifestations were associated with systemic alterations.

Adolescent patients' experience with the Carriere distalizer appliance

AIM

To examine adolescent patients' experience with the Carriere Distalizer Appliance (CDA) and compare it with that of the Forsus Fatigue Resistant Device (FFRD).

MATERIALS AND METHODS

A survey was administered to 42 patients treated with the CDA and 70 patients treated with the FFRD. Amount of time required to become accustomed to the appliance, how many patients experienced side effects as well as the degree of discomfort were explored.

RESULTS

The overall experience with the device was significantly better for the CDA group than for the FFRD group. Both groups felt that delivery and removal of the appliance was quick and easy, the appliance was noticeable to some extent, and the majority became accustomed to it within two weeks with a maximum of one month. In general, associated discomfort and effects on daily life and activities were less for the CDA group than for the FFRD group. Side effects decreased over time for both groups, often more so for the CDA group. The major side effects experienced by the CDA group were difficulty eating and sore teeth, and these improved significantly over time. Soreness from the appliance rubbing on the cheek or lip was significantly less for the CDA group.

CONCLUSION

The CDA appears to be more comfortable, offers a more positive overall experience, and has fewer negative comfort-related side effects compared to FFRD.

Social isolation impairs oral palatal wound healing in sprague-dawley rats: a role for miR-29 and miR-203 via VEGF suppression

Objective

To investigate the effects of social isolation on oral mucosal healing in rats, and to determine if wound-associated genes and microRNAs (miRNAs) may contribute to this response.

Methods

Rats were group housed or socially isolated for 4 weeks before a 3.5 mm wound was placed on the hard oral palate. Wound closure was assessed daily and tissues were collected for determination of gene expression levels and miRNAs (i.e., miR-29a,b,c and miR-203). The predicted target of these microRNAs (i.e., vascular endothelial growth factor A, VEGFA) was functionally validated.

Results

Social isolation stress delayed the healing process of oral palatal mucosal wounds in rats. Lower mRNA levels of interleukin-1β (IL1β), macrophage inflammatory protein-1α (MIP1α), fibroblast growth factor 7 (FGF7), and VEGFA were found in the biopsied tissues of isolated animals on days 1 and/or 3 post-wounding. Intriguingly, the isolated rats persistently exhibited higher levels of miR-29 family members and miR-203. Our results confirmed that VEGFA is a direct target of these miRNAs, as both miR-29a,c and miR-203 strongly and specifically suppressed endogenous VEGFA expression in vitro.

Conclusions

This study in rats demonstrates for the first time that social isolation delays oral mucosal healing, and suggests a potential role for healing-associated gene and miRNA interactions during this process via modulation of VEGF expression.

Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic

This study sought to identify and quantify complications with local anesthetic administration and reversal on consecutive patients seen for comprehensive dental care in a school-based, portable dental clinic, and includes data on the patients seen by the participating portable dental providers. In 923 dental visits where local anesthetic was administered, a standardized form was used to gain further information and identify any complications; this was accompanied by a questionnaire for the student's teacher, in order to quantify the student's distraction and disruption ratings following the dental visit. After statistical analysis of the 923 consecutive cases, the overall complication rate was 5.3%. All of the complications were considered to be mild or moderate, and there were no severe event reports. The complications encountered most frequently (n = 49) were associated with self-inflicted soft tissue injury. The results of this study indicate that comprehensive care with local anesthesia delivered by a school-based portable dental clinic has a low risk of complications. Whereas safe administration of dental care is achievable with or without phentolamine mesylate as a local anesthetic reversal agent, its use was determined to improve safety outcomes. Three factors appeared to directly increase the incidence of complications: the administration of an inferior alveolar nerve block, attention deficit disorder, and obesity. Teacher evaluations demonstrated that children receiving care by a portable dental team were able to reorient back to classwork and were not disruptive to classmates.

[Denture stomatitis - definition, etiology, classification and treatment]

Denture stomatitis pertains to a number of pathological symptoms in the oral cavity caused by wearing acrylic dentures. Etiological factors include: mucosal trauma, fungal infection and accumulation of denture plaque. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms. Early diagnosis of the lesion is essential to assure rational therapy.

