Benign oral mucosal lesions: Clinical and pathological findings

Silk Fibroin Microneedles Loaded with Lipopolysaccharide-Pretreated Bone Marrow Mesenchymal Stem Cell-Derived Exosomes for Oral Ulcer Treatment

Oral ulcers, superficial lesions on the surface of the oral mucosa, have a high incidence rate, and their main symptoms include local pain and erosion. Lipopolysaccharide (LPS)-preconditioned bone marrow mesenchymal stem cells and their secreted exosomes (LPS-pre-Exos) have been shown to promote recovery in various inflammatory conditions and wounds. However, studies documenting LPS-pre-Exos as a therapeutic intervention for oral mucosal-like diseases are lacking. In this study, we prepared a silk fibroin microneedle (MN) patch consisting of LPS-pre-Exos and zeolitic imidazolate framework-8 (ZIF-8) that localized at the tip and base, respectively, and used this MN patch for oral ulcer treatment. Upon insertion into the oral mucosa, continuous LPS-pre-Exos release was observed, which promoted macrophage polarization and tissue healing. Additionally, the ZIF-8 framework in the MN patch facilitated the controlled release of Zn2+, which demonstrated potent antimicrobial properties via synergistic effects. The in vitro experimental results showed that the silk fibroin MN patch can continuously release LPS-pre-Exos and Zn2+ for more than 7 days. Thus, the LPS-pre-Exos and ZIF-8-loaded silk fibroin MN patch exhibited good anti-inflammatory and antibacterial properties, promoting oral ulcer healing, and showed good histocompatibility. Hence, it may represent a potentially valuable strategy for facilitating oral ulcer healing.

Knowledge, attitude, and practice of patients with oral diseases toward oral examinations: a cross-sectional survey study

Background

Properly adhering to oral hygiene and medical care is an important public health issue. Several studies examined the knowledge, attitudes, and practices (KAP) toward oral care in various populations and generally reported relatively sufficient knowledge but unfavorable attitudes and poor practice. However, no previous studies have examined the KAP toward oral examinations among Chinese patients with oral diseases. This study aimed to examine the KAP toward oral examinations among patients with oral diseases in China.

Methods

This cross-sectional study was conducted in patients with oral diseases who visited The Affiliated Stomatological Hospital of Tongji University between December 2023 and February 2024. Data collection and KAP scores assessment were performed using a self-designed questionnaire.

Results

A total of 519 valid questionnaires were included, with 292 females. The mean knowledge, attitude, and practice scores were 6.42 ± 2.47 (possible range: 0-9 points), 35.04 ± 5.68 (possible range: 10-50 points), and 16.22 ± 2.05 (possible range: 4-20 points), respectively, indicating sufficient knowledge, positive attitudes, and proactive practice. Pearson's correlation analysis showed that knowledge was positively correlated to attitude (r = 0.468, p < 0.001) and practice (OR = 0.416, p < 0.001). Attitude was positively correlated to the practice (r = 0.503, p < 0.001). Moreover, the structural equation model showed that knowledge influenced attitude (estimate = 1.010, p < 0.001) and practice (estimate = 0.169, p < 0.001). Attitude influenced practice (estimate = 0.122, p < 0.001). The frequency of oral examination per year influenced knowledge (estimate = -0.761, p < 0.001) and practice (estimate = -0.515, p < 0.001). Expenses for oral disease per year influenced attitude (estimate = 0.537, p < 0.001).

Conclusion

Patients with oral disease might have sufficient knowledge, positive attitude, and proactive practice toward oral examinations. Specific knowledge items were identified to require improvements.

An alternative method for esthetic and functional management of oral pyogenic granuloma

BACKGROUND

Pyogenic granulomas (PGs) are gingival enlargements which cause esthetic and functional problems that hinder chewing and maintaining oral hygiene. In this series consisting of six cases, we report the rehabilitation of PG using partly de-epithelialized gingival grafts.

METHODS

Following documentation of clinical measurements, a concurrent treatment plan of excision and reconstruction with partly de-epithelialized gingival grafts were followed for all the cases. Six months following procedures, clinical parameters were measured again and a short patient-reported outcome measures consisting of three questions were applied.

