Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

Oral Health and Nutraceutical Agents

Oral health is essential for both overall health and quality of life. The mouth is a window into the body's health, and nutrition can strongly impact the state of general and oral health. A healthy diet involves the synergistic effect of various nutraceutical agents, potentially capable of conferring protective actions against some inflammatory and chronic-degenerative disorders. Nutraceuticals, mostly present in plant-derived products, present multiple potential clinical, preventive, and therapeutic benefits. Accordingly, preclinical and epidemiological studies suggested a protective role for these compounds, but their real preventive and therapeutic effects in humans still await confirmation. Available evidence suggests that plant extracts are more effective than individual constituents because they contain different phytochemicals with multiple pharmacological targets and additive/synergistic effects, maximizing the benefits for oral health. Moreover, nutritional recommendations for oral health should be personalized and aligned with valid suggestions for overall health. This review is aimed to: introduce the basic concepts of nutraceuticals, including their main food sources; examine the logic that supports their relationship with oral health, and summarize and critically discuss clinical trials testing the utility of nutraceuticals in the prevention and treatment of oral diseases.

A high-order focus interaction model and oral ulcer dataset for oral ulcer segmentation

Computer-aided diagnosis has been slow to develop in the field of oral ulcers. One of the major reasons for this is the lack of publicly available datasets. However, oral ulcers have cancerous lesions and their mortality rate is high. The ability to recognize oral ulcers at an early stage in a timely and effective manner is a very critical issue. In recent years, although there exists a small group of researchers working on these, the datasets are private. Therefore to address this challenge, in this paper a multi-tasking oral ulcer dataset (Autooral) containing two major tasks of lesion segmentation and classification is proposed and made publicly available. To the best of our knowledge, we are the first team to make publicly available an oral ulcer dataset with multi-tasking. In addition, we propose a novel modeling framework, HF-UNet, for segmenting oral ulcer lesion regions. Specifically, the proposed high-order focus interaction module (HFblock) performs acquisition of global properties and focus for acquisition of local properties through high-order attention. The proposed lesion localization module (LL-M) employs a novel hybrid sobel filter, which improves the recognition of ulcer edges. Experimental results on the proposed Autooral dataset show that our proposed HF-UNet segmentation of oral ulcers achieves a DSC value of about 0.80 and the inference memory occupies only 2029 MB. The proposed method guarantees a low running load while maintaining a high-performance segmentation capability. The proposed Autooral dataset and code are available from  https://github.com/wurenkai/HF-UNet-and-Autooral-dataset .

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments.

MATERIALS AND METHODS

The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias.

RESULTS

After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34).

CONCLUSION

Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited.

CLINICAL RELEVANCE

Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Topical Adipose Mesenchymal Stem cell metabolites regulate the expression of MMP-1, MMP-9, EGF, TGF-β in oral mucosa ulcer rat model

Objective

Matrix metalloproteinase (MMP-1 and -9), Epidermal Growth Factor (EGF), and Transforming Growth factor (TGF)-β are expressed in the oral ulcer wound-healing process. The Adipose mesenchymal stem cell metabolites (AdMSCMs) may accelerate wound-healing. This study aimed to investigate the expression of MMP-1, MMP-9, EGF, and TGF-β in the oral mucosa ulcer rat model treated with topical AdMSCMs.

Materials and Methods

Oral ulcer models were created in twenty healthy male Wistar rats (Rattus novergicus) divided into AdMSCMs and control groups. The oral ulcer model was treated topically using AdMSCMs oral gel three times daily for 3 and 7 days. The expression of MMP-1, MMP-9, EGF, TGF-β was evaluated through histological examination using the immunohistochemistry method. Independent t-test was used to compare the mean of expression of MMP-1, MMP-9, EGF, TGF-β between control and treatment groups (AdMSCMs), and paired t-test was used to analyze the mean between day 3 and day 7 of each group.

Results

A lower expression of MMP-1, MMP-9 in AdMSCMs group and higher expression EGF and TGF-β in AdMSCMs group compared to the control group in day 3 and day 7. Independent t-test results showed a significant difference in the expression of MMP-1, MMP-9, EGF between the control and AdMSCMs group in day 3 and day 7. Only TGF-β expression mean difference between day 3 and day 7 showed a significant difference compared to the control groups (p < 0.05).

Conclusions

AdMSCMs oral gel may accelerate oral ulcer healing models by reducing the expression MMP-1, MMP-9, and increasing EGF and TGF-β expressions during the wound-healing process.

Vaping as a Risk Factor for Oral Erythema Multiforme: A Case Report and Literature Review

Introduction

Erythema multiforme is a hypersensitivity reaction caused by various factors, such as viruses, chemicals, and drugs. Electronic cigarettes (e-cigarettes) or vape is a battery-powered nicotine delivery device that substitutes for traditional cigarettes. The chemical components of vaping, including propylene glycol and nicotine, can cause hypersensitivity reactions.

Objective

To report a case of oral erythema multiforme in an e-cigarettes user, treatment, and review the literature regarding the impact of these devices on oral health.

Clinical Case

A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.

Conclusion

Erythema multiforme restricted to the mouth is rare, especially associated with electronic cigarettes. Early identification of oral ulcerative disorders is crucial for accurate diagnosis and treatment, where clinicians should consider oral erythema multiforme as a possible diagnosis.

Association between age, gender, and oral traumatic ulcerative lesions: a retrospective study

BACKGROUND

Oral traumatic ulcerative lesions (OTUL) are commonly encountered in clinical practice, yet there is limited research on their clinical characteristics and traumatic etiological factors. This retrospective study aimed to analyze the age, gender, clinical characteristics, and traumatic etiological factors in a large cohort of patients with OTUL and provide valuable insights for dental clinicians to optimize patient care and prevention strategies.

METHODS

A total of 1543 patients with OTUL were enrolled in this study. Age, gender, medical history, clinical characteristics and traumatic etiological factors were collected and analyzed. Logistic regression analysis was performed to determine the significance of age and gender as factors related to OTUL.

RESULTS

The study revealed significant variations in clinical characteristics and traumatic etiological factors among different age groups and between genders. Logistic regression analysis demonstrated that both age and gender were significant factors related to OTUL.

CONCLUSION

The clinical characteristics of OTUL and traumatic etiological factors appear to be significantly different according to age and gender. More targeted prevention strategies should be implemented for all age and gender groups.

Chronic Traumatic Ulcer: A Case Report

Chronic traumatic ulcers (CTUs) of the oral cavity are frequently brought on by repeated mechanical stress, such as biting or friction from dental appliances, or sharp or broken carious teeth. Although they are frequently disregarded, patients with nonhealing ulcers in the mouth should have CTUs taken into consideration. This report highlights the significance of differential diagnosis and suitable treatment options by discussing a case of a CTU that persisted on the tongue's right lateral border.

Ocular involvement in oral vesiculobullous diseases: A review on reported cases in the literature

Introduction

Vesiculobullous disorders are a group of autoimmune diseases manifesting as chronic ulcers in the oral cavity. Ocular involvement may accompany oral ulcers and cause various problems for patients. This review summarizes the data regarding ocular involvement in patients with oral vesiculobullous.