Common experiences of pain in children and adolescents--an exploratory factor analysis of a questionnaire

The aim of the study was to reduce everyday and dental treatment pain items included in the extended Children's Pain Inventory (CPI), used in a prior study on Swedish children and adolescents. Another aim was to, by means of exploratory factor analysis (EFA), expose hitherto undiscovered dimensions of the CPI pain variables and thus to improve the psychometric properties of CPI. As some pain items are relevant merely to some individuals, a new and more useful questionnaire construction would enhance the internal validity of the instrument in observational surveys. EFA was applied on the extended CPI instrument. 368 children, 8-19 years old, had answered a questionnaire comprising 10 dental and 28 everyday pain variables. These pain items were analysed using a series of sequentially implemented EFA. Interpretations and decisions on the final number of the extracted factors was based on accepted principles; Kaiser's Eigenvalue >1 criterion, inspection of the scree plot and the interpretability of the items loading. The factors were orthogonally rotated using the Varimax method to maximize the amount of variance. Of all tested EFA models in the analysis, a two, three, four, and five factor model surfaced. The interpretability of the factors and their items loading were stepwise examined; the items were modulated and the factors re-evaluated. A four factor pain model emerged as the most interpretable, explaining 79% of the total variance depicting Eigenvalues > 1.014. The factors were named indicating the profile of the content: Factor I cutting trauma to skin/mucosal pain, Factor II head/neck pain, Factor III tenderness/blunt trauma pain, Factor IV oral/dental treatment pain.

Saliva and wound healing

Wounds in the oral cavity heal faster and with less scarring than wounds in other parts of the body. One of the factors implicated in this phenomenon is the presence of saliva, which promotes the healing of oral wounds in several ways. Saliva creates a humid environment, which improves the survival and functioning of inflammatory cells that are crucial for wound healing. Furthermore, saliva contains a variety of proteins that play a role in the various stages of the intraoral wound healing. Tissue factor, present in salivary exosomes, accelerates the clotting of blood dramatically. The subsequent proliferation of epithelial cells is promoted by growth factors in saliva, especially epidermal growth factor. The importance of secretory leucocyte protease inhibitor is demonstrated by the observation that in the absence of this salivary protein, oral wound healing is considerably delayed. Members of the salivary histatin family promote wound closure in vitro by enhancing cell spreading and cell migration. Cell proliferation is not enhanced by histatin. Cyclization of histatin increased its biological activity approximately 1,000-fold compared to linear histatin. These studies suggest that histatins could potentially be used for the development of new wound healing medications.

Lateral lower lip piercing--prevalence of associated oral complications: a split-mouth cross-sectional study

OBJECTIVE

To investigate via a split-mouth cross-sectional study the prevalence of gingival recessions associated with lateral lower lip piercing in a population obtained from a nondental setting.

METHOD AND MATERIALS

A split-mouth study was performed in a sample of 47 patients with one lateral lower lip piercing. Teeth in direct contact with the intraoral closure of the stud were defined as test teeth; contralateral teeth were selected as controls. Clinical examination included full-mouth plaque and bleeding indices, probing depth, recession, clinical attachment level, periodontal biotype, evaluation of hard tissues, occlusal trauma, stud characteristics, and mucosal inspection and palpation.

RESULTS

Midbuccal recession was noted in four test teeth compared with one control tooth (8.5% and 2.1%, respectively; P = .250). The canine and first premolars were the most affected. Tooth chipping occurred in one test tooth and no control teeth. Plaque levels were significantly higher in test than control teeth (P < .001).

CONCLUSION

Lateral lower lip piercing is associated with significantly higher plaque accumulation on adjacent teeth. A small percentage of lateral lower lip piercings may cause tooth chipping or buccal recession in adjacent teeth.

Local anesthesia needle breakage in a 5-year-old child during inferior alveolar nerve block with the Vazirani-Akinosi technique

Breakage of a local anesthetic needle in dentistry is a rare but potentially serious event. Here we describe a case of breakage of a hypodermic needle during administration of local anesthesia with a Vazirani-Akinosi mandibular nerve block in a 5-year-old uncooperative patient under moderate sedation with midazolam. The needle was localized using a fluoroscopy device and then removed under general anaesthesia. The postoperative course was unremarkable, without any neurological or vascular deficits.

Characterization of oral ulcer and pathological scar in nude mice model

Ulceration of mouth mucosa is frequently occurs after injuries in oral cavity. Oral ulcers are relatively common and these lesions cause strong pain and discomfort. Frequently, injury of the oral tissues results in abnormal fibroblast activation and keloid formation. This pathological scar formation is often associates with pain and malfunction of the organ. To understand these phenomena and develop effective treatment, reproducible animal models have to be introduced. Athymic nude mice where used to create animal models. 1% HCl acid solution was used for chemical damage of the mucosa tissue. Surgical operation was performed to create traumatic injury in the mouse oral cavity. Tissues were analyzed using immunohistochemistry methods. All of the HCl treated animals developed ulcers on the skin and mucosa of the oral cavity. Most of the mice on the place of surgical wound developed keloid tissue. Mice in which we induced pathological processes of the oral tissue, did not gain body weight. Moreover their mass had tendency to decrease. Hematoxilyn-eosin staining of the ulcerated mice tissues revealed extended coagulation necrosis - covering all tissue layers of the oral cavity. Strong local inflammatory cell infiltration and absence of proliferative cells has been demonstrated in these ulcerated and adjusted oral tissues. Morphological analysis of scar tissue revealed fibrotic hypertrophy of the injured oral tissues in these animals with the expressed infiltration of inflammatory cells. Our animal models reflect morphology of the specific injury and functionally imitate the disease.