RESULTS

In histological evaluations, PG features were observed. In the fourth postoperative week, interdental papilla and attached gingiva were restored. Six months follow-up showed reduction in plaque and gingival indices, clinical attachment loss, and mobility. Mean keratinized tissue height was increased from 2.58 ± 2.20 to 6.66 ± 1.66 in the 6th month of operation. Oldest case was stable after 12 months of follow-up and no infection was found at grafting sites. Papillary coverage was achieved.

CONCLUSION

If the PG is not completely removed due to esthetic reservations, a recurrence may occur. Within our limitations, we can suggest that the immediate esthetic rehabilitation with partly de-epithelialized gingival graft presents a compatible approach in the treatment of mucogingival defects after aggressive excision of PG.

Cell-penetrating peptides for transmucosal delivery of proteins

Enabling non-invasive delivery of proteins across the mucosal barriers promises improved patient compliance and therapeutic efficacies. Cell-penetrating peptides (CPPs) are emerging as a promising and versatile tool to enhance protein and peptide permeation across various mucosal barriers. This review examines the structural and physicochemical attributes of the nasal, buccal, sublingual, and oral mucosa that hamper macromolecular delivery. Recent development of CPPs for overcoming those mucosal barriers for protein delivery is summarized and analyzed. Perspectives regarding current challenges and future research directions towards improving non-invasive transmucosal delivery of macromolecules for ultimate clinical translation are discussed.

Evaluation of diode laser efficacy in treating benign oral soft tissue masses: A case series

INTRODUCTION AND IMPORTANCE

The diode laser, with a wavelength ranging from 810 to 980 nm, is a modern treatment modality that offers significant advantages in the management of benign oral soft tissue masses. Therefore, this report aimed to assess the efficacy of diode laser application for excisional biopsy of such masses.

CASE PRESENTATION

Three female patients, aged 9, 39, and 45 years, visited the Oral Medicine Clinic with complaints of painless masses in the oral cavity persisting for two to three months. Their intraoral examination showed the presence of pedunculated or sessile exophytic lesions with a smooth surface. The lesions appeared as single, pink to red protrusions located in various sites, including the left buccal mucosa, right lateral border of the tongue, and lower gingiva.

CLINICAL DISCUSSION

Excisional biopsy of the masses was carried out in the patients using the diode laser. The surgical procedures ranged from 10 to 20 min, with minimal intraoperative bleeding and precise cutting, while no pain was reported. Postoperatively, at two weeks and four months follow-up, the intraoral wounds exhibited excellent healing without complications such as pain, bleeding, swelling, scarring, infection, or mass recurrence. The clinical diagnosis of irritational fibroma (two cases) and fibrous epulis were confirmed by histopathological examination.

CONCLUSION

Diode laser emerges as a highly efficacious method for the excisional biopsy of benign oral soft tissue masses, providing intraoperative and postoperative advantages over scalpel surgery.

Ossifying fibroma from surgical excision to periodontal management: case report

Introduction and importance

Peripheral ossifying fibroma is one of the commonly occurring reactive benign lesions that occurs in the gingiva, predominantly in females, especially in the anterior maxillary region of young women and in pediatric patients. It causes unsatisfactory esthetics, difficulty in maintaining good oral hygiene and difficulty in mastication.The importance of this clinical case is to emphasize the interest of early management of the residual defect after the removal of the gum growth.

Case presentation

A 39-year-old female patient was referred to the clinical department of periodontology, with the chief complaint of bleeding gingiva, unsatisfactory esthetics and gum growth on the interproximal area in relation to left maxillary canine and premolar region, with the size ~2 cm×1.5 cm.

Clinical discussion

This article describes an atypical case of peripheral ossifying fibroma with the clinical, histopathologic, and radiographic features in the posterior maxilla in an adult female patient. Treatment consisted of complete surgical excision, gingival curettage, and management of keratinezed gingiva by utilizing laterally displaced flap. Clinical healing was satisfactory at 2 weeks, and excellent coverage of residual mucogingival defect with no evidence of recurrence was achieved 3 weeks postoperatively. The patient was satisfied with case resolution with a follow-up of 1 year.

Conclusion

Although surgical excision is the treatment of choice, sometimes it may induce residual soft tissue defect, which may further precipitate functional and esthetic discrepancies if not managed.