Methods

Web of Science, Scopus, PubMed/MEDLINE, and Embase electronic databases were searched according to related keywords. Finally, 58 articles were included, all of which were case reports or series. Characteristics such as the age and sex of patients, location and type of oral lesion, type of ophthalmic injury, the interval between oral and ocular lesion, and treatment of oral and ocular disorders were summarized in tables.

Results

Eye involvement was 1.6 times more prevalent in women, and most patients were between 30 and 60 years old (67.4 %). Pemphigus vulgaris accounted for almost half of the cases (48.4 %), though lichen planus is more prevalent in the general population. The most frequently affected oral site was the buccal mucosa (17.5 %), and oral ulcers usually presented as erythema, erosion, or inflammation (22.7 %). Conjunctivitis was the most common type of eye involvement (18.4 %), and ophthalmic lesions regularly appeared 12-60 months after the development of oral lesions (30.1 %). Blindness was reported in only one case. Corticosteroids and immunosuppressives were the most frequent oral and ocular lesion therapies.

Conclusion

Considering the serious burdens of any ocular injury, monitoring the ocular health of patients with oral vesiculobullous diseases is highly recommended in high-risk cases, especially middle-aged women with oral pemphigus vulgaris.

Efficacy of Topical Application of Chum Salmon (Oncorhynchus keta) Skin-derived Collagen Extracts in Improving Oral Traumatic Ulcer Healing

Background

Traumatic ulcer is a wound on the oral mucosa that often causes pain and impaired eating function. Healing of these wounds takes a long time and can interfere with an individual's daily activities. One therapeutic approach that is being developed is the use of topical application of chum salmon skin-derived collagen extract. Collagen is the main component of the extracellular matrix and plays a major role in wound healing. The skin of chum salmon (Oncorhynchus keta) contains collagen that is effective for the treatment of wounds.

Aim

The aim of this study was to evaluate the effectiveness of topical applications of chum salmon (O. keta) skin-derived collagen extracts in improving the healing of traumatic ulcers through analysis of neutrophil and macrophage numbers and collagen density.

Materials and Methods

Twenty-four male Wistar rats were randomly divided into four groups consisting of six rats each. The labial mucosa of the lower lips of the rats was injured with heated amalgam stoppers to create oral traumatic ulcers. Group 1 was a control group; in Groups 2, 3, and 4, 25%, 50%, and 75% of collagen extracts from chum salmon (O. keta) skin were applied topically once a day for 7 days, respectively. The neutrophil and macrophage numbers were observed by hematoxylin and eosin staining. Masson's Trichrome staining was used to analyze the collagen density. Data were analyzed using one-way analysis of variance and continued with post hoc least significant difference tests. Significance is considered if P < 0.05.

Results

The oral traumatic ulcers gradually healed until day 7. The number of neutrophils and macrophages was significantly decreased in the treatment groups, and collagen density was increased, compared to the control group (P < 0.05). The decrease of neutrophil and macrophage numbers occurred significantly with the increased collagen extract concentrations (P < 0.05). Collagen density also increased significantly with the increased collagen extract concentrations (P < 0.05).

Conclusion

Topical applications of chum salmon (O. keta) skin-derived collagen extracts accelerate the healing process of oral traumatic ulcers by decreasing neutrophil and macrophage numbers and increasing collagen density.

Hematological parameters in patients with recurrent Aphthous Stomatitis: a systematic review and meta-analysis

OBJECTIVES

Recurrent Aphthous Stomatitis (RAS) known as recurrent aphthous ulcer is a common and painful ulcerations in oral cavity. It has been suggested that hematological parameters seems to be considered as an etiologic factor. So, this meta-analysis and systematic review was aimed to examine the relationship between RAS and hematological parameters.

METHODS

Relevant studies were found using online international databases including Scopus, Science direct, Web of science (ISI), PubMed, and Google Scholar search engine between 2000 and October 2023. The quality of all papers was determined by NOS checklist. Heterogeneity between the results of primary studies was evaluated with I-square index and publication bias was performed by Egger's test and funnel plots. Also, sensitivity analysis was done to check the effect of each of the primary studies on the overall estimate. Also, the statistical analyses were done using Stata software Ver. 11.

RESULTS

By combining the results of primary studies, the standardized mean difference (SMD) of vitamin B12, ferritin, folic acid, hemoglobin, iron and zinc indices with a 95% confidence interval (CI) between the case (patients with RAS) and control (Healthy) groups were estimated -0.52(-0.89, -0.14), -0.20(-0.51, 0.11), -0.42(-0.95, 0.11), -0.58(-0.90, -0.27), 0.01(-0.12, 0.15), -0.33(-0.81, 0.14) respectively. The patients with vitamin B12, ferritin, folic acid, and iron deficiencies and reduced hemoglobin (Hb) level reported 2.93(2.28, 3.78), 2.50(1.48, 4.22), 1.51(0.53, 4.29), 1.46(0.70, 3.03), and 2.14(1.38, 3.32), times more susceptible to develop RAS than healthy individuals.

CONCLUSION

The results of the meta-analysis indicated that the SMD of vitamin B12 serum and Hb levels in the case group was 52%. Our result have also showed that the odds ratio of vitamin B12, ferritin deficiencies, and decreased Hb level in case group was 2.93, 2.50, and 2.14 times more than healthy group.

Oral mucosa sporotrichosis: Report of a rare case acquired by direct inoculation

Sporotrichosis is a rare type of fungal infection caused by Sporothrix fungus. Transmissions are commonly by traumatic inoculation of the fungus through the skin and subcutaneous tissue either from environmental exposure or contact with infected animals. Due to its mode of transmission, it is commonly affecting the upper limbs. Definitive diagnosis can be obtained by fungal culture test on secretion fluids, pus, bloods or tissue biopsy. We report a rare presentation of this disease appearing as a solitary chronic ulcer of the lip which was successfully treated with itraconazole.

Convolutional neural network misclassification analysis in oral lesions: an error evaluation criterion by image characteristics

OBJECTIVE

This retrospective study analyzed the errors generated by a convolutional neural network (CNN) when performing automated classification of oral lesions according to their clinical characteristics, seeking to identify patterns in systemic errors in the intermediate layers of the CNN.

STUDY DESIGN

A cross-sectional analysis nested in a previous trial in which automated classification by a CNN model of elementary lesions from clinical images of oral lesions was performed. The resulting CNN classification errors formed the dataset for this study. A total of 116 real outputs were identified that diverged from the estimated outputs, representing 7.6% of the total images analyzed by the CNN.

RESULTS

The discrepancies between the real and estimated outputs were associated with problems relating to image sharpness, resolution, and focus; human errors; and the impact of data augmentation.

CONCLUSIONS

From qualitative analysis of errors in the process of automated classification of clinical images, it was possible to confirm the impact of image quality, as well as identify the strong impact of the data augmentation process. Knowledge of the factors that models evaluate to make decisions can increase confidence in the high classification potential of CNNs.

