Oral manifestations of systemic disease

Intravital longitudinal cellular visualization of oral mucosa in a murine model based on rotatory side-view confocal endomicroscopy

Oral mucosa is a soft tissue lining the inside of the mouth, protecting the oral cavity from microbiological insults. The mucosal immune system is composed of diverse types of cells that defend against a wide range of pathogens. The pathophysiology of various oral mucosal diseases has been studied mostly by ex vivo histological analysis of harvested specimens. However, to analyze dynamic cellular processes in the oral mucosa, longitudinal in vivo observation of the oral mucosa in a single mouse during pathogenesis is a highly desirable and efficient approach. Herein, by utilizing micro GRIN lens-based rotatory side-view confocal endomicroscopy, we demonstrated non-invasive longitudinal cellular-level in vivo imaging of the oral mucosa, visualizing fluorescently labeled cells including various immune cells, pericytes, nerve cells, and lymphatic and vascular endothelial cells. With rotational and sliding movement of the side-view endomicroscope on the oral mucosa, we successfully achieved a multi-color wide-area cellular-level visualization in a noninvasive manner. By using a transgenic mouse expressing photoconvertible protein, Kaede, we achieved longitudinal repetitive imaging of the same microscopic area in the buccal mucosa of a single mouse for up to 10 days. Finally, we performed longitudinal intravital visualization of the oral mucosa in a DNFB-derived oral contact allergy mouse model, which revealed highly dynamic spatiotemporal changes of CSF1R or LysM expressing immune cells such as monocytes, macrophages, and granulocytes in response to allergic challenge for one week. This technique can be a useful tool to investigate the complex pathophysiology of oral mucosal diseases.

The effects of Ziziphus Spina leaves’ Hydro-Alcoholic Extract Vaginal Cream and Clotrimazole on Candida albicans in Wistar Rats

Background:

In vitro, Ziziphus Spina-Christi (ZSC) leaves have been shown to have antimicrobial and antifungal effects. This study aimed to examine the effects of Ziziphus Spina leaves hydro-alcoholic extracts with Clotrimazole against Candida albicans in female rats.

Methods:

Four groups of rats were infected vaginally with C. Albicans, and 1 group not infected was considered negative control. The infected groups received the following treatments: 2 groups were treated with vaginal 5%, or 10%, of Ziziphus Spina extract creams. One group received 1% clotrimazole, and 1 group did not receive any treatment considered a positive control.

Results:

The mean number of colony-forming units (CFUs) before the intervention was 195.83 ± 395.126 in the 5% ZSC group, 346.33 ± 396.719 in the 10% ZSC group, 345.17 ± 507.431 in the clotrimazole group, 212.20 ± 148.304 in the positive control group (P = .604), and 0 in the negative control group (P = .003). After 1 week, the average number of CFUs considerably dropped to 65.14 ± 36.03 in the 5% ZSC group, 1.43 ± 3.60 in the 10% ZSC group, and 0.43 ± 1.13 in the clotrimazole group. The number in the positive control group remained unchanged (212.20 ± 148.304) (P = .005). After 2 weeks, the average number of CFUs was 0 in the 10% ZSC group, Clotrimazole and negative control groups and was 4.57 ± 23.99 in the 5% ZSC group (P < .001).

Conclusions:

Our findings indicated that the effectiveness of Vaginal creams containing 10% Ziziphus Spina is similar to Clotrimazole in eliminating C. Albicans.

Oral Manifestation of Systemic Diseases

The US Surgeon General's report Oral Health in America highlighted ways in which oral health and systemic conditions are associated with each other. An oral examination can reveal signs and symptoms associated with systemic diseases. In this article, multiple systemic diseases including but not limited to viral and immune modulated conditions and associated oral symptoms are discussed.

Prevalence and subjective knowledge of tongue lesions in an Indian population

AIM

The current study was designed to determine prevalence of various tongue lesions and their association with age, gender, systemic illness, deleterious habits, and distribution over the surfaces of tongue. It also explored the awareness and knowledge of subjects in relation to presence of tongue lesions, etiological factor, symptoms, and treatment received if any.

METHODS

The present study was conducted on 1360 randomly selected dental outpatients from 1/10/2013 to 30/09/2014. Examination of tongue included surface changes, size, movements, and the presence of mucosal lesions. The subjects were asked about the knowledge, symptoms, and treatment obtained in case of awareness regarding the lesion.

RESULTS

The prevalence of tongue lesions was found to be 13.75%. The most prevalent lesion was found to be coated tongue. The majority of the lesions were located on dorsum of tongue and not related with age, gender, habit, and systemic condition. A considerable number of subjects were aware of the changes on their tongue but negligible number sought any treatment.

CONCLUSIONS

The presence of tongue lesions in the study population was found be significant. Hence, general dental practitioners and health care providers should be educated about the diagnosis, etiology, investigations, and proper management of such tongue lesions.

Prevalence of oral lesions in hospitalized patients with infectious diseases in northern Brazil

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Pará, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Pará, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P>0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.

Why must physicians know about oral diseases?

BACKGROUND

Poor oral health reflects social inequalities, hence the prevention of oral diseases should be a priority in developed and underdeveloped countries around the world. Medical practitioners must play an active role in oral health promotion.

SUMMARY

Proper knowledge of oral diseases is crucial in medical practice due to the following reasons: (a) Periodontal disease is associated with multiple systemic conditions of medical interest, (b) a large number of systemic diseases have oral manifestations, (c) many drugs are associated with oral adverse drug reactions, (d) physicians are generally not sufficiently trained to detect oral cancer manifestations, (e) physicians could play a pivotal role in oral public health, and (f) early detection of oral diseases by physicians could improve the oral health status of the population.

CONCLUSIONS

Physicians need to get more involved in oral health promotion. Moreover, oral health education should be included in the curriculum of future medical students.

Invasive candidal laryngitis as a manifestation of cyclic neutropenia in an Omani infant

Cyclic neutropenia is a congenital episodic defect in the development of neutrophils in the bone marrow. It is usually diagnosed late in infancy as it generally takes several cycles of neutropenia before the condition is suspected. These patients often have recurrent mild infectious episodes, but may develop life-threatening bacterial infections; however, they are unlikely to develop fungal infections as the neutropenia is usually self-limiting and of short duration. The authors report the case of an 8-month-old Omani female infant with cyclic neutropenia presenting as severe fungal (Candida) invasive laryngitis, needing life-saving tracheostomy and i.v. antifungal treatment.