Combination therapy using multifunctional dissolvable hyaluronic acid microneedles for oral ulcers

Oral ulcers are common in the oral mucosa. Frequent occurrences of oral ulcers commonly afflict patients, seriously impacting their daily life. Treatments with good anti-inflammatory and antibacterial properties are important for promoting the healing of oral ulcers. In this study, a multifunctional, soluble hyaluronic acid (HA) microneedle (MN) patch was prepared to promote oral ulcer healing. The tip layer of the MN patch was loaded with triamcinolone acetonide (TA) and epidermal growth factor (EGF) to inhibit inflammation and promote angiogenesis. Zeolitic imidazolate framework-8 (ZIF-8) was loaded onto the base layer of the MN patch, which effectively released Zn2+ to mediate antibacterial effects. In addition, HA exerts a protective effect on the mucous membrane. Owing to these properties, the multifunctional MN patches were found to have good anti-inflammatory, antibacterial, and tissue-healing abilities, indicating that the multifunctional MN patch design successfully promoted the healing of oral ulcers.

Q-switched ruby laser is safe and effective in treating primary gingival hyperpigmentation

BACKGROUND

Physiologic gingival hyperpigmentation (PGH) is a benign condition that results from increased melanin production and is prevalent among darker skin individuals. Although the use of lasers for PGH has gained popularity in recent years, the lasers being used are mostly ablative, and act through a non-selective tissue damage mechanism.

AIMS

The objective of this study was to evaluate the use of a non-ablative 694-nm Q-switched ruby laser (QSRL) for the depigmentation of PGH.

METHODS

A retrospective single-center study of patients diagnosed with PGH and treated with a QSRL Between March 2019 and November 2020.

RESULTS

Four patients were treated with QSRL for 1-3 sessions, until complete depigmentation was achieved. The average follow-up was 11 months (range 7-18 months) with no patient exhibiting re-pigmentation. Adverse events included mild local tenderness and transient erosions in two patients.

CONCLUSION

The 694-nm QSRL is a novel and promising safe and effective method for treating PGH with the advantages of being a non-ablative modality that minimizes tissue damage and optimizes the outcome.

Targeting Th17 cells: a promising strategy to treat oral mucosal inflammatory diseases

With the improved quality of life, oral health is under increased pressure. Numerous common oral mucosal diseases, such as oral lichen planus(OLP) and gingivitis, are related to the destruction of the oral immune barrier. The cytokines secreted by T-helper 17 (Th17) cells are essential for maintaining oral immune homeostasis and play essential roles in immune surveillance. When antigens stimulate the epithelium, Th17 cells expand, differentiate, and generate inflammatory factors to recruit other lymphocytes, such as neutrophils, to clear the infection, which helps to maintain the integrity of the epithelial barrier. In contrast, excessive Th17/IL-17 axis reactions may cause autoimmune damage. Therefore, an in-depth understanding of the role of Th17 cells in oral mucosa may provide prospects for treating oral mucosal diseases. We reviewed the role of Th17 cells in various oral and skin mucosal systemic diseases with oral characteristics, and based on the findings of these reports, we emphasize that Th17 cellular response may be a critical factor in inflammatory diseases of the oral mucosa. In addition, we should pay attention to the role and relationship of "pathogenic Th17" and "non-pathogenic Th17" in oral mucosal diseases. We hope to provide a reference for Th17 cells as a potential therapeutic target for treating oral mucosal inflammatory disorders in the future.

WeChat app combined CBL in oral medicine clinical training: A review

Hotly used in student-centered medical education worldwide, case based learning (CBL) is worthen with WeChat, the most popular communication app and is widely used in all walks of life. We have practiced several years combining WeChat and CBL in the clinical training of oral medicine for young doctors, promoting outcomes over traditional bedside training. This article's objective is demonstrating the acceptability and merits of WeChat CBL in the clinical training of oral medicine for young doctor. A total of eighty young doctors and 2 tutors participated in this study for interns of a every 2-month training during January 2018 to 2020. The control group used clinical bedside mode; the experimental group used bedside plus WeChat CBL mode. The evaluations included participation passion, daily routine and final test. Ten clerkships and thirty residents were in same number respectively of experiment and control groups. The participants in the experimental group produced a higher degree of participation in discussions. The twice and above Q&A action percentage is 40% in experimental group rather than 25% in control group. Daily assessment and final examination scores in the experimental group were significantly higher than those in the control group (P < .001). WeChat CBL mode has a positive effect on students' learning enthusiasm, assessments and evaluations in clinical training of oral medicine.