Revisited and innovative perspectives of oral ulcer: from biological specificity to local treatment

Mouth ulcers, a highly prevalent ailment affecting the oral mucosa, leading to pain and discomfort, significantly impacting the patient's daily life. The development of innovative approaches for oral ulcer treatment is of great importance. Moreover, a deeper and more comprehensive understanding of mouth ulcers will facilitate the development of innovative therapeutic strategies. The oral environment possesses distinct traits as it serves as the gateway to the digestive and respiratory systems. The permeability of various epithelial layers can influence drug absorption. Moreover, oral mucosal injuries exhibit distinct healing patterns compared to cutaneous lesions, influenced by various inherent and extrinsic factors. Furthermore, the moist and dynamic oral environment, influenced by saliva and daily physiological functions like chewing and speaking, presents additional challenges in local therapy. Also, suitable mucosal adhesion materials are crucial to alleviate pain and promote healing process. To this end, the review comprehensively examines the anatomical and structural aspects of the oral cavity, elucidates the healing mechanisms of oral ulcers, explores the factors contributing to scar-free healing in the oral mucosa, and investigates the application of mucosal adhesive materials as drug delivery systems. This endeavor seeks to offer novel insights and perspectives for the treatment of oral ulcers.

Plants with Anti-Ulcer Activity and Mechanism: A Review of Preclinical and Clinical Studies

Ulcer disorders including the oral mucosa, large intestine, and stomach mucosa, cause significant global health burdens. Conventional treatments such as non-steroid anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), histamine H2 receptor antagonists (H2RAs), and cytoprotective agents have drawbacks like mucosal injury, diminish gastric acid secretion, and interact with concurrent medications. Therefore, alternative therapeutic approaches are needed to tackle this health concern. Plants are rich in active metabolites in the bark, roots, leaves, fruits, and seeds, and have been utilized for medicinal purposes since ancient times. The use of herbal therapy is crucial, and regulations are necessary to ensure the quality of products, particularly in randomized studies, to assess their efficacy and safety in treating ulcer disorders. This study aims to explore the anti-ulcer activity of medicinal plants in treating peptic ulcer disease, ulcerative colitis, and aphthous ulcers. Articles were searched in Scopus and PubMed, and filtered for publication from 2013 to 2023, resulting in a total of 460 from Scopus and 239 from PubMed. The articles were further screened by title and abstract and resulted in 55 articles. Natural products, rich in active metabolites, were described to manage ulcer disease by protecting the mucosa, reducing ulcer effects, inhibiting pro-inflammatory factors, and reducing bacterial load, thus improving patients' quality of life. Natural extracts have proven effective in managing other health problems, including ulcers by reducing pain and decreasing lesions. This review provides an overview of preclinical and clinical studies on medicinal plants, focusing on their effectiveness in treating conditions like peptic ulcers, ulcerative colitis, and aphthous ulcers.

An In-Vivo Study of Effects of Platelet-Rich Plasma on Transforming Growth Factor-β1 and Matrix Metalloprotein 9 Expression in Traumatic Ulcers with Diabetes Mellitus

OBJECTIVE

 Diabetes mellitus is not only characterized by alterations in the wound healing process but also during oral ulcer healing. The platelet-rich plasma (PRP) can be used to stimulate the healing process. This study was performed to analyze the effect of PRP on traumatic ulcers with diabetes mellitus in an animal model by analyzing the expression of transforming growth factor β1 (TGF-β1) and matrix metalloprotein 9 (MMP-9).

MATERIALS AND METHODS

 The diabetes mellitus model was developed using streptozotocin that was administrated to Rattus novergicus. The traumatic ulcer model was obtained by placing a heated tip of a ball burnisher for 5 seconds on the lower mucosa labial. Then, the traumatic ulcer was treated with PRP for 3, 5, and 7 days. The expression of TGF-β1 and MMP-9 was analyzed with indirect immunohistochemistry, and differences between each marker were analyzed with statistical analysis.

RESULTS

 All animals showed clinical oral ulceration as a yellow base during the experiment. The application of PRP showed a higher level of TGF-β1 expression than the controls for 3, 5, and 7 days (p < 0.05). In contrast, the MMP-9 expression was lower than the control for 5 and 7 days (p < 0.05).

CONCLUSION

 The PRP affected traumatic ulcers with diabetes mellitus by promoting healing through TGF-β1 expression and suppressing the MMP-9 expression. This material can serve to develop a promising topical therapy for traumatic ulcers, especially with an underlying disease such as diabetes mellitus.

Factors affecting the healing of decubital lesions in patients wearing newly made dentures

Background/purpose

Decubital lesions or traumatic ulcers caused by dentures usually appear one or two day(s) after new dentures placement due to mismatch of the microrelief of the tissue and the microrelief of the gingival surface of the prosthesis. The study aimed to analyze factors that could influence the healing of ulcers during a one-week period after the placement of new partial and complete dentures.

Materials and methods

The prospective cohort study included 60 patients with new denture-induced traumatic ulcers. Traumatic ulcers were treated with denture adjustment, or combination of adjustment with 0.2% or 0.3% hyaluronic acid gels respectively for seven days. Healing of ulcers were observed through measurement of perimeter, area, maximum and minimum diameters on digital photographs. Multivariate logistic regression was used to predict other factors that could affect healing process.

Results

Perimeter, area, maximum and minimum diameters of denture-related ulcers were significant decreased after application of gels on the fifth and seventh day. The fifth day ulcers were not healed if dentures were only adjusted, while healed lesion was 40% for the other two groups. On the seventh day, the percent of healed lesion in the group with dentures adjustment was 20%, while it was increased to 75% healed lesions for combination of denture adjustment and hyaluronic acid gels. Anticoagulant/anti-aggregation drugs also had positive impact on ulcer healing; antihypertensives that included diuretics slowed ulcer healing, other monitored factors in the study did not show a significant impact.

Conclusion

Hyaluronic acid in combination with the dentures adjustment for seven days leads to higher healing rate, and reduction in size of ulcers that did not heal until this time point.

Non-Healing Chronic Traumatic Ulcer, an Entity That Can Resemble Other Chronic Ulcers

Introduction

Traumatic ulcer commonly occurs in the oral cavity, resulting in the loss of the entire epithelium. Traumatic ulcers often appear to mimic other lesions of the oral mucosa but the causative factors and other characteristic features rule out the differential diagnosis. It may have a similar appearance to some oral ulcer lesions such as traumatic ulcer granuloma with stromal eosinophilia (TUGSE) and oral squamous cell carcinoma (OSCC).

Objective

To identify traumatic ulcers from other chronic lesions such as TUGSE and OSCC.

Case

First case, a 63-year-old female complained of pain on the right side of the tongue for 4 months. Intraoral examination showed a painful single ulcer, mild keratosis white halo, and induration on the right lateral of the tongue. The second case, a 38-year-old male complained of pain on the left side of the tongue for 2 months. Intraoral examination showed a painful single ulcer, mild keratosis white halo, and induration on the left lateral of the tongue. In both cases, there were some retained roots where the ulcer was located, and due to its contact with lateral of the tongue and the appearance of the lesion, we got a provisional diagnosis of traumatic ulcer.

Case Management

These ulcers had a visual appearance similar to OSCC and TUGSE, so eliminating etiological factors and a comprehensive treatment plan were needed. We planned to extract teeth close to the lesion that was suspected to be the etiology of traumatic ulcer. We also prescribed 0.1% triamcinolone acetonide in orabase to improve healing. One week later, the ulcer in both patients had healed.

Conclusion

Recognition of traumatic ulcer characteristics is crucial in eliminating local factors to get rid of any differential diagnosis.

