A Clinicopathological Study of OSMF to Evaluate the Response After Treatment with Intralesional Steroid Versus Intralesional Steroid Plus Hyaluronidase

Oral submucous fibrosis (OSMF) is a chronic debilitating and a well-recognized potentially malignant condition of the oral cavity, sometimes involving oropharynx associated with trismus and burning sensation. Apart from medical management and counselling, local injection of hyaluronidase mixed with triamcinolone acetonide has been used at our centre for the last 20 years with satisfactory clinical results and without any significant side effects. The problem with the treatment was that the doses and duration of treatment has not been standardized. Therefore, in this study, authors aim to evaluate and compare the efficacy of Triamcinolone alone versus Triamcinolone acetonide plus Hyaluronidase at weekly interval and improvement in Clinical and Histopathological staging of disease after 6 weeks of treatment. This study was conducted in Department of Otorhinolaryngology & Head Neck Surgery, with a total sample of 80 participants divided into two Groups, group A received Inj. Triamcinolone acetonide and group B received Inj. Triamcinolone Acetonide and Hyaluronidase 1500 IU at weekly interval. Pre-treatment and post-treatment clinical and histopathological profile of the patients were recorded and analyzed using SPSS 16 software. According to pre-treatment status, the proportion of clinical grades I, II and III were found in proportion 12.5%, 18.8% and 15.0% respectively. No significant difference was found in proportion of various grades between the groups (p = 0.388). At post treatment, the grading was reduced with changed proportion of grades I, II and III cases as 33.8%, 41.3% and 7.5% respectively. There was no significant difference in proportion of various grades between the groups (p = 0.681). Further, the intragroup comparison showed significant improvement Pre to post in group A (p = 0.002), Group B (p < 0.001) and overall, as well (p < 0.001). The inj. Triamcinolone acetonide and Inj. Hyaluronidase showed a better improvement on post treatment histopathological grading although the difference between the two groups was not significant statistically.

Assessment of Aloe Vera and Tulsi's Effectiveness in Treating Oral Submucous Fibrosis

Objectives

Aloe vera and tulsi were compared in this study to see how well they treated oral submucous fibrosis (OSMF).

Materials and Method

The study involved thirty healthy volunteers aged from 20 to 55 without any systemic complications. The patients were given medications that needed to be applied two to three times daily. For four months, patients were followed up with monthly follow-up visits. The differences in the mouth opening and changes to the burning sensation on the visual analog scale (VAS) were statistically analyzed.

Results

Both the burning sensation and mouth opening showed a statistically significant improvement.

Conclusion

Tulsi and aloe vera provide a secure and effective method for treating OSMF symptoms.

Efficacy of Spirulina 500 mg vs Triamcinolone Acetonide 0.1% for the Treatment of Oral Lichen Planus: A Randomized Clinical Trial

AIM

The present study aimed at evaluating the efficacy of spirulina 500 mg in reducing the burning sensation and lesion size in oral lichen planus (OLP).

MATERIALS AND METHODS

A total of 60 subjects who attended the oral medicine specialty clinic with histopathologically confirmed OLP and having symptoms of burning sensation were recruited for the study. They were randomly divided into two groups: group A (30) subjects were prescribed Spirulina 500 mg twice daily along with only a week application of topical triamcinolone acetonide 0.1% thrice daily; group B subjects were prescribed topical triamcinolone acetonide 0.1% alone thrice daily for 8 weeks. Both the groups were followed up posttreatment monthly for three consecutive months.

RESULTS

Data were recorded, and statistical analysis by using ANOVA one-way test, and Chi-square test were performed, which showed statistically significant p-value (<0.005) for the parameters "burning sensation" and "size of the lesion". When compared between groups, group A showed a favorable outcome of the intervention.

CONCLUSION

Spirulina 500 mg supplementation twice daily could be effective adjunct therapy with steroids to treat OLP.

CLINICAL SIGNIFICANCE

This research allowed us to delve into spirulina as one of the treatment modalities for OLP. Further studies are needed as it is a rich source of proteins and vitamins and demonstrates potent anti-inflammatory, immunomodulatory, and antioxidant actions.

Comparative efficacy of topical coconut cream and clobetasol propionate ointment for the management of oral lichen planus: A double-blinded randomized control trial

CONTEXT

Oral lichen planus (OLP) is a quite common chronic inflammatory mucocutaneous disorder affecting the oral cavity and skin. The current treatment relies on systemic or topical corticosteroids but is known to cause side effects thereby demanding a search for an alternative.

AIM

This study aims to assess and to compare the efficacy of topical Coconut (Cocos nucifera) 50% cream and Clobetasol propionate 0.05% ointment for the management of OLP.