Freehand scanning photoacoustic microscopy with simultaneous localization and mapping

Optical-resolution photoacoustic microscopy offers high-resolution, label-free hemodynamic and functional imaging to many biomedical applications. However, long-standing technical barriers, such as limited field of view, bulky scanning probes, and slow imaging speed, have limited the application of optical-resolution photoacoustic microscopy. Here, we present freehand scanning photoacoustic microscopy (FS-PAM) that can flexibly image various anatomical sites. We develop a compact handheld photoacoustic probe to acquire 3D images with high speed, and great flexibility. The high scanning speed not only enables video camera mode imaging but also allows for the first implementation of simultaneous localization and mapping (SLAM) in photoacoustic microscopy. We demonstrate fast in vivo imaging of some mouse organs, and human oral mucosa. The high imaging speed greatly reduces motion artifacts and distortions from tissue moving, breathing, and unintended handshaking. We demonstrate small-lesion localization in a large region of the brain. FS-PAM offers a flexible high-speed imaging tool with an extendable field of view, enabling more biomedical imaging applications.

Oral Mucosal Lesions in Childhood

Childhood diseases are a continuous source of interest in all areas of general and dental medicine. Congenital, developmental, and hereditary diseases may either be present upon birth or appear in early childhood. Developmental anomalies, although often asymptomatic, may become grounds for different infections. Furthermore, they can indicate certain systemic disorders. Childhood age frequently brings about benign tumors and different types of traumatic lesions to the oral mucosa. Traumatic lesions can be caused by chemical, mechanical, or thermal injury. Mucocele and ranula are, by definition, traumatic injuries of the salivary glands or their ducts. Recurrent aphthous lesions are the most common type of ulcerations in childhood, and their etiology is considered multifactorial. Oral mucosal lesions in children require different treatment approaches depending on etiological factors and clinical presentation. Clinicians should have adequate knowledge of oral anatomy in order to diagnose and treat pathological conditions.

Prevalence and Genotyping of HPV in Oral Squamous Cell Carcinoma in Northern Brazil

Highly oncogenic human papillomavirus (HPV) is well known to be associated with and a risk factor for various types of oral carcinomas such as oral squamous cell carcinoma (OSCC). The aim of this study was to evaluate and describe the HPV-induced OSCC prevalence and genotyping in the city of Belém, northern Brazil. This cross-sectional study features 101 participants who attended an oral pathology referral center in a dental college looking for diagnoses of oral lesions (OL). After signing the consent term and meeting the inclusion criteria, all participants went through a sociodemographic and epidemiological questionnaire. Then, OL were collected by excisional or incisional biopsy depending on OL size; after that, OL tissues were preserved in paraffin blocks to histopathological diagnoses. Afterwards, paraffin blocks were divided into benign and malignant/premalignant lesions based on the classification of potentially malignant disorders of the oral and oropharyngeal mucosa. Then, the paraffin blocks had DNA extraction performed by the ReliaPrep FFPE gDNA Miniprep method in order to identify HPV DNA of high oncogenic risk and low oncogenic risk. Then, the viral DNA was amplified and typed using the Inno-Lipa genotyping Extra II method, and the collected data were analyzed by Chi-square and G-tests. In total, 59/101 (58.4%) OL were malignant/premalignant lesions, of which OSCC was the most prevalent with 40/59 (67.7%) and 42/101 (41.6%) benign lesions. The most common area of OL incidence was upper gingiva 46/101 (45.5%). Regarding HPV DNA detection, approximately 27/101 (26.7%) had positive results; of these, 17/59 (28.8%) were malignant/premalignant lesions, and the most prevalent genotypes detected were 16, 18, 52 and 58, while among benign lesions, 10/42 (66.6%) had HPV-positive results, and the most prevalent genotypes detected were 6, 11 and 42. Age range was the only risk factor with a significant association between HPV and OSCC presence (p-value: 0.0004). A correlation between OSCC and oral HPV among analyzed samples could not be demonstrated in our small cohort.

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2–3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.

Recurrent Gingival Lesions in a Pediatric Patient

We present the case of a 13-year-old girl who developed numerous gingival masses that recurred after two prior resections. Following the initial resection as a child, she reported that there was a period of resolution for several years before recurrence as a teenager. After the second resection, the masses recurred after 4 months. The lesions obscured the majority of her dentition and interfered with speech, eating, and oral hygiene. The patient underwent staged resection of the masses, and the wounds were allowed to heal by secondary intention. The histopathologic findings of the specimens were consistent with a diagnosis of peripheral ossifying fibroma, which is unusual as these are generally solitary lesions. We believe that this case brings attention to an underrecognized and atypical presentation of peripheral ossifying fibroma, and it should be considered in the differential diagnosis of multicentric gingival masses.