Risk indicators for oral ulcers among people living with HIV during the first wave of the pandemic: a cross sectional study

BACKGROUND

Little is currently known about HIV-related parameters that may increase the risk for oral ulcers during the COVID-19 pandemic. This study aimed to overcome this gap in research by assessing the associations between HIV viral load, antiretroviral adherence profile, co-morbidity status, SARS-CoV-2 infection and oral ulcers among people living with HIV (PLHIV).

METHODS

This was a secondary analysis of data generated from 21,206 to 18 years and above, recruited from 152 countries through an online survey between July and December 2020. Data were extracted for 874 people who reported living with HIV. The dependent variable was reporting having oral ulcer. The independent variables were the viral load, adherence to antiretroviral treatment and a history of SARS-CoV-2 infection. The confounding variables were age at last birthday and sex at birth. A multivariable logistic regression analysis was conducted to determine the associations between the dependent and independent variables after adjusting for the confounding variables.

RESULTS

Of the 874 participants, 99 (11.3%) reported having oral ulcers during the first wave of the COVID-19 pandemic. The odds of PLHIV having oral ulcers during the first wave of the COVID-19 pandemic was significantly higher for people who did not know their viral load than those who had undetectable viral load (AOR: 2.036; 95% CI: 1.204-3.443; p = 0.008); and people who did not adhere to the use of antiretroviral treatment than those who adhered (AOR: 4.113; 95% CI: 2.567-6.589; p < 0.001). Also, PLHIV who had SARS-CoV-2 infection had significantly higher odds of having oral ulcers than those who did not have the infection (AOR: 14.556; 95% CI: 4.500-47.078; p < 0.001). PLHIV who had co-morbidities had non-significantly higher odds of having oral ulcers than those without co-morbidities (AOR: 1.170; 95% CI: 0.656-2.085; p = 0.595).

CONCLUSION

Oral ulcers may be an indicator of poor adherence to antiretroviral therapy and unsuppressed viral load among PLHIV. It may also be an indicator of SARS-CoV-2 infection and a signal to take prompt and critical care of affected individuals because of the risk for severe COVID-19 for these individuals.

Traumatic ulcer of the tongue mimicking a malignant lesion: Case report

INTRODUCTION AND IMPORTANCE

The most prevalent oral ulcers are those caused by trauma, and their etiopathogenesis has been frequently obvious. Yet, oral ulcers can be misdiagnosed and managed incorrectly.

CASE PRESENTATION

A 25-year-old patient presented to our service with a painful lesion on the right lateral border of the tongue that had evolved for one week. A possible traumatic factor was identified. The ulcer completely recovered once the trauma's cause was removed. An accurate diagnosis was achieved by combining a precise physical examination with clinical follow-up.

CLINICAL DISCUSSION

Single oral ulcers have various clinical presentations that can be confusing. Some of them may mimic oral squamous cell carcinoma (OSCC), especially when accompanied by any induration. Determining the cause of oral ulceration requires a careful medical history and a clinical examination with inspection and palpation, which may be combined with other accessory investigations if necessary.

CONCLUSION

This clinical case reinforces the importance of investigating local causes before moving on to systemic ones. We present differential diagnosis and management algorithm of single oral ulcers.

Diagnosis of Epstein-Barr and cytomegalovirus infections using decision trees: an effective way to avoid antibiotic overuse in paediatric tonsillopharyngitis

BACKGROUND

The incidence of tonsillopharyngitis is especially prevalent in children. Despite the fact that viruses cause the majority of infections, antibiotics are frequently used as a treatment, contrary to international guidelines. This is not only an inappropriate method of treatment for viral infections, but it also significantly contributes to the emergence of antibiotic-resistant strains. In this study, EBV and CMV-related tonsillopharyngitis were distinguished from other pathogens by using machine learning techniques to construct a classification tree based on clinical characteristics.

MATERIALS AND METHODS

In 2016 and 2017, we assessed information regarding 242 children with tonsillopharyngitis. Patients were categorized according to whether acute cytomegalovirus or Epstein-Barr virus infections were confirmed (n = 91) or not (n = 151). Based on symptoms and blood test parameters, we constructed decision trees to discriminate the two groups. The classification efficiency of the model was characterized by its sensitivity, specificity, positive predictive value, and negative predictive value. Fisher's exact and Welch's tests were used to perform univariable statistical analyses.

RESULTS

The best decision tree distinguished EBV/CMV infection from non-EBV/CMV group with 83.33% positive predictive value, 88.90% sensitivity and 90.30% specificity. GPT (U/l) was found to be the most discriminatory variable (p < 0.0001). Using the model, unnecessary antibiotic treatment could be reduced by 66.66% (p = 0.0002).

DISCUSSION

Our classification model can be used as a diagnostic decision support tool to distinguish EBC/CMV infection from non EBV/CMV tonsillopharyngitis, thereby significantly reducing the overuse of antibiotics. It is hoped that the model may become a tool worth considering in routine clinical practice and may be developed to differentiate between viral and bacterial infections.

Oral chemical ulceration due to iatrogenic hydraulic oil leakage from the dental unit of a surgical handpiece: A case report

Oral chemical ulceration is a rare condition. The causes differ from misuse of dental material by dentists and over-the-counter drugs (OTC) to the herbal ingredients in our foods. Detailed patient history helps to explore the diagnosis and further management of such a lesion, which extend from no intervention in mild cases to surgical intervention in severe cases. This report represents a case of chemical ulceration of the mouth caused by hydraulic fluid oil leakage inside a dental chair in a 24-year-old female, leading to the patient developing multiple painful oral ulceration after surgical extraction. The purpose of the report is to increase awareness among health practitioners of unusual causes that could happen during dental interventions.

Association of Surfactant Protein D Single Nucleotide Polymorphisms rs721917, rs2243639, rs3088308 with Recurrent Aphthous Stomatitis in Pakistani Population

Recurrent aphthous stomatitis (RAS) is a benign ulcerative condition, defined by the recurrent formation of non-contagious mucosal ulcers. Surfactant protein D (SP-D) is secreted frequently at surfaces exposed directly to body fluids. This study aims to investigate the association of SP-D single nucleotide polymorphisms (SNPs) with the onset of RAS. Blood samples from 212 subjects (106 cases/controls each) were collected during 2019 and genotyped for SP-D SNPs (rs721917, rs2243639, rs3088308) by polymerase chain reaction and restriction fragment length polymorphism followed by 12% polyacrylamide gel electrophoresis. Minor aphthous (75.5%) was the commonly observed ulcer type as compared to herpetiform (21.7%) and major aphthous ulcers (2.8%). A family history of RAS was reported in 70% of cases. RAS was found significantly associated with rs3088308 genotypes T/A (95% (Cl): 1.57-5.03, p = 0.0005), A/A (95% (Cl): 1.8-6.7, p = 0.0002), T-allele (95% (Cl): 1.09-2.36, p = 0.01), A-allele (95% (Cl): 1.42-3.91, p = 0.01), rs721917 genotype T/T (95% (Cl): 1.15-25.35, p = 0.03), and T-allele (95% (Cl): 1.28-3.10, p = 0.002). Female gender and obese body mass index (BMI) were significantly associated with rs3088308 genotypes T/A (95% (CI): 1.89-15.7, p = 0.001), T/T (95% (Cl): 1.52-11.9, p = 0.005), A-allele (95% (Cl): 1.65-7.58, p < 0.001), and T-allele (95% (Cl): 1.4-10.1, p <0.001) and rs721917 genotype T/T (95% (CI) = 1.3-33, p = 0.02), respectively. This study describes the association of SP-D SNPs (rs721917, rs3088308) with RAS in the Pakistani population.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE): Case report of a 63-year-old male patient with a rare self-healing oral mucosal lesion

Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)/Riga Fede disease is a rare mucosal and submucosal benign reactive inflammatory process, usually involving the tongue. Trauma is believed to be a major factor amongst the multiple pathogenic mechanisms that have been hypothesized in TUGSE. The lesion presents as an isolated indurated or even ulcerated mass, which may mimic, clinically a squamous cell carcinoma (SCC). We herein report a case of TUGSE in a 63-year-old male referred by his treating physician for high suspicion of tongue malignancy. Histopathological examination confirmed the diagnosis of TUGSE, without any evidence of a neoplasic, infectious or hematologic process. TUGSE occurs in patients with an age range of 41-60 years. Sufficiently deep biopsies with comprehensive immunohistochemical and molecular analyses are mandatory to confirm the benign nature of the lesion and to, definitely, rule out malignancy. This report highlights the need for adequate histological differential diagnosis to avoid inappropriate heavy treatments in a benign condition.

Oral Manifestations in Monkeypox: A Scoping Review on Implications for Oral Health

BACKGROUND

The monkeypox outbreak in 2022 caused concern in the public. Infected patients usually present prodromal symptoms, such as lesions on their skin and mucous membranes, including the oral cavity. The current study aims to review the most common oral/perioral manifestations reported to date.

METHODS

A literature search was conducted in the PubMed, Research Gate, and Wiley Online Library databases, as well as in the Google search engine, using keywords related to the condition. Of the 56 publications identified, 30 were selected, including 27 case reports, two case series types, and one cross-sectional study published from 2003 to 2023 in endemic and non-endemic countries. Of the 54 patients in these studies, data on the oral symptoms and sites of monkeypox were interpreted from 47 patients.

RESULTS

Oral/perioral signs as one of the initial manifestations were reported in 23 out of 47 patients (48.93%). Out of the 47 patients with oral/perioral involvement, the most common signs/symptoms were sore throat, followed by ulcers, vesicles, dysphagia and odynophagia, and erythema.

CONCLUSION

The most common oral symptom of monkeypox is sore throat, followed by ulcers. The symptoms usually occur in the pharynx/oropharynx, followed by the tonsils and tongue. Adequate knowledge about the characteristics of this virus and their association with the oral cavity is necessary, and could help oral health professionals to distinguish between different infections.

In Vitro Cell Proliferation and Migration Properties of Oral Mucosal Fibroblasts: A Comparative Study on the Effects of Cord Blood- and Peripheral Blood-Platelet Lysate

Cord blood-platelet lysate (CB-PL), containing growth factors such as a platelet-derived growth factor, has a similar efficacy to peripheral blood-platelet lysate (PB-PL) in initiating cell growth and differentiation, which makes it a unique alternative to be implemented into oral ulceration healing. This research study aimed to compare the effectiveness of CB-PL and PB-PL in promoting oral wound closure in vitro. Alamar blue assay was used to determine the optimal concentration of CB-PL and PB-PL in enhancing the proliferation of human oral mucosal fibroblasts (HOMF). The percentage of wound closure was measured using the wound-healing assay for CB-PL and PB-PL at the optimal concentration of 1.25% and 0.3125%, respectively. The gene expressions of cell phenotypic makers (Col. I, Col. III, elastin and fibronectin) were determined via qRT-PCR. The concentrations of PDGF-BB were quantified using ELISA. We found that CB-PL was as effective as PB-PL in promoting wound-healing and both PL were more effective compared to the control (CTRL) group in accelerating the cell migration in the wound-healing assay. The gene expressions of Col. III and fibronectin were significantly higher in PB-PL compared to CB-PL. The PDGF-BB concentration of PB-PL was the highest and it decreased after the wound closed on day 3. Therefore, we concluded that PL from both sources can be a beneficial treatment for wound-healing, but PB-PL showed the most promising wound-healing properties in this study.

Use of Artificial Intelligence in the Classification of Elementary Oral Lesions from Clinical Images

OBJECTIVES

Artificial intelligence has generated a significant impact in the health field. The aim of this study was to perform the training and validation of a convolutional neural network (CNN)-based model to automatically classify six clinical representation categories of oral lesion images.

METHOD

The CNN model was developed with the objective of automatically classifying the images into six categories of elementary lesions: (1) papule/nodule; (2) macule/spot; (3) vesicle/bullous; (4) erosion; (5) ulcer and (6) plaque. We selected four architectures and using our dataset we decided to test the following architectures: ResNet-50, VGG16, InceptionV3 and Xception. We used the confusion matrix as the main metric for the CNN evaluation and discussion.

RESULTS

A total of 5069 images of oral mucosa lesions were used. The oral elementary lesions classification reached the best result using an architecture based on InceptionV3. After hyperparameter optimization, we reached more than 71% correct predictions in all six lesion classes. The classification achieved an average accuracy of 95.09% in our dataset.

CONCLUSIONS

We reported the development of an artificial intelligence model for the automated classification of elementary lesions from oral clinical images, achieving satisfactory performance. Future directions include the study of including trained layers to establish patterns of characteristics that determine benign, potentially malignant and malignant lesions.

Application of Stichopus hermanni Nanoparticle Gel in the Healing of Traumatic Ulcers

OBJECTIVE

 The aim of this research was to investigate the use of Stichopus herrmanni nanoparticle gel on the ulcer healing process by observing blood vessels, fibroblasts, and Collagen type-I (COL-1) expression on the 4 and 7th days after trauma.

MATERIALS AND METHODS

 Gold sea cucumber (Stichopus herrmanni) powder was processed by freeze-drying method, then by high-energy milling to form nanoparticle size, and then with CMC 2% to make hydrogel. Traumatic ulcers were formed by induction using a burner. Five groups of male Wistar rats, each consisting of six tails, were divided into a negative control group that was given a placebo, the positive control group was given 0.2% hyaluronic acid, and the treatment group was given gold sea cucumbers with concentrations of 0.135, 0.27, and 0.54% (SH1-SH2-SH3). Fibroblast and blood vessels were examined with hematoxylin-eosin on day 3 and 7, while COL-1 expression was examined with immunohistochemistry on day 7. The rats' mucosa was taken on the 3rd and 7th days after the traumatic ulcer was formed.

STATISTICAL ANALYSIS

 The data were analyzed using a one-way analysis of variance followed by a post-hoc test with a p less than 0.05.

RESULTS

 Nanoparticles gel freeze-drying of Stichopus herrmanni increased blood vessels on day 3. Angiogenesis continued to occur, which resulted in increased fibroblast and COL-1 expression on day 7.

CONCLUSIONS

 The application of Stichopus herrmanni nanoparticle gel at 0.27% effectively increased the number of blood vessels, fibroblasts, and COL-1 expression in healing traumatic ulcers.