SETTINGS AND DESIGN

An institution-based double-blinded randomized control trial.

MATERIALS AND METHODS

Sixty clinically diagnosed OLP patients were allotted to two groups (30 in each): Group I (Coconut cream-50%) and Group II (Clobetasol Propionate ointment-0.05%). Patients were examined every 15 days until two months for a change in the lesion size and reduction in the burning sensation. The measurement of lesion size and burning sensation was done using Adobe Photoshop software (version CS3) and Numeric Pain Rating scale (NPS), respectively.

STATISTICAL ANALYSIS USED

The recordings were subjected to the statistical analysis using Wilcoxon matched-pairs and Mann-Whitney U tests for intra-group and inter-group comparisons, respectively.

RESULTS

There was an 85% regression in the size of the lesion in Group I whereas Group II had it to be 95%, and a 100% reduction in the NPS score in Group I whereas Group II had it to be 95%.

CONCLUSION

The Coconut cream showed a significant decrease in the size of the lesion and the burning sensation with no side effects neither any signs of toxicity reported during the treatment or follow-up, thereby proving to be a safe and promising medication for OLP.

Tolerability of a green tea-based mouth rinse: A pilot study

Introduction

Mouth rinse containing essential oil is one of the most popular, over the counter dental products which has been promoted to have anti-inflammatory, anti-plaque and anti-microbial properties. An essential oil alcohol-free mouth rinse with green tea has been introduced recently and promoted for management of periodontitis and gingivitis. As the role of chlorhexidine gluconate (CHX) mouth rinse in management of periodontal disease has been evaluated previously, the aim of this study is to compare the tolerability of none-alcohol containing green tea-based (NAGT) mouth rinse with CHX mouth rinse.

Methods

Forty healthy subjects were enrolled in September 2018 at King Abdulaziz University and allocated randomly to two study arms: NAGT mouth rinse and chlorhexidine gluconate mouth rinse. Study subjects were instructed to follow the manufacturer instructions and rinse twice daily for two weeks. Collected data included age, gender, smoking history in addition to subjective assessment using a validated questionnaire. Intraoral clinical examination was completed at baseline and 2-weeks time point.

Results

The data of 36 patients were included in this study and analyzed. At 2 weeks, NAGT group reported higher burning sensation score compared to chlorhexidine group (mean: 4.33 and 0.6 respectively; P < 0.05). Reported mucosal dryness was more evident in NAGT group (mean: 1.9 Vs 1.7 for chlorhexidine group). Oral examination revealed significant mucosal desquamation (27.8%) in NAGT group. However, oral ulceration was reported equally in both groups (5.6%).

Conclusion

The current data demonstrates an overall less tolerability of a non-alcohol containing green tea-based mouth rinse compared to chlorhexidine gluconate. Further long term randomized clinical trials are recommended to confirm our findings.

Evaluation of Therapeutic Efficacy of Different Treatment Modalities in Oral Submucous Fibrosis: A Comparative Study

AIM

Aim of this study was to assess the efficiency of different treatment modalities for oral submucous fibrosis.

MATERIALS AND METHODS

Sixty patients were included in the study, which was diagnosed as stage II oral submucous fibrosis (OSMF) based on habitual history and clinical findings. Three groups were made after randomization, i.e., group 1: capsule lycopene group, group 2: capsule lycopene and injection dexamethasone, group 3: injection dexamethasone and hyaluronidase group. Symptom severity was done by visual analog scale (VAS) scoring system viz burning sensation/pain in the patients; patient satisfaction was assessed. Vernier calipers were used to measure patients' maximum mouth opening at day 1, 1st month, 2nd month, 3rd month.

RESULTS

Male and female had the mean age of 28.20 ± 4.26 and 39.34 ± 2.12 in group 1, in group 2 was 27.88 ± 7.12 and 40.92 ± 7.16, in group 3 was 28.90 ± 8.69 and 40.10 ± 6.22, respectively. There was no statistically significant difference between treatment modalities based on satisfaction. On 2nd month, maximum patients with no pain were more in group 3 followed by group 2, and this was statistically significant. At a 3rd month, the maximum reduction in pain was in group 3 followed by group 2 and group 1. Mouth opening was improved in the group 3 followed by groups 2 and 1, respectively. On 3rd month statistically significant difference was observed between the study groups.

CONCLUSION

The present study concludes that the treatment with dexamethasone + hyaluronidase group showed better results in improvement in mouth opening in OSMF patients than lycopene, lycopene and dexamethasone groups. Improvement in mouth opening, reduced burning sensation in OSMF patients was also shown by lycopene. Hence lycopene can be considered as a good alternative for treatment for OSMF when dexamethasone is contraindicated due to different reasons.

