Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

Orofacial Manifestation of Systemic Sclerosis: A Cross-Sectional Study and Future Prospects of Oral Capillaroscopy

BACKGROUND AND OBJECTIVES

oral alterations in Systemic Sclerosis (SSc) patients are widespread and include microstomia, periodontitis, telangiectasias, mandibular resorption, bone lesions, and xerostomia. This cross-sectional study aims to evaluate the differences between SSc patients (cases) and healthy subjects (controls) regarding oral manifestations, quality of life (QoL), and microcirculation alterations.

METHODS

plaque index (PCR), periodontal index (PSR), DMFT, salivary flow rate, and buccal opening were measured by expert clinicians. S-HAQ test, the Self-Rating Anxiety State (SAS), the Self-Rating Depression Scale (SDS), and the WHOQOL-BREF test were administered to patients to evaluate their QoL. Microvascular alterations were assessed by oral videocapillaroscopy, performed on gingival and labial mucosa. A statistical analysis was conducted to find significant differences between healthy people and SSc patients.

RESULTS

59 patients were enrolled in this study. Standard salivary flow is significantly more frequent in controls, while xerostomia, reduced flow, microstomia, lip retraction, and periodontitis are significantly more frequent in the cases. Gingival capillaroscopy showed differences concerning loop visibility, thickening of the gum, tortuosity of gingival loops, and reduced gingival density. Labial capillaroscopy demonstrates that visibility of the labial loops, the labial ectasias, and the tortuosity of the loops are significantly associated with the presence of scleroderma. Hand and facial deformities, hypomobility of the tongue, cheeks, lips, microstomia, and xerostomia significantly compromised the quality of life of SSc patients, which was significantly worse among them. Moreover, oral videocapillaroscopy could be a proper diagnostic method to detect oral microcirculation alterations. SSc patients often present ectasias, rarefaction of the reticulum, microhemorrhages, and megacapillaries, which negatively impact their oral health.

CONCLUSIONS

periodontitis, reduced salivary flow, and microstomia could be considered SSc oral manifestations. Joint deformities, facial appearance, and comorbidities significantly reduce the QoL of SSc patients compared to healthy subjects. Oral videocapillaroscopy could be an innovative and reliable technique to detect oral microcirculation anomalies.

[Optimization of postoperative protocol and diagnosis of inflammatory complications of post-extraction wounds at the stages of prosthetic rehabilitation]

THE AIM OF THE STUDY

Was to optimize the protocol for postoperative orthopedic management and diagnosis of wound healing zones in patients after multiple teeth extractions.

MATERIAL AND METHODS

At the Department of Orthopedic Dentistry and Orthodontics, Ryazan State Medical University, orthopedic treatment of 30 patients was carried out after the extraction of upper teeth. Patients were divided into 3 groups depending on the used immediate prostheses: (I) traditional, (II) having a shock-absorbing polypropylene mesh in their design, (III) having a drug reservoir made of elastic plastic and a ring made of monomer-free plastic in the region of the closing borders prosthesis. To assess the effectiveness of treatment, patients on days 5, 10, 20 underwent diagnostic supravital staining of the mucous membrane using an iodine-containing solution, planimetric control, and computerized capillaroscopy.

RESULTS

In group I by the end of the observation period a pronounced dynamics of inflammation persisted in 30% of cases, the objective signs of which amounted to 12.5±2.06 mm² of the area of the positive indicator of supravital staining, while in group II it was 7.2±2.09, in group III - 8.3±1.41 mm² (p≤0.05). According to the results of supravital staining and capillaroscopy at day 20, in group II morphological and objective indicators of inflammation productivity were significantly higher than in group III: the density of the vascular network in group II was 52.5±2.17, in group III - 46.3±2.4 capillary loops/µm², staining area 7.2±2.09 and 8.3±1.41 mm², respectively (p≤0.05).

CONCLUSION

More active wound healing in patients of group II was achieved by optimizing the design of the immediate prosthesis. An accessible and objective assessment of the severity of inflammation using vital staining allows you to accurately assess the dynamics of wound healing with a blurred or unexpressed clinical picture and timely suggest the features of inflammation to correct the course of treatment.

Potential Utility of Oral Mucosal Capillaroscopy as an Indicator of Microvascular Damage in Behçet Disease: A Preliminary Study

Introduction

Behçet disease (BD) is an auto-inflammatory condition characterized by multisystemic vasculitis. Oral mucosal capillaroscopy is an easy-to-use, repeatable, non-invasive method for evaluating mucosal microvasculature, contributing to the differential diagnosis and prognosis of various acute and chronic inflammatory diseases.

Objectives

This study aims to characterize and describe the oral labial mucosal capillary findings in patients with BD using handheld dermatoscopy and to investigate the relationship between the capillary findings and the severity of the disease.

Methods

This cross-sectional study included patients with BD and healthy subjects. Capillaroscopic examination of the oral labial mucosa in each subject was performed by a handheld dermatoscope using polarized light. The clinical severity of BD was evaluated using Krause's Clinical Severity Scoring for BD.

Results

Sixty patients with BD and 60 healthy subjects were enrolled in the study. The frequencies of irregular capillaries, microhemorrhages, glomerular vessels, megacapillaries, and tortuous vessels were statistically significantly higher in the patient group when compared to the healthy individuals. In addition, a correlation was detected between the oral mucosal capillaroscopic findings and disease duration, severity, and vascular complications.

Conclusions

Our study is the first to explore the potential role of oral mucosal capillaroscopic examination in patients with BD. Data obtained from this study indicated that oral mucosal capillaroscopy may be a useful tool to demonstrate microvascular damage in patients with BD.

Evaluation of gingival microcirculation in patients with gestational diabetes mellitus

OBJECTIVE

The aim of this study was to evaluate the possible microcircularity variations at periodontal mucous level in patients with gestational diabetes mellitus (GDM).

MATERIAL AND METHODS

Overall 55 periodontally healthy and non-smoker participants were enrolled in the study by whom 30 were diagnosed with GDM (26 to 34 weeks pregnant) and 25 were systemically healthy unpregnant controls. The analysis was performed in the masticatory/gingival mucosa of maxillary anterior region and by the optical probe videocapillaroscopy technique equipped with 200× lenses. The following parameters were recorded: capillary loop visibility, capillary orientation to surface, microhemorrhages, capillary density and tortuosity.

RESULTS

The average capillary density was significantly higher in participants with GDM (27 ± 5.46 no. loops/mm²) compared to controls (21.16 ± 3 no. loops/mm²) (P = 0.035) while increased tortuosity scores was observed in controls compared with the GDM group (P = 0.017). There was not any significantly difference between study groups among the other variables (P > 0.05).

CONCLUSIONS

Capillary alterations including capillary density and tortuosity were demonstrated in gingival microcirculation of patients with GDM. These microcirculatory changes could provide us new understanding on the dynamics of the relationship between GDM and periodontal tissues.