Immunoglobulin Disorders and the Oral Cavity: A Narrative Review

The oral mucosa is a mechanical barrier against the penetration and colonization of microorganisms. Oral homeostasis is maintained by congenital and adaptive systems in conjunction with normal oral flora and an intact oral mucosa. Components contributing to the defense of the oral cavity include the salivary glands, innate antimicrobial proteins of saliva, plasma proteins, circulating white blood cells, keratinocyte products of the oral mucosa, and gingival crevicular fluid. General disturbances in the level of immunoglobulins in the human body may be manifested as pathological lesions in the oral mucosa. Symptoms of immunoglobulin-related general diseases such as mucous membrane pemphigoid (MMP), pemphigus vulgaris (PV), linear IgA bullous dermatosis (LABD), Epidermolysis Bullosa Aquisita (EBA), and Hyper-IgE syndrome (HIES) may appear in the oral cavity. In this review, authors present selected diseases associated with immunoglobulins in which the lesions appear in the oral cavity. Early detection and treatment of autoimmune diseases, sometimes showing a severe evolution (e.g., PV), allow the control of their dissemination and involvement of skin or other body organs. Immunoglobulin disorders with oral manifestations are not common, but knowledge, differentiation and diagnosis are essential for proper treatment.

Alginate/Chitosan-Based Hydrogel Film Containing α-Mangostin for Recurrent Aphthous Stomatitis Therapy in Rats

Recurrent aphthous stomatitis (RAS) is a prevalent clinical disorder that causes mouth ulcers. Furthermore, corticosteroid treatment has been widely utilized for RAS therapy; however, it has side effects on the oral mucosa that limit its application. This study aimed to develop a novel RAS therapy with the natural ingredient α-mangostin, delivered by alginate and chitosan polymers-based hydrogel film (α-M Alg/Chi-HF). To prepare α-M Alg/Chi-HF, the solvent evaporation and casting methods were used, then characterized by using SEM, FTIR, and XRD. Based on the characterization studies, the α-M in α-M/EtOH Alg/Chi-HF with ethanol (EtOH) was found to be more homogenous compared to α-M in Alg/Chi-HF with distilled water (H2O) as a casting solvent. The in vitro viability study using NIH3T3 cells showed 100% viability of α-M Alg/Chi-HF (EtOH) and Alg/Chi-HF after 24 h incubation, indicating well tolerability of these hydrogel films. Interestingly, the in vivo studies using male white rats (Rattus norvegicus Berkenhout) proved that α-M/EtOH Alg/Chi-HF with a recovery of 81.47 ± 0.09% in seven days significantly more effective RAS therapy compared to control. These results suggest that α-M/EtOH Alg/Chi-HF has the potential as an alternative for RAS therapy.

Marine collagen peptides: A novel biomaterial for the healing of oral mucosal ulcers

The purpose of this study was to analyze the therapeutic effects of marine collagen peptides (MCPs) from tilapia skin on oral mucosal ulcers in a rat model. CCK-8 and wound healing assays were performed in vitro to evaluate proliferation and migration of L929 cells after treatment with MCPs. The effects of MCPs on the healing of oral mucosal ulcers in a rat model were macroscopically and microscopically analyzed in vivo. Results showed that MCPs promoted proliferation and migration of L929 cells. Moreover, 75%MCPs enhanced the ulcer healing process, suppressed inflammatory response and up-regulated the expression levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). MCPs are potentially used as a new therapeutic strategy for oral mucosal ulceration.

The role of Herpes Simplex Virus type 1 in oral diseases in children

Relevance. Herpes virus infections are the most common and poorly controllable viral infections. There are many difficulties in herpetic lesion verification and treatment in dental practice.

Purpose. The study aimed to present the results of a foreign publication investigation on the role of herpes simplex virus type 1 in the development of oral diseases in children.

Material and methods. Foreign scientific articles about the oral HSV-1 infections published from 2018 to 2022 formed the basis for the study. The study searched the publications on PubMed and Google Scholar bases.

Results. The article presents the newest data on the prevalence, clinical characteristics and diagnosis of oral HSV infection in children. Primary herpetic gingivostomatitis (PHGS), chronic recurrent herpetic gingivostomatitis, chronic recurrent herpes labialis are the main clinical presentations of herpes infection diagnosed in a dental practice. Primary herpetic gingivostomatitis is very common in children aged six months to fve years and occurs in newborns from 2 to 43 days of life. Modern virology success can improve diagnosis and treatment of oral herpetic lesions.

Conclusion. Primary herpetic gingivostomatitis is an acute infectious disease that requires the joint attention of a general practitioner and a dentist to ensure comprehensive treatment.

Predisposing Factors for Recurrent Aphthous Stomatitis among Undergraduate Dental Students

Objectives The prevalence of recurrent aphthous stomatitis (RAS) among the general population worldwide is 20%. This study aims to discover any correlations between RAS predisposing factors and the gender and year of study of undergraduate dental students at the Faculty of Dental Medicine at Airlangga University.

Methods A cross-sectional analytical study using simple random sampling was performed. The respondents answered seven questions on a self-reported online questionnaire set up using Google Forms. Chi-square analyses were conducted to determine any correlation between RAS predisposing factors and the gender and year of study of the students.

Results The highest predisposing factors for RAS in undergraduate dental students were local trauma (77.7%) followed by stress (71.3%) and nutritional deficiencies (41.5%). Stress correlated strongly with the year of study (p = 0.015). There was no correlation between gender and RAS predisposing factors (p > 0.05).

Conclusion There was a correlation between stress, one of the predisposing factors for RAS, and the year of study, but there was no correlation between gender and RAS predisposing factors including local trauma, stress, nutritional deficiency, genetics, allergies, and systemic diseases.

Factors associated with the healing time of pemphigus vulgaris oral lesions: a prospective study

OBJECTIVES

This study determines the healing time of lesions on different locations and the contributing factors to the healing time in patients with pemphigus.

METHODS

In this prospective study, newly diagnosed patients with mucosal lesions were included. A dermatologist evaluated the lesions, disease status, side effects and assigned the PDAI. Follow-up visits were conducted monthly until the patient reached complete remission and every three months thereafter. A Tzanck smear was performed on lesions clinically suspected to be herpetic in origin.

RESULTS

Sixty patients enrolled in the study with a mean age of 45.9 ± 11.7 years. The buccal lesions took the longest to resolve(73[33.5-105.5] days). However, the posterior pharynx lesions showed the shortest healing time(20[13.0-25.5] days). The likelihood of improvement in buccal and soft palate lesions decreased by 5% and 3% with each additional year of age, respectively. Also, the resolution duration of soft palate lesions was significantly shorter in female patients than males(median of 24.0 days vs. 38.5 days). In contrast, lower gingival lesions resolve significantly faster in male patients by a median of 9 days. HSV infection increases the healing time of lesions by 26 days(median of 55 days vs. 29 days, hazard ratio 2.62, 95%CI:1.04-5.92).

CONCLUSIONS

Buccal and lower gingival lesions are more recalcitrant to treatment, while posterior pharynx lesions heal most rapidly. Furthermore, older age was also associated with a lower rate of lesion improvement.

Diseases with oral manifestations among adult asthmatics in Finland: a population-based matched cohort study

OBJECTIVES

Many comorbidities are associated with adult asthma and may exacerbate the asthma burden of disease. This study aims to investigate the risk for major oral diseases or oral-manifesting diseases in asthmatic compared with non-asthmatic adults.

DESIGN

We conducted a population-based matched cohort study with a 13.8-year follow-up.