CLINICAL SIGNIFICANCE

Any oral cavity part can be affected by OSMF including the pharynx. It is a potentially malignant disorder. So early recognition and initiation of the effective regimen for the treatment in both early and advanced cases of OSMF are necessary.

Thioctic acid in oral submucous fibrosis (India's disease) - A better tomorrow

Oral submucous fibrosis (OSMF), because of its common occurrence in Indian population is known as India's disease. Regardless of diagnostic and therapeutic developments, oral potentially malignant disorders (PMD) and cancers are disseminating at a distressing rate. There is this prerequisite for unrelenting determination to find out apt treatment options so that malignant transformation may be prevented and more so the prevailing morbidity and mortality. Considering the frequency with which oral submucous fibrosis undergoes malignant transformation with free radicals playing a major part, the role of antioxidants in general and thioctic acid also known as alpha lipoic acid (ALA) in particular need to be studied in these individuals. Previous few studies indicated the use of alpha lipoic acid in oral submucous fibrosis patients leading to improvement in signs and symptoms. So, it led us to set forth and propose probable role of thioctic acid in improving symptoms in these patients. As oral submucous fibrosis poses as a threat with its various signs and symptoms and as a potentially malignant disorder as well as considering the role of free radicals in malignant transformation, we proposed the possible mechanisms behind the commonest signs and symptoms in oral submucous fibrosis and role of alpha lipoic acid in managing these signs and symptoms.

Patients with burning mouth sensations. A clinical investigation of causative factors in a group of "compete denture wearers" Jordanian population

Aim

To find out the prevalence of “true” burning mouth syndrome and study the association between patients’ spontaneous complaints of burning mouth and systemic conditions in a group of middle age and elderly “denture wearers” patients in Jordan.

Methods

A group of 129 patients (112 female and 17 male) of “complete denture wearers” subjects aged 40 years and over attended prosthetic clinic at King Hussein Medical Hospital complaining from oral burning, with no oral lesion possibly responsible for the burning sensations were selected. Assessment of oral and general status was done based on questioners, detailed history taking, medical records and extra and intraoral examination. The existed complete dentures retention, stability, jaw relationship and the free way space were evaluated. The current blood test and instrumental protocol for examination of patients with burning mouth complains were performed for each patient. Then those studied patients with burning mouth sensations including “true” burning mouth syndrome have been compared to the controls with regard to the presence of local problem, undermined local, systemic or psychological disease.

Results

The diagnosis of “true” burning mouth syndrome was established in (2.3%) of the studied population two females and one male. In most patients (58%) more than one site was affected. Significant positive associations were found between local factors (i.e., wearing complete dentures with unsatisfactory retention or jaw relationship, dry mouth or candidasis) and patients suffering from burning mouth sensation. The results also show that some systemic or psychological disorders were significantly more present among patients with burning mouth symptoms when compared to the control group (p < 0.05).

Conclusion

Spontaneous symptoms of burning mouth without mucosal signs should be considered as a manifestation of undermind pathology and/or distress, and the multi-factorial causes of burning mouth syndrome and sensation need to be referred to the suitable specialist for better treatment results.

Comparison of Therapeutic Efficacy of Placental Extract with Dexamethasone and Hyaluronic Acid with Dexamethasone for Oral Submucous Fibrosis - A Retrospective Analysis

INTRODUCTION

Oral Submucous Fibrosis (OSMF) is a potentially malignant disease of the oral cavity associated with betel nut chewing. The management of OSMF has been a subject of controversy and no definitive and widely accepted treatment is currently available for this condition.

AIM

To retrospectively evaluate the therapeutic efficacy of two treatment regimens (placental extract with dexamethasone and hyaluronic acid with dexamethasone) for the treatment of OSMF.

MATERIALS AND METHODS

The records of the patients diagnosed with OSMF were obtained from the departmental archives. A total of 25 records were selected and divided into two study groups based on the treatment regimens, as Group A (placental extract + dexamethasone) and Group B (hyaluronidase + dexamethasone). The records were studied for improvement in mouth opening and reduction in burning sensation. Descriptive statistics, paired t test and student's t test were used for statistical analysis.

RESULTS

In Group A and Group B, the average increase in mouth opening from baseline record to 8th week of treatment was 3.53±1.26mm and 3.65±1.42mm respectively and average decrease in burning sensation, noted by VAS scale, was 5.13±1.13 and 4.90 ±1.29 respectively. The pre- and post-treatment differences were found to be statistically significant for both the groups (p<0.001) and for both the treatment outcomes. When the average difference of the treatment outcomes was compared between the two study groups, no statistically significant difference was noted (p>0.05).