Accidental chemical burns of oral mucosa by herbicide

Glyphosate (GlySH) is a broad spectrum, nonselective herbicide, widely used in agriculture. This case report describes a 25-year-old man presenting with extensive chemical burns and ulceration of the oral cavity as a result of accidental exposure to GlySH. This paper aims to illustrate the typical appearance of GlySH related chemical mucosal burn and to demonstrate the severity of the corrosive effect of GlySH which need team approach to prevent unfavorable sequelae such as microstomia.

Oral piercing injuries treated in United States emergency departments, 2002-2008

PURPOSE

The purpose of this study was to report the epidemiology and clinical history of oral piercing injuries presenting to US hospital emergency departments (EDs).

METHODS

A retrospective analysis of oral piercing injuries was performed using patient injury data collected from 2002 through 2008 using the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission. National estimates of ED visits were analyzed by injury type, anatomic site, and mechanism of injury according to age, gender, and race.

RESULTS

An estimated 24,459 oral piercing injuries presented to US EDs during the 7-year period. The male:female ratio for ED visits was 1:2.6. Patients 14- to 22-years-old accounted for 73% of the ED visits. Injuries to the lips (46%), tongue (42%), and teeth (10%) predominated. Infections (42%) and soft tissue puncture wounds (29%) caused injury most commonly. Thirty-nine percent of ED visits resulted from patients' inability to remove mucosally overgrown oral piercings. Hospitalization was rarely required (<1%).

CONCLUSIONS

Oral piercing injuries treated in US hospital emergency departments are most prevalent in teenagers and young adults. National data indicates that dentists working in emergency departments should be prepared to manage oral hard and soft tissue complications caused by oral piercings.

Intraoral chemical burn from use of 3% hydrogen peroxide

Injudicious use of over-the-counter 3% hydrogen peroxide, a relatively potent oxidative agent, can result in a chemical burn to the oral mucosa. This article describes a patient who rinsed with 3% hydrogen peroxide for periods of more than two minutes as a self-prescribed remedy for oral discomfort following seafood ingestion. Subsequently, the patient experienced pain and extensive chemical burns of the sublingual and buccal mucosa and gingiva. In addition, the buccal mucosa underwent necrosis. Prolonged oral mucosal contact with 3% hydrogen peroxide is ill-advised.

Narrow band (light) imaging of oral mucosa in routine dental patients. Part I: Assessment of value in detection of mucosal changes

The purpose of this investigation was to determine the value of adding narrow band (light) imaging (NBI) to the standard oral soft tissue examination process used to detect mucosal change. A total of 620 dental patients who came to the clinic for regular dental evaluation or for treatment of acute dental problems were given a standard oral soft tissue examination by dental students under faculty supervision. The results of the white light examination were recorded after the tissues were examined with NBI, at which point areas with a loss of fluorescence (LOF) were recorded. The nature of the tissue change was classified clinically as normal variation, inflammatory, traumatic, dysplastic, or other, and patients were categorized depending on their clinical findings: normal, need follow-up visit, or immediate biopsy. Risk factors related to oral dysplasia also were recorded. The addition of NBI added between one and two minutes to the examination process. Of the 620 examinations, an area with an LOF suggestive of pathology was detected in 69 subjects (11.1%). After a second immediate evaluation, 28 of the 69 subjects were scheduled for follow-up or biopsy. None of the lesions discovered in these 28 subjects had been detected using standard (white light) examination. Adding NBI to the routine clinical examination resulted in detection of changes not seen with white light examination in 11.1% of patients; of these, a small but important number were found to have otherwise undetected persistent changes representing inflammatory lesions or potentially dangerous oral dysplasia. Adding NBI as an adjunctive diagnostic procedure improved the quality and outcome of the examination process.

[An index for untreated severe caries]

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.