SETTING

A baseline questionnaire was completed by participants in 1997 and follow-up data were extracted from the national hospital discharge registry of the National Institute for Health and Welfare in Finland from 1997 to 2014.

PARTICIPANTS

A total of 1394 adults with asthma were matched with 2398 adults without asthma based on sex, age and area of residence. Asthmatic adults were identified from the Drug Reimbursement Register of the Finnish Social Insurance Institution based on a special drug reimbursement right resulting from asthma. Participants without asthma were identified from the Population Register.

MAIN OUTCOMES AND MEASURES

Oral health-related primary diagnoses were retrieved using codes from the International Classification of Diseases, 10th edition and divided into groups of diseases. Cox's proportional hazards models stratified by matching unit and models matched and adjusted for pack-years, education level and body mass index (when possible) were used to evaluate the matched and further adjusted HRs for diseases comparing asthmatic and non-asthmatic cohorts.

RESULTS

Adult asthma was associated with a higher risk for any oral-manifesting disease (adjusted HR 1.41, 95% CI 1.11 to 1.80), herpes zoster (adjusted HR 6.18, 95% CI 1.21 to 31.6), benign tumours of the oral cavity and pharynx (matched HR 1.94, 95% CI 1.05 to 3.56) and dermatological diseases (pemphigus, pemphigoid, dermatitis herpetiformis, psoriasis and lichen planus, HR 1.67, 95% CI 1.01 to 2.78).

CONCLUSIONS

In this study, adult asthmatics experienced a higher risk for a major oral disease or oral-manifesting disease.

Evaluation of clinical, histology, TNF-α, and collagen expressions on oral ulcer in rats after treatment with areca nut and chrysanthemum oral gel

Background: Areca nut (Areca catechu Linn.) is the seed of the fruit of the oriental palm that is commonly used among Southeast Asian communities. Chrysanthemum (Dendrathema grandiflora) is a flowering plant originating from East Asia and dominantly grows in China. Both of these plants have strong antioxidant activities. To investigate the mechanism of their wound healing activities, we prepared areca nut and chrysanthemum polyethylene oral gel and performed several in vivo assays using Sprague–Dawley rats. Methods: Sprague–Dawley rats were divided into five groups: Negative control group (rats with base gel treatment), positive control group (rats treated with triamcinolone acetonide), F1 (treatment with 20% areca nut:80% chrysanthemum), F2 (treatment with 50% areca nut:50% chrysanthemum), and F3 (treatment with 80% areca nut:20% chrysanthemum). Traumatic ulcers were performed on the buccal mucosa of all experimental animals that received topical oral gel and triamcinolone acetonide twice a day for seven days. The clinical and histological characteristics were analyzed and scored. Results: During the six days, the ulcerated area receded linearly over time and was completely cicatrized in F2 and positive control group (Dependent t-test, p<0.05). There were significant increases in body weight in F2 and positive control groups. There were no significant differences between groups in histology examination (Kruskal Wallis test, p<0.05). The moderate score of TNF-α levels was seen in F2 and positive control groups (ANOVA/Tukey test). Similar results were seen in the collagenases assay. Conclusions: A balanced combination of areca nut and chrysanthemum extract in the oral gel can optimize the healing of traumatic oral ulcers in rats through the increase of TNF-α and collagen deposition.

Oral ulcers in children- a clinical narrative overview

The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.

Verrucous Carcinoma of Buccal Mucosa in Female: A Rare Case Report of Traumatic Tooth Origin

Verrucous carcinoma or Ackermann's tumor is considered a low-grade variant of squamous cell carcinoma frequently presenting at the oral mucosa and skin. Oral verrucous carcinoma clinically presents as a proliferative or cauliflower-like lesion or as ulceroproliferative lesion on the buccal mucosa followed by other sites such as the gingiva, tongue, and hard palate. Tobacco in both smoking and smokeless form, alcohol, and opportunist viral infections are the most associated etiologies in most of the reported literature cases. Here, in this paper, we discuss a rare case scenario of a 52-year-old female diagnosed with verrucous carcinoma of the left buccal mucosa with constant traumatic irritation caused by tooth as etiology for the occurrence of lesion, though verrucous carcinoma is described as a benign lesion with minimum aggressive potential but long-standing cases have shown transformation into squamous cell carcinoma. Therefore, early diagnosis and surgical excision of the lesion are the most appropriate treatment modality of verrucous carcinoma.

Comprehending the crosstalk between Notch, Wnt and Hedgehog signaling pathways in oral squamous cell carcinoma - clinical implications

BACKGROUND

Oral squamous cell carcinoma (OSCC) is a malignant oral cavity neoplasm that affects many people, especially in developing countries. Despite several advances that have been made in diagnosis and treatment, the morbidity and mortality rates due to OSCC remain high. Accumulating evidence indicates that aberrant activation of cellular signaling pathways, such as the Notch, Wnt and Hedgehog pathways, occurs during the development and metastasis of OSCC. In this review, we have articulated the roles of the Notch, Wnt and Hedgehog signaling pathways in OSCC and their crosstalk during tumor development and progression. We have also examined possible interactions and associations between these pathways and treatment regimens that could be employed to effectively tackle OSCC and/or prevent its recurrence.

CONCLUSIONS

Activation of the Notch signaling pathway upregulates the expression of several genes, including c-Myc, β-catenin, NF-κB and Shh. Associations between the Notch signaling pathway and other pathways have been shown to enhance OSCC tumor aggressiveness. Crosstalk between these pathways supports the maintenance of cancer stem cells (CSCs) and regulates OSCC cell motility. Thus, application of compounds that block these pathways may be a valid strategy to treat OSCC. Such compounds have already been employed in other types of cancer and could be repurposed for OSCC.

The effects of adipose tissue-derived stem cells seeded onto the curcumin-loaded collagen scaffold in healing of experimentally- induced oral mucosal ulcers in rat

OBJECTIVES

Various therapeutic approaches, including stem-cell-based strategies and tissue engineering, have been proposed for oral ulcerative lesions. We investigated the effects of adipose tissue-derived stem cells (ADSCs) seeded onto the curcumin-loaded collagen scaffold in the mucosal healing of oral ulcers in rats.

MATERIALS AND METHODS

The current experimental study was conducted on 40 male Sprague-Dawley rats. Oral ulcers were created over both sides of buccal mucosa, and the rats were randomly divided into four equal groups: 1) an untreated group (negative control); 2) Teriadent-treated group (positive control); 3) group treated with curcumin-loaded collagen scaffold; and 4) group received the ADSCs (3 × 106 cells) seeded onto the curcumin-loaded collagen scaffold. Rats were sacrificed on 3rd and 7th day after ulceration for histopathological examination as well as measurement of tissue levels of myeloperoxidase (MPO), superoxide dismutase (SOD), and Interleukin-1 beta (IL-1β) activity.

RESULTS

Compared with the negative control, the tissue levels of MPO and IL-1β were significantly decreased in all treated groups (P<0.0001); however, the SOD activity was elevated (P<0.0001). The highest SOD activity as well as the lowest MPO and IL-1β levels were observed in the ADSCs-curcumin-loaded collagen scaffold group. The ulcer healing process at 3rd and 7th day follow-up was much more progressed in the ADSCs-curcumin-loaded collagen scaffold group in comparison with the untreated group (P=0.037 and P=0.004, respectively).