Molecular and Cellular Mechanisms of Perineural Invasion in Oral Squamous Cell Carcinoma: Potential Targets for Therapeutic Intervention

Simple Summary

Squamous cell carcinoma is the most common type of oral cavity cancer. It can spread along and invade nerves in a process called perineural invasion. Perineural invasion can increase the chances of tumor recurrence and reduce survival in patients with oral cancer. Understanding how oral cancer interacts with nerves to facilitate perineural invasion is an important area of research. Targeting key events that contribute to perineural invasion in oral cavity cancer may reduce tumor recurrence and improve survival. In this review, we describe the impact of perineural invasion in oral cancer and the mechanisms that contribute to perineural invasion. Highlighting the key events of perineural invasion is important for the identification and testing of novel therapies for oral cancer with perineural invasion.

Abstract

The most common oral cavity cancer is squamous cell carcinoma (SCC), of which perineural invasion (PNI) is a significant prognostic factor associated with decreased survival and an increased rate of locoregional recurrence. In the classical theory of PNI, cancer was believed to invade nerves directly through the path of least resistance in the perineural space; however, more recent evidence suggests that PNI requires reciprocal signaling interactions between tumor cells and nerve components, particularly Schwann cells. Specifically, head and neck SCC can express neurotrophins and neurotrophin receptors that may contribute to cancer migration towards nerves, PNI, and neuritogenesis towards cancer. Through reciprocal signaling, recent studies also suggest that Schwann cells may play an important role in promoting PNI by migrating toward cancer cells, intercalating, and dispersing cancer, and facilitating cancer migration toward nerves. The interactions of neurotrophins with their high affinity receptors is a new area of interest in the development of pharmaceutical therapies for many types of cancer. In this comprehensive review, we discuss diagnosis and treatment of oral cavity SCC, how PNI affects locoregional recurrence and survival, and the impact of adjuvant therapies on tumors with PNI. We also describe the molecular and cellular mechanisms associated with PNI, including the expression of neurotrophins and their receptors, and highlight potential targets for therapeutic intervention for PNI in oral SCC.

An extensive intraoral blue nevus in an elder patient

OBJECTIVE

To report a rare case of intraoral extensive blue nevus in an elder patient.

BACKGROUND

Oral blue nevi is a well-recognised skin melanocytic neoplasm that rarely occurs in the oral cavity and may mimic melanoma in the early stages.

METHODS

An incisional biopsy was performed, and the diagnosis was blue nevus.

CONCLUSION

Both the clinician and pathologist must be aware of such a presentation to diagnose and treat appropriately.

Otorhinolaryngology Manifestations of Systemic Illness

Ear-nose-throat (ENT) manifestations are among the most frequently observed clinical features of systemic illnesses. The patients often present with overt findings of head and neck lesions such as salivary gland swelling or lymphadenopathy. In contrast, patients may present with covert findings of auditory, nasal, and laryngeal symptoms that are less obvious and are often overlooked. Therefore, clinicians should have a high index of suspicion to identify the underlying disease. Early recognition and prompt treatment or referral to specialists may prevent morbidity and mortality. This article discusses various systemic illnesses with ENT manifestations that are commonly encountered.

Update on MRI for Oral Cavity

ABSTRACT

Magnetic resonance imaging (MRI) is the imaging modality of choice to evaluate the complex anatomy and pathology of the oral cavity. In this article, an overview of MRI findings of common benign lesions in the oral cavity including congenital, vascular, and inflammatory/infectious lesions will be reviewed. In addition, MRI findings of common benign and malignant oral cavity tumors will be presented.

Application of mucous membrane dermoscopy (mucoscopy) in diagnostics of benign oral lesions - literature review and preliminary observations from International Dermoscopy Society study

Dermoscopy of mucosal surface termed "mucoscopy" is an upcoming offshoot of dermatological imaging. However, the literature on mucoscopy is limited to individual cases and small case series. An organized review or systematic analysis of mucoscopy is lacking. The aim of this review was to summarize the published literature on mucoscopic features of benign conditions affecting the oral mucosa and semi-mucosa. Additionally, the results of mucoscopic features of diseases, which have not been described before have been presented.