Unveiling denture-induced oral lesions: A comprehensive study on classification and pain assessment

BACKGROUND

Denture-induced oral Lesions (DIOLs) often manifests shortly after the placement or adjustment of new or realigned dentures, frequently resulting in severe pain and discomfort.

OBJECTIVES

This study aimed to classify DIOLs placing a particular emphasis on assessing the associated pain.

METHODS

A prospective case study was conducted involving 126 patients who were fitted with a total of 193 dentures of various types at the Hadassah School of Dental Medicine. All patients underwent comprehensive intra-oral examinations within 1-8 weeks following denture delivery, completed symptom questionnaires and had their medical records reviewed. Key variables documented included age, gender, overall health status, denture type, and a detailed description of the DIOLs. The description encompassed factors such as lesion location, shape, colour, size, border characteristics, ulcerative appearance, membrane coverage, 3D morphology (elevated, immersed and flat) and patient-reported Verbal Pain Score (VPS) when touching the DIOLs, when wearing the denture, and when not wearing the denture.

RESULTS

Notably, 25.4% of denture wearers required no adjustments, while 14.4% necessitated more than three revisions. A majority (71.8%) of DIOLs cases were associated with mandibular complete dentures, primarily situated on the alveolar ridge. The mean VPS indicated a pain intensity of 7 ± 2.1, with temporary dentures in both jaws causing the most discomfort. Implant-supported overdentures were particularly painful when placed in the mandible. Additionally, VPS scores were higher among older individuals and those with prior prosthetic experiences. A significant correlation was observed between pain intensity and presence of chronic health condition (0.036).

CONCLUSIONS

This study revealed distinct characteristics of DIOLs and highlighted the multifactorial nature of pain experienced following the development of DIOLs. Insights into the influence of patient and denture characteristics on DIOLs and pain intensity can guide healthcare professionals in optimising patient comfort and satisfaction.

Prevalence and association of oral manifestations with disease severity in patients diagnosed with COVID‑19: A cross‑sectional study

Systemic disorders may exhibit early signs when conducting an oral examination. Since the onset of the COVID-19 pandemic, several studies have been published detailing the direct impact of the virus on the oral cavity. The present study aimed to determine whether indeed there are any significant disparities in oropharyngeal manifestations between individuals infected with severe acute respiratory syndrome coronavirus 2 and a control group, and whether the virus has the ability to invade and reproduce inside oral keratinocytes and fibroblasts, resulting in the development of oral ulcerations and superficial lesions. The present study provides an overview of the symptoms that occur at an early stage of the illness, and the most commonly affected regions of the oral cavity, including the tongue, lips, palate and oropharynx are examined. In the present retrospective study, 52 patients infected with COVID-19 were recruited between April, 2021 and October, 2022. In addition, 52 individuals who tested negative for the virus were recruited as the control group. The study was conducted through a thorough examination and questionnaire provided to all participants. The results revealed that among the cohort of patients from the COVID-19 group examined (n=52), a proportion (mean, 16.15) displayed oral manifestations. Specifically, 75% of the patients in the COVID-19 group described oral cavity pain, and 69% of these patients had changes in teeth color or dental caries. In summary, in relation to the control group, the prevalence of oropharyngeal symptoms was generally lower compared to the COVID-19 group, apart from oral cavity pain (30.8%), tonsillitis (17.3%), bleeding (34.6%), teeth color changes (36.5%), recurrence (15.4%) and abscesses (7.7%). Thus, on the whole, the patients without COVID-19 had fewer oral manifestations.

Prevalence and clinical markers of herpes simplex virus infection in oral lesions of bullous pemphigoid

Background

The manifestations of bullous pemphigoid (BP) and herpes simplex virus (HSV) infection are similar in oral mucosa, and the laboratory detection of HSV has some limitations, making it difficult to identify the HSV infection in oral lesions of BP. In addition, the treatments for BP and HSV infection have contradictory aspects. Thus, it is important to identify the HSV infection in BP patients in time.

Objective

To identify the prevalence and clinical markers of HSV infection in oral lesions of BP.