CONCLUSION

According to the findings of this study, ADSCs seeded onto the curcumin-loaded collagen scaffold seems to have a promising potential for oral ulcer healing applications.

A case report of traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) in a 21-year-old

We present an unusual case of a persistent solitary left palatoglossal ulcer with no history of trauma or associated risk factors. A TUGSE lesion, which mimics that of malignancy, must always be noted as a differential even in risk factor absence.

Oral Medicine Considerations for Older Patients

With the projected increase to 1.3 billion people aged 65 years or older by 2040, healthcare professionals are faced with significant challenges in managing this population of patients. In the oral cavity, oral mucosal disease is a significant problem found in older populations. Several facial pain conditions are more likely to be seen in this cohort of patients. Although management of this group of patients may not always be appropriate in general practice, an awareness of the range of oral medicine conditions that may be encountered in older patients is essential to allow prompt referral and treatment.

A nonspecific ulcer on upper lip presented as the first and sole sign of syphilis

Syphilis, a sexually transmitted disease, can be categorized as acquired syphilis and congenital syphilis, manifesting diverse lesions involving multiple sites. Oral manifestations at the primary stage of acquired syphilis are usually characterized by its short period and non-specific varied presentations. And oral ulcers as initial and the only presentation of syphilis oral lesions are infrequent and occur in less than 2% of patients. Because of its transient nature and variable manifestations which could mimic other oral ulcerative lesions, oral syphilis presenting as sole ulceration at early stage can be easily neglected and rather difficult to diagnose. Herein, we report a 35-year-old female patient manifested a sole atypical ulceration on her upper lip for approximately 1 month. We highlighted the importance of early and accurate diagnosis, focused on the characteristics of oral chancre, and gave an insight to the differential diagnoses, which would be enlightening and useful in clinical practice.

The Role of Rice Hull Liquid Smoke in the Traumatic Ulcer Healing

Objective  The aim of this study was to prove the role of rice hull liquid smoke (RH-LS) on lymphocytes, macrophages, fibroblasts, interleukin 6 (IL-6), and transforming growth factor β (TGF-β) expression during traumatic ulcer healing.

Materials and Methods  The RH-LS was obtained from the pyrolysis process. Traumatic ulcers were made 10 mm along the labial fornix incisive inferior of Wistar rat using a round stainless-steel blade. In control group, traumatic ulcers were treated using sterile water, and meanwhile in experimental group were treated using RH-LS once a day for 3, 5, and 7 days. After treatment, animal was terminated and their labial fornix incisive inferior tissues were biopsy and stained using hematoxylin and eosin staining to determine lymphocytes, macrophages, and fibroblasts. The IL-6 and TGF-β expressions were analyzed used immunohistochemistry staining.

Result  The lymphocytes, macrophages, and fibroblasts were higher in the RH-LS group for 3-, 5-, and 7-day treatment ( p < 0.05). The IL-6 expression was higher only in the 5-day treatment, and the TGF-β expression was higher in the 3- and 7-day treatment.

Conclusion  The RH-LS able to accelerated the traumatic ulcer healing by increasing the number of lymphocytes, macrophages, fibroblasts, IL-6, and TGF-β expression.

Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates

Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.

Safety and Effectiveness of Copaiba Oleoresin (C. reticulata Ducke) on Inflammation and Tissue Repair of Oral Wounds in Rats

In traditional communities of the Brazilian Amazon, the copaiba oleoresin (C. reticulata Ducke) is widely known for its therapeutic activity, especially its wound healing and anti-inflammatory actions. Our study aimed to evaluate these effects in oral lesions and the safety of the dosage proposed. A punch biopsy wound was induced on the ventral surface of the tongue of forty-five male Wistar rats under anesthesia. Animals were randomly allocated to one of three groups based on the treatment: control, corticoid and copaiba. A daily dose of each treatment and vehicle was administrated by oral gavage for three consecutive days. Sample collections took place on the third, seventh and 15th days post-wounding for clinical and histopathological analyses. Blood was collected on the third and seventh days for kidneys and liver function tests. Semi-quantitative analyses were performed based on scores of inflammation and reepithelization. Tissue collagen deposition was detected by PicroSirius red staining. Copaiba-treated wounds revealed a smaller wound area, decreased of acute inflammatory reaction and enhanced reepithelization. The levels of kidney and liver function tests did not reveal presence of damage post-treatments. Our findings suggest that copaiba oleoresin is a safe and effective alternative therapy for inflammation and tissue repair of oral wounds in this animal model.

Evaluation of the effect of hydro alcoholic extract of cinnamon on herpes simplex virus-1

BACKGROUND

Long-term treatments of herpes simplex with drugs such as acyclovir, the side effects to such drugs including limited usage during the lactation period, and concerns for the emergence of drug-resistant strains have given rise to a need for new medications with fewer complications. Nowadays, there is an increasing usage of herbal medicines throughout the world due to their higher effectiveness and safety. The present study aims to assess the effects of hydroalcoholic cinnamon extract on herpes simplex virus type 1 (HSV-1) in culture with vero cells.

MATERIALS AND METHODS

In this in vitro study Hydroalcoholic extract of cinnamon was extracted through percolation. To assess cell survival rates, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was employed, and the tissue culture infective dose 50 assay was used to quantify the virus. Effects of the extract were evaluated in three stages, including before, during, and after viral inoculation into the culture medium. Two-way ANOVA and Post hoc analysis the test was performed in 1, 0.5, and 0.25 mg/ml concentrations of cinnamon extract in every stage (P < 0.05).

RESULTS

Over 50% of the cells survived in the 0.25 mg/ml extract concentration. Results of our viral quantification showed a viral load of 10⁵. The cinnamon extract was able to reduce the viral titer in all concentrations under study.

CONCLUSION

Hydroalcoholic extract of cinnamon was effective in reducing the viral titer of HSV-1. This effect could have been caused by prevention of viral attachment to cells; however, further research is required to determine the exact mechanisms at play.

A decision tree to improve identification of pathogenic mutations in clinical practice

BACKGROUND

A variant of unknown significance (VUS) is a variant form of a gene that has been identified through genetic testing, but whose significance to the organism function is not known. An actual challenge in precision medicine is to precisely identify which detected mutations from a sequencing process have a suitable role in the treatment or diagnosis of a disease. The average accuracy of pathogenicity predictors is 85%. However, there is a significant discordance about the identification of mutational impact and pathogenicity among them. Therefore, manual verification is necessary for confirming the real effect of a mutation in its casuistic.

METHODS

In this work, we use variables categorization and selection for building a decision tree model, and later we measure and compare its accuracy with four known mutation predictors and seventeen supervised machine-learning (ML) algorithms.

RESULTS

The results showed that the proposed tree reached the highest precision among all tested variables: 91% for True Neutrals, 8% for False Neutrals, 9% for False Pathogenic, and 92% for True Pathogenic.

CONCLUSIONS

The decision tree exceptionally demonstrated high classification precision with cancer data, producing consistently relevant forecasts for the sample tests with an accuracy close to the best ones achieved from supervised ML algorithms. Besides, the decision tree algorithm is easier to apply in clinical practice by non-IT experts. From the cancer research community perspective, this approach can be successfully applied as an alternative for the determination of potential pathogenicity of VOUS.