CONCLUSION

The results of the present study indicate that both the treatment regimens studied are equally effective in the treatment of oral submucous fibrosis.

Impact of Vernal Keratoconjunctivitis on School Children in Egypt

PURPOSE

To evaluate the prevalence of vernal keratoconjunctivitis (VKC) and its impact on school children in Egypt.

METHODS

A total of 3,706 students from six randomly selected schools of Menoufia were included where 126 had symptoms according to the VKC related symptoms questionnaire. Selected children were referred to a hospital for further assessment.

RESULTS

The mean age of included children was 8.79±31.87 years, with a VKC prevalence of 3.3%, and male-to-female ratio of 2.3:1. The most frequently reported symptoms were ocular itching, followed by burning sensation, tearing, red eye, discharge, and photophobia. Signs vary between mild and severe cases; however, all cases had a negative impact on school attendance and performance.

CONCLUSION

The prevalence of VKC differs according to the age group of included cases and the local temperature of the study area. School attendance, performance, lifestyle, and social activities were negatively affected by VKC.

Effect of Habits and Nutritional Status on Clinical Grading and Histopathological Staging in Patients with Oral Sub Mucous Fibrosis

BACKGROUND

Oral submucous fibrosis (OSMF) is a chronic progressive debilitating disease affecting the oral, oropharyngeal and sometimes the oesophageal mucosa resulting in inability to eat due to burning, ulcers and stiffness.

AIM

The study was undertaken, to evaluate the correlation of clinical staging, histological grading and nutritional status using body mass index (BMI) with gutkha (habit) index in OSMF patients.

MATERIALS AND METHODS

The study group comprised of 50 patients clinically diagnosed and histopathologically confirmed cases of OSMF. Habit (gutkha) index was calculated by multiplying duration and frequency. Body mass index was calculated by dividing weight in kilograms and height in centimetres of the patient.

RESULTS

Male to female ratio was 2.8:1. Clinical grading increased with increase in gutkha index, patients with gutkha index 1-50, maximum were in mild stage; with gutkha index 51-100, maximum in moderate and patients with gutkha index 101-150, all were in severe stage. Histological staging showed direct correlation with gutkha index, it increased with increase in gutkha index with p <0.05. Site analysis showed that buccal mucosa and retromolar area were involved in all the patient and floor of mouth in 46% of patients Body mass index analysis revealed that out of 27 patients with moderate clinical staging 3 was underweight; out of 3 with severe clinical staging, 2 was underweight.

CONCLUSION

The duration and frequency of areca nut product use effects on the incidence and severity of OSMF and the patient becomes unable to eat due to burning, ulcers and inability to open mouth which affect the health of the individual. Thus it is important to access the nutritional status to improve the survival rate of patients.

Clinical evaluation of the role of tulsi and turmeric in the management of oral submucous fibrosis: A pilot, prospective observational study

The aim of the present study was to investigate the clinical efficacy of herbal medicines (1 gm tulsi and 1 gm turmeric mixed in glycerine base) for the treatment of oral submucous fibrosis (OSMF). Forty-one patients in the age group of 17- 56 years without any systemic complications were included in the study. The patients were treated with medicines, which were to be applied 3-4 times a day. Blood samples were collected before and after treatment to screen for any systemic changes due to these medications. Burning sensation and mouth opening were recorded before and after treatment. Patients were followed up on monthly subsequent visits for three months. Changes in the burning sensation on visual analogue scale (VAS) scale and difference in the mouth opening were analyzed statistically. A statistically significant improvement was seen in both burning sensation and mouth opening. Tulsi and turmeric offers a safe and efficacious combination of natural products available for symptomatic treatment of OSMF.

An innovative metal base denture design for a 55-year-old menopausal woman

Menopause is a normal developmental stage in a woman's life, marking the permanent cessation of menstruation resulting from irreversible changes in the hormonal and reproductive functions of the ovaries and is associated with a large number of symptoms ranging from physical to psychological. Some of the common oral manifestations are oral burning sensation with associated mucosal infections, pain, altered taste perception, and alveolar bone loss. These symptoms may unfavorably affect oral health and treatment needs requiring dentists to devise newer methods that would add along to the treatment modalities advised by gynecologists in relieving menopausal women from above symptoms. The present case report describes an innovative method of fabricating a metal base denture in an edentulous female that would help perimenopausal/menopausal/post-menopausal edentulous women feel hot/cold sensations of food/liquids, thereby giving them relief from pain, better taste perception, and relief from associated allergic and candidal infections that are common with conventional acrylic base dentures.