Methods

This prospective cross-sectional descriptive analytical study was conducted on 42 BP patients with oral lesions. A total of 32 BP patients without oral lesions and 41 healthy individuals were enrolled as control groups. Polymerase chain reaction was used to detect HSV. Clinical and laboratory characteristics of patients with HSV infection were compared with those without infection.

Results

A total of 19 (45.2%) BP patients with oral lesions, none (0.0%) BP patients without oral lesions, and four (9.8%) healthy individuals were positive for HSV on oral mucosa. Among BP patients with oral lesions, the inconsistent activity between oral and skin lesions (p=0.001), absence of blister/blood blister in oral lesions (p=0.020), and pain for oral lesions (p=0.014) were more often seen in HSV-positive than HSV-negative BP patients; the dosage of glucocorticoid (p=0.023) and the accumulated glucocorticoid dosage in the last 2 weeks (2-week AGC dosage) (p=0.018) were higher in HSV-positive BP patients. Combining the above five variables as test variable, the AUC was 0.898 (p<0.001) with HSV infection as state variable in ROC analysis. The absence of blister/blood blister in oral lesions (p=0.030) and pain for oral lesions (p=0.038) were found to be independent predictors of HSV infection in multivariable analysis. A total of 14 (73.7%) HSV-positive BP patients were treated with 2-week famciclovir and the oral mucosa BPDAI scores significantly decreased (p<0.001).

Conclusion

HSV infection is common in BP oral lesions. The inconsistent activity between oral and skin lesions, absence of blister in oral lesions, pain for oral lesions, higher currently used glucocorticoid dosage, and higher 2-week AGC dosage in BP patients should alert physicians to HSV infection in oral lesions and treat them with 2-week famciclovir in time.

Case report: Rare oral manifestations in Cowden syndrome with PTEN mutation

Background

Cowden syndrome (CS) is a rare genetic disorder associated with PTEN gene mutations. It is characterized by macrocephaly, specific mucocutaneous features, and a predisposition to benign and malignant tumors. Cases of CS primarily presenting with oral clinical manifestations are relatively uncommon.

Methods/Results

We report the case of a 41-year-old male proband who presented with bilateral commissural and lingual externally projecting symmetric lesions for over two years. The proband also exhibited other features, including macrocephaly, communication difficulties, and obesity. Similar oral clinical manifestations were observed in family members. Whole exome sequencing analysis revealed PTEN gene mutations associated with CS in both the proband and his younger brother. This case serves as a reminder to be aware of the diverse presentations of CS in oral clinical practice and highlights the importance of genetic testing for guiding diagnosis and treatment.

Conclusion

There are few reported cases of CS primarily presenting with oral lesions. This finding contributes to further understanding of certain aspects of the pathogenesis of CS and enhances awareness of CS cases primarily exhibiting oral clinical manifestations.

Smartphone oral self-photography in teledentistry: Recommendations for the patient

In the current context of the coronavirus disease 2019 pandemic, the deployment of telemedicine has accelerated considerably. Like telemedicine, teledentistry involves the use of telecommunication technologies to provide medical information and services. Teledentistry can contribute to remote assessment (teletriage) and continuity of care (telemonitoring). This evaluation at a distance can be done by sending photos taken by the patient with a smartphone. Providing patients with a simple and reproducible protocol and explaining how to take a photo is important for sufficient image quality. The aim of this technical note is to help clinicians advise their patients on how to take photographs of their oral cavity simply and with sufficient quality to be reproducible.

Oral lesions in adult- and juvenile-onset systemic lupus erythematosus patients: A case series report

Systemic lupus erythematosus (SLE) is an autoimmune disease with various oral manifestations, including ulceration, white keratotic plaques, oral discoid lupus erythematosus, oral lichen planus (OLP)-like lesions, non-specific erythema, purpura, petechiae, and cheilitis, which resemble lesions of other systemic diseases. Recognizing the oral manifestation of SLE is essential for comprehensive patient management. This study reports 4 cases of SLE with various oral lesions, underlying conditions and diagnostic methods.In September 2019, 2 adult SLE patients and 2 juvenile SLE patients were consulted at the Oral Medicine Clinic. The assessment of systemic diseases was conducted by the Internal Medicine and Pediatrics resident, whereas the Oral Medicine resident performed the intraoral examinations. The medical history, clinical findings and laboratory results were analyzed to establish the diagnosis.The first patient was a 38-year-old female presenting with multiple white keratotic plaques throughout the mucosa, an OLP-like lesion on the right buccal mucosa, petechiae on the hard palate, and petechiae and purpura on the upper and lower extremities. The second case was a 24-year-old female with a malar rash and multiple ulcerations on the vermilion zone, an OLP-like lesion on the left buccal mucosa, and a palatal ulcer. The third and fourth cases were 16-year-old females with a prominent butterfly rash. The patients presented with acute pseudomembranous candidiasis, an aphthous-like ulcer and keratotic plaques. They received antimicrobial therapy for the intraoral lesions and showed promising results.The oral lesions in adultand juvenile-onset SLE patients varied depending on the disease severity and treatment received.

Retrospective Broiler Health Survey: Scope, Parameters, and Overall Trends

A retrospective analysis encompassing 18 yr (1999-2016) of broiler chicken health surveys from broiler production complexes throughout the United States was conducted to identify trends and areas of opportunity. The analysis used necropsy data from 19,577 broiler chickens considered to be "healthy" or "clinically normal" by visual assessment. The very low incidence of dehydrated (0.01%) or undersized (0.02%) broilers is evidence that the objective of examining "healthy" birds was achieved. The results of the correlation analysis were what was expected for "healthy" broilers, with these birds having positive correlations with skin color and size of the bursa of Fabricius. The average age of broilers included in this analysis ranged from 26.2 days in 2008 to 33.7 days in 2013. The percentage of "normal" broilers (those without visible lesions or abnormalities) varied from 5.63% in 2012 to 28.33% in 1999. The results of this study identified four areas of opportunity for improving poultry health: 1) coccidiosis, 2) oral lesions and gizzard erosions, 3) retained yolks, and 4) pododermatitis.

Contribution to the study of inflammasome and programmed cell death in paracoccidioidomycosis oral lesions

BACKGROUND

Paracoccidioidomycosis is the most prevalent systemic mycosis in Latin America, with a high incidence in Brazil, Colombia and Venezuela, and constitutes a serious public health problem, a frequent cause of morbidity and disability for work. Some mechanisms of cell death are described as important tools in infectious processes. When apoptosis is blocked, RIPK (Receptor-interacting protein kinase) 3 dependent, a caspase-independent form of cell death, can limit the replication and spread of pathogens. Some molecules that mediate necroptosis include RIPK3 and have been extensively studied due to their signalling mechanism and pathological function. RIPK3 activates NLRP1 and NLRP3-mediated inflammasome formation. Caspase-1 has an important role in processing the cytokines ILβ and IL18 to their active form. Such molecules are part of the inflammasome characterization, whose caspase-1-dependent activation promotes the death of pyroptotic cells and the secretion of proinflammatory cytokines. Knowledge about the mechanisms of pathogen-mediated cell death can be useful for understanding of the pathogenesis of infections and inflammatory conditions.

OBJECTIVE

The objective of this work was to identify the mechanisms of programmed cell death and inflammasome components in human oral mucosal lesions of paracoccidioidomycosis through immunohistochemical methods and identification of RIPK-3, IL1β, IL18, NLRP-1 and caspase-1. Thirty specimens were included, and a histopathological analysis of the lesions was performed using haematoxylin-eosin staining.

RESULTS

Our results on in situ expression of inflammasome elements and programmed cell death showed increased expression of IL-1β, NLRP-1, caspase-1 and RIPK-3. We suggest that inflammasome complex participate in the immunopathogenesis in paracoccidioidomycosis oral lesions in an interplay with RIPK3.

A reflection on COVID-19 and oral mucosal lesion: a systematic review

Introduction

The aim of this systematic review is to provide a clinical update of the current knowledge on COVID-19 and oral mucosal lesions, to analyze the types and prevalence of oral mucosal lesions in patients with COVID-19, and to clarify the potential association between COVID-19 and oral mucosal lesions.

Methods

The literature search was conducted using PubMed, Web of Science, Scopus and the Cochrane Library, as well as literatures via manual searches of the reference lists of included studies. Studies published in English that mentioned oral mucosal lesions in patients with COVID-19 were included, resulting in a total of 31 studies.

Results

Most of the included studies were considered to have a moderate to high risk of bias according to the Joanna Briggs Institute bias assessment tools. Based on COVID-19 severity, the characteristics and patterns of oral mucosal lesions in COVID-19 patients were described, analyzed and synthesized. Overall, ulcers without specific diagnosis had the highest prevalence in COVID-19 patients, followed by traumatic ulcers, candidiasis, petechiae and aphthous-like lesions. Homogeneity of data cannot be achieved in statical analysis, indicating randomness of outcome (ulcers without specific diagnosis, 95% CI: 28%-96%, I2 = 98.7%).

Discussion

Given the limited evidence from currently available studies, the association between COVID-19 and oral mucosal lesions remains difficult to clarify. Healthcare professionals should be aware of the possible association between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.

Oral mucosa and cutaneous manifestations of psoriasis in an older patient: A case report

BACKGROUND

Psoriasis is a common cutaneous disease; however, information about psoriasis-related oral mucosal lesions is scarce in the literature.

CASE DESCRIPTION

We report a case of a 73-year-old male patient with cutaneous and oral palatal alterations. An incisional biopsy of these lesions revealed psoriasis.

CONCLUSION

The current case highlights the importance of a systematic examination of the oral cavity in psoriasis patients for the appropriate diagnosis and management on the control of these lesions.

Canine oral lesions: a decision-tree approach to ulcers, leukoplakia, and pigmented lesions

Lesions in the oral cavity of dogs can be erythematous, leukoplakic, or pigmented in coloration. The diagnosis of oral erosions, ulcers, and white lesions in contrast to pigmented lesions in veterinary practice can be challenging. The most benign-looking oral ulcers can be associated with local malignant or systemic disease. Many factors are important in the evaluation and correct diagnosis of oral lesions, including medical and drug history, description of the lesion, number of lesions, depth of the lesion, biopsy technique, and correct histologic interpretation. The goal of this paper is to create a decision tree to guide the classification and proper diagnosis of canine oral mucosal lesions.

Prevalence of oral lesions and evaluation of the periodontal status among diabetic females attending Princess Nourah Bint Abdulrahman University (PNU)

Objective

To evaluate the prevalence of different oral lesions and periodontal status among diabetic Saudi female patients in the College of Dentistry, PNU University.

Materials and Method

A retrospective study was performed by reviewing the files of all patients who visited the College of Dentistry, PNU University, during the last 5 years. We selected diabetic 20-40-year-old Saudi female patients. Ethical approval was obtained from the Institutional Review Board of PNU University. Data collection sheets were used to gather information on demographics, education, medical and dental history, and extra and intra-oral findings. Data on the duration of diabetes, any major complications, and type of diabetes therapy were retrieved from medical records. The data were entered into an Excel sheet, and descriptive statistics were performed. The analytical phase proceeded to correlate oral lesions with patient age, type of diabetes, and periodontal status.

Result

A total of 226 diabetic patients were found after reviewing the records. The most common oral mucosal lesions were traumatic ulcers (10.2%), cheek biting (8.8%), and fissured tongue (8.4%). Furthermore, 81.86% of them had periodontitis, and 18.14% had a healthy periodontal status.

Conclusion

The prevalence of periodontitis among diabetic female patients is higher than that of oral lesions. Stage III periodontitis showed the strongest association to oral lesion.

Ultrasonographic features of mass lesions in the oral submucosal epithelium using intraoral ultrasonography

BACKGROUND

Mass lesions occurring under the oral mucosal epithelium are often small and difficult to diagnose; however, intraoral ultrasonography can delineate these lesions. We aimed to investigate the features of submucosal mass lesions in the oral cavity using intraoral ultrasonography.

METHODS

Fifty patients with hemangioma, irritation fibroma, mucous cyst, lipoma, and pleomorphic adenoma were included. Age, site, largest diameter, thickness, marginal morphology type, border type, internal echo posterior echo, and internal or peripheral Doppler images of the lesions were recorded.

RESULTS

The hemangiomas were internally hypoechoic and exhibited a cord-like structure; irritation fibromas, mainly internally isoechoic; mucous cysts, hypoechoic; and the lipomas appeared as homogeneous, isoechoic, or hyperechoic images with unclear borders. Pleomorphic adenomas were surrounded by a single hypoechoic zone, suggesting a thick capsular structure, were predominantly isoechoic internally, and appeared as cyst-like hypoechoic images.

CONCLUSIONS

The features of the lesions were identified and delineated using intraoral ultrasonography.

Benign and Malignant Oral Lesion Image Classification Using Fine-Tuned Transfer Learning Techniques

Oral lesions are a prevalent manifestation of oral disease, and the timely identification of oral lesions is imperative for effective intervention. Fortunately, deep learning algorithms have shown great potential for automated lesion detection. The primary aim of this study was to employ deep learning-based image classification algorithms to identify oral lesions. We used three deep learning models, namely VGG19, DeIT, and MobileNet, to assess the efficacy of various categorization methods. To evaluate the accuracy and reliability of the models, we employed a dataset consisting of oral pictures encompassing two distinct categories: benign and malignant lesions. The experimental findings indicate that VGG19 and MobileNet attained an almost perfect accuracy rate of 100%, while DeIT achieved a slightly lower accuracy rate of 98.73%. The results of this study indicate that deep learning algorithms for picture classification demonstrate a high level of effectiveness in detecting oral lesions by achieving 100% for VGG19 and MobileNet and 98.73% for DeIT. Specifically, the VGG19 and MobileNet models exhibit notable suitability for this particular task.

COVID-19 and Oral Mucosal Lesions: a Systematic Review

Introduction

COVID-19 disease is caused by a mutated strain of the coronavirus family "SARS-CoV-2". It affects especially the respiratory system, but many clinical manifestations outside this system have been reported. Oral manifestations are uncommon, however, with the absence of common signs, they may represent the onset of COVID-19 disease. The aim of this systematic review is to observe if there is a correlation between SARS-CoV-2 infection and oral manifestations.

Methods

The research was conducted on PubMed, Scopus, Google Scholars and Cochrane Library from March 2020 to May 2023. Each study was subjected to data extraction; including authors, year and month of publication, study type, patients' average age, type and localization of oral lesions, the positivity of the SARS-CoV-2 virus test, and comorbidities.

Results

A total of 43 studies met the inclusion criteria and a total of 507 COVID-19 patients with 496 oral lesions were included. The most frequent was ulceration and the most common localization was the tongue.

Conclusions

The results of our systematic review show a possible correlation between COVID-19 infection and oral manifestations. Further studies are required to determine if the lesions are directly connected to the virus.

Differential expression of cancer stem cell markers and pro-inflammatory cytokine IL-1β in the oral squamous cell carcinoma and oral submucosal fibrosis

Objectives

The poor prognosis of oral squamous cell carcinoma (OSCC) is vastly due to late diagnosis. The oral submucosal fibrosis (OSMF) is often unnoticed pathology linked with high risk of malignancy. Recently, we demonstrated that the clinicopathological alterations in OSMF and OSCC patients were correlated with cancer stem cell (CSCs) markers (CD133 and CD44). However, the parallel alterations of interleukin-1 beta (IL-1β) with CSCs expression are largely unexplored. Thus, we aimed to investigate the relationship between IL-1β alterations and CSC marker expression in both OSMF and OSCC situations.

Materials and Methods

A total of 135 people have signed up for the study. There were sixty each in OSMF and OSCC groups, as well as 15 healthy controls. Levels of serum IL-1β were examined by ELISA. Immunohistochemistry (IHC) was used to examine the expression of CD133 and CD44. For evaluating differential CSCs expression, IHC scoring (0-4) was utilized.

Results

The IHC results showed maximum subjects in the OSMF and OSCC displaying CD44 and CD133 positivity, although the extent of expression in terms of IHC scoring found variable. CD133 and CD44-positive subjects showed increased levels of IL-1β in the OSMF and OSCC group. Nevertheless, the enhancement of IL-1β is more pronounced in the OSCC cases. Further, we observed a direct link of IL-1β levels with IHC scoring. Multivariate regression analysis demonstrated a significant role for CD44 and CD133 positivity in the increase of IL-1β levels.

Conclusion

We concluded that concurrent simultaneous changes in CSC biomarkers and IL-1β may help with early detection of OSMF and OSCC conditions.

Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report

Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.

Oral Manifestations of Crohn's Disease: A Systematic Review

Crohn's disease (CD) is a chronic inflammatory intestinal condition that can affect the entire gastrointestinal tract. It is characterized by its clinical heterogeneity and irregularities in its course. The etiology and pathogenesis are not well established, so it is difficult to establish an early diagnosis and an effective treatment plan. The objective of this systematic review was to present a qualitative synthesis of the studies referring to the oral manifestations of CD. This systematic review was carried out following the PRISMA guide. Research was conducted in the Pubmed, Web of Science, Scopus, Scielo, and Cocrahne Library databases on 23 February 2023, and updated on 1 September 2023. Articles published between 2012 and 2023 were selected. Articles that analyzed the oral manifestation of CD patients and met the established search terms. In addition, the quality of all the selected studies was analyzed following the CARE guidelines for case reports and the STROBE scale for observational studies. A total of 19 articles were included in this review that met the inclusion criteria. Regarding the oral manifestation of CD, oral ulcers, angular cheilitis, and gingivitis stand out. Periodontitis and vegetative pyostomatitis were the least representative manifestations. The most prevalent locations were lips, mucosa, and gingivae. Ulcers, gingivitis, and angular cheilitis are the most frequent oral manifestations in patients with CD. Their early identification and possible relationship with the disease are important for an early diagnosis and an adequate treatment plan.

Artificial Intelligence-Based Diagnosis of Oral Lichen Planus Using Deep Convolutional Neural Networks

OBJECTIVE

 The aim of this study was to employ artificial intelligence (AI) via convolutional neural network (CNN) for the separation of oral lichen planus (OLP) and non-OLP in biopsy-proven clinical cases of OLP and non-OLP.

MATERIALS AND METHODS

 Data comprised of clinical photographs of 609 OLP and 480 non-OLP which diagnosis has been confirmed histopathologically. Fifty-five photographs from the OLP and non-OLP groups were randomly selected for use as the test dataset, while the remaining were used as training and validation datasets. Data augmentation was performed on the training dataset to increase the number and variation of photographs. Performance metrics for the CNN model performance included accuracy, positive predictive value, negative predictive value, sensitivity, specificity, and F1-score. Gradient-weighted class activation mapping was also used to visualize the important regions associated with discriminative clinical features on which the model relies.

RESULTS

 All the selected CNN models were able to diagnose OLP and non-OLP lesions using photographs. The performance of the Xception model was significantly higher than that of the other models in terms of overall accuracy and F1-score.

CONCLUSIONS

 Our demonstration shows that CNN models can achieve an accuracy of 82 to 88%. Xception model performed the best in terms of both accuracy and F1-score.

[Impact of acute lymphoblastic leukemia on the microbiome and oral lesions: scoping review]

Objective

To describe the existing knowledge about the alterations of the MBO oral microbiome and the presence of OL Oral Lesions in patients with Acute Lymphoblastic Leukemia ALL.

Materials and Methods

An electronic search was carried out in the PubMed, SciELO, and academic Google databases, and descriptive, analytical, observational articles on MBO, OL, and ALL were included, following the PRISMA criteria. 642 were evaluated, duplicate articles, case reports, and those where only changes were reported during or after chemotherapy treatment were eliminated.

Results

10 articles were evaluated, published between 1997 and 2021, 4 articles agreed that the MBO of patients with ALL is in dysbiosis showing a significant increase in firmicutes 0.1%, bacillus 0.05%, and opportunistic bacteria such as Moraxella spp, Klebsiella spp 5.66%, Pseudomonas spp 3.77%, Enterobacter spp 1.88%, Acinetobacter spp 1.88% and E. coli 1.08%, the most frequent OL reported in 5 articles were spontaneous gingival bleeding 3.5%, gingivitis 25% and ulcers 9.4%.

Conclusions

The oral cavity of patients with ALL is in dysbiosis and associated OL is identified. It is necessary to establish preventive strategies with a niche-ecological approach to restore the MBO, to reduce the risk of opportunistic infections and other OL during chemotherapy treatment.

An insight into perceptions of general pathologists about the need for oral pathology services: An observational study

Objective

The objective of this study was to identify the degree of perception of oral pathology as a specialty among the general pathologists and the need of utilizing oral pathologists in assisting to identify oral lesions in diagnostic challenges.

Methods

A questionnaire-based survey was conducted among qualified general pathologists to collect the data. The survey items focused on various aspects, including the analysis of oral pathology as a specialty, the importance of employing oral pathologists for identifying oral lesions in diagnostic challenges, and the difficulties encountered in managing such lesions. The data collected was analyzed using descriptive and inferential statistics. For comparing the relationship between work experience and the referral of odontogenic cysts and tumors cases, a Chi-square test was employed. A significance level of p ⩽ 0.05 was deemed as statistically significant.

Results

Two hundred and fifty general pathologists responded to the questionnaire. Two hundred and thirty two (92.8%) participants showed awareness of oral pathology as a specialty. For the diagnosis of oral, jaws, and salivary glands pathologic lesions, the majority 198 (79.2%) respondents believed that oral pathologists are required for the diagnosis. Regarding the referrals of lesions to oral pathologists, 137 (54.8%), participants did not refer. In terms of training in oral pathology, all of the participants agreed that they would undertake short-term posting in oral pathology. For challenging cases, all the general pathologists believed that oral pathologists should be part of the team.

Conclusion

The general pathologists recognized oral pathology as a specialty and feel the need for an oral pathologist opinion in diagnosis. However, most of the general pathologists did not refer the complex cases to oral pathologists. Therefore, it is of paramount importance to encourage oral pathologists and their hiring at histopathology laboratories that are diagnosing complex head and neck cases.

Analysis of Discrepancy Index between Clinical and Histopathological Diagnosis of Oral Lesions

OBJECTIVE

To analyze the discrepancy index between the clinical and histological diagnosis of oral lesions.

MATERIALS AND METHOD

A sample of 910 cases from year 2013-2021 were analyzed using non probability convenience sampling technique. This included patient records and histopathological reports of patients treated at IIDC & H and FUCD & H. Clinical presentations were classified under five categories; growth/swelling, vesico-ulcerative, white, red/pigmented, and cystic lesions. To evaluate the details of diagnostic discrepancies, the data was categorized into 4 major groups: 1) Neoplastic-Neoplastic,2) Non-Neoplastic-Non-Neoplastic ,3) Neoplastic-Non-Neoplastic and 4) Non-Neoplastic-Neoplastic. The association between clinical diagnosis and histopathological diagnosis was calculated by using pearson chi square test and statistical significance was considered with the p value less than (0.05).

RESULTS

Most common clinical presentation was swelling/growth; 601 (66%), followed by ulceration; 223 (24.5%). There were 528 (58%) incisional and 382 (42%) excisional biopsies. The definitive diagnosis based on histopathological findings showed malignant neoplasms as the commonest category; 287 (31.5%) followed by inflammatory/reactive lesions 271 (29.8%). A consensus was noted between the clinical and histologic diagnosis in 74.8% cases, while a discrepancy index of 25.1 % was calculated. Regarding diagnostic discrepancy among four major categories of our research, maximum discrepancy was noted in neoplastic-nonneoplastic category (29.6%) and minimum discrepancy was noted in malignant - benign category (2.7%).  Statistically significant difference between the clinical and histopathological diagnosis was observed with a p value of 0.000.

CONCLUSION

Considerable amount of diagnostic discordance was observed in all types of pathologies analyzed in the study.

Child abuse and neglect: oral and dental signs and the role of the dentist

Historically, the law, dental and forensic literature has included numerous articles concerning abused children. The orofacial structures are injured frequently in the maltreated child. Injuries of the neck