Effect of low-level laser therapy on experimental wounds of hard palate mucosa in mice

Under general anesthesia and sterile conditions, incision wound was induced in the hard palate mucosa of adult male mice. The wounds of groups 1 and 2 were irradiated daily with He-Ne laser at 3 and 7.5 J/cm2 for 120 and 300 s, respectively, while the incision wound of group 3 not exposed served as controls. On day 3 of injury, the laser-treated wounds contained significantly lower neutrophils than the wounds in the control group. By day 7 after injury, the laser-treated wounds contained significantly more fibroblasts and at the same time contained significantly fewer macrophages. In conclusion, an acceleration of the wound healing process of experimental wounds in the hard palate mucosa of mice at low-level laser therapy with a He-Ne laser at energy densities of 3 and 7.5 J/cm2 was observed.

Emergency orthodontic care

Orthodontic appliances or parts of orthodontic appliances have caused problems from less severe like discomfort, ulcers and irritation of lips or cheeks to most severe problems like swallowing or aspiration of appliances or its parts. The type of appliances that have caused problems and their clinical management are discussed. Suggestions are made to try and avoid the problems that were encountered in the literature in patients undergoing orthodontic treatment.

Exploring scarless healing of oral soft tissues

Our research group is comparing clinical, histological and molecular healing profiles of oral and skin wounds using human and pig models. The goal is to determine the molecular cues that lead to scarless healing in the oral mucosa and use that information to develop scar prevention therapies for skin and prevent aberrant wound healing in the oral cavity. Wound healing in human and pig palatal mucosa is almost identical, and scar formation is reduced in oral wounds compared with skin. The striking difference between these tissues is transient and rapidly resolving inflammation in oral wounds compared with long-lasting inflammation in the skin wounds. Currently, we are looking at wound transcriptomes (genes differentially regulated) and proteomes (a set of proteins) to investigate how these wound healing responses in skin and oral mucosa are regulated at the molecular level.

Efficacy of topical 1% lidocaine in the symptomatic treatment of pain associated with oral mucosal trauma or minor oral aphthous ulcer: a randomized, double-blind, placebo-controlled, parallel-group, single-dose study

AIMS

To determine the efficacy in pain reduction of a topical 1% lidocaine compared to a placebo cream in patients with oral mucosal lesions due to trauma or minor oral aphthous ulcer.

METHODS

The design was a double-blind, randomized, placebo-controlled, six-center trial on 59 patients. Pain intensity and relief were measured using a 100-mm visual analog scale (VAS). One-tailed Student t test and ANOVA analyses were used for statistical analyses.

RESULTS

Independent of the pain origin (oral mucosal trauma or minor oral aphthous ulcer), the application of the 1% lidocaine cream led to a mean reduction in VAS pain intensity of 29.4 mm ± 17.0, which was significantly greater than the decrease obtained with the placebo cream. Analysis showed a statistically significant efficacy of the 1% lidocaine cream (P = .0003). Its efficacy was not related to the type of lesion, and no adverse drug reaction, either local or systemic, was reported by any of the patients.

CONCLUSION

A significant reduction in pain intensity occurred after application of 1% lidocaine cream and was significantly greater than that with the placebo cream. Taking into account the study's limitations, this product seems safe to use.

Nd:YAG laser versus traditional scalpel. A preliminary histological analysis of specimens from the human oral mucosa

Hyperplastic fibro-epithelial lesions are the most common tumor-like swellings in the mouth. The neodymium yttrium aluminium garnet (Nd:YAG) laser appears to be useful for the surgical treatment of these lesions. Some controversies of laser surgery concern the accuracy of pathological diagnosis as well as the control of thermal damage on the target tissue. The aim of this study was to establish if the thermal changes induced by the Nd:YAG laser may affect the histopathological diagnosis and the evaluation of the resection margins. Furthermore, we compared the histological features of oral benign fibro-epithelial lesions excised through Nd:YAG laser and traditional scalpel. Twenty-six benign fibro-epithelial oral lesions from 26 patients, localized in the same oral subsites (cheek and buccal mucosa), were collected at the Unit of Oral Pathology and Oral Laser-assisted Surgery of the Academic Hospital of the University of Parma, Italy. Specimens were subclassified into three groups according to the tool used for the surgical excision. Group 1 included six specimens excised through Nd:YAG laser with an output power of 3.5 W and a frequency of 60 Hz (power density 488,281 W/cm2); Group 2 included nine specimens excised through Nd:YAG laser with an output power of 5 W and a frequency of 30 Hz; Group 3 included 11 specimens excised through a Bard-Parker scalpel blade no. 15c. Epithelial changes, connective tissue modifications, presence of vascular modifications, incision morphology and the overall width of tissue modification were evaluated. Differences between specimens removed with two different parameters of Nd:YAG laser were not significant with regard to stromal changes (p=0.4828) and vascular stasis (p=0.2104). Analysis of regularity of incision revealed a difference which was not statistically significant (p=1.000) between group 1 and group 2. Epithelial and stromal changes were significantly more frequent in specimens with a mean size less than 7 mm (p<0.0001). Nd:YAG laser induced serious thermal effects in small specimens (mean size less than 7 mm) independently from the frequency and power employed. The quality of incision was better and the width of overall tissue injuries was less in the specimens obtained with higher frequency and lower power (group 1: Nd:YAG laser at 3.5 W and 60 Hz).

Buccal mucosal lesions caused by the interradicular miniscrew: a preliminary report

PURPOSE

The purposes of this study were to examine the incidence of buccal mucosal lesions and identify factors affecting this complication caused by an interradicular miniscrew used as orthodontic anchorage.

MATERIALS AND METHODS

Data from patients who used the Aarhus screw as orthodontic anchorage in the authors' practice from May 2003 to December 2008 were collected. The factors related to buccal injury during the use of miniscrews were evaluated using the Rank or Fisher exact test. Results were considered significant at P < .05.

RESULTS

In all, 136 Aarhus screws in 54 patients were examined. The overall incidence of buccal lesions caused by interradicular miniscrews was 11.8%. The incidences of trauma were 10.4% in men and 12.5% in women, 9.5% in the maxilla and 12.8% in the mandible, 15.0% in patients with a high mandibular plane angle and 9.2% in patients with an average angle, and 28.1% with a miniscrew insertion angle between 10 and 30 degrees, 8.6% with an insertion angle between 30 and 60 degrees, and 4.4% with an insertion angle between 60 and 80 degrees. There were statistically significant differences according to site of placement (P = .00) and occlusogingival position (P = .00).

CONCLUSIONS

Interradicular miniscrews may be associated with damage to the buccal mucosa. For buccal mucosal lesions caused by interradicular miniscrews, site of placement and occlusogingival position are the major risk factors, and the angle of placement and the mandibular plane angle are secondary risk factors. The patient's sex and the arch in which the screw is placed (maxilla versus mandible) have little effect.

Oral mucositis

Mucosal damage is one of the most common adverse effects of radiotherapy and of cytotoxic therapy for cancer. With prevalence between 10% and 100%, depending of the cytotoxic regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. In this paper we address oral mucositis and discuss its pathobiology, risk factors, impact and management in view of the most recent evidence. Despite of clear progress and the development of clinical guidelines, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.

Detection of vesicant-induced upper airway mucosa damage in the hamster cheek pouch model using optical coherence tomography

Hamster cheek pouches were exposed to 2-chloroethyl ethyl sulfide [CEES, half-mustard gas (HMG)] at a concentration of 0.4, 2.0, or 5.0 mg/ml for 1 or 5 min. Twenty-four hours post-HMG exposure, tissue damage was assessed by both stereomicrography and optical coherence tomography (OCT). Damage that was not visible on gross visual examination was apparent in the OCT images. Tissue changes were found to be dependent on both HMG concentration and exposure time. The submucosal and muscle layers of the cheek pouch tissue showed the greatest amount of structural alteration. Routine light microscope histology was performed to confirm the OCT observations.

CO2 and diode laser for excisional biopsies of oral mucosal lesions. A pilot study evaluating clinical and histopathological parameters

PURPOSE

The present pilot study evaluates the histopathological characteristics and suitability of CO2 and diode lasers for performing excisional biopsies in the buccal mucosa with special emphasis on the extent of the thermal damage zone created.

PATIENTS AND METHODS

15 patients agreed to undergo surgical removal of their fibrous hyperplasias with a laser. These patients were randomly assigned to one diode or two CO2 laser groups. The CO2 laser was used in a continuous wave mode (cw) with a power of 5 W (Watts), and in a pulsed char-free mode (cf). Power settings for the diode laser were 5.12 W in a pulsed mode. The thermal damage zone of the three lasers and intraoperative and postoperative complications were assessed and compared.

RESULTS

The collateral thermal damage zone on the borders of the excisional biopsies was significantly smaller with the CO, laser for both settings tested compared to the diode laser regarding values in pm or histopathological index scores. The only intraoperative complication encountered was bleeding, which had to be controlled with electrocauterization. No postoperative complications occurred in any of the three groups.

CONCLUSIONS

The CO2 laser seems to be appropriate for excisional biopsies of benign oral mucosal lesions. The CO2 laser offers clear advantages in terms of smaller thermal damage zones over the diode laser. More study participants are needed to demonstrate potential differences between the two different CO2 laser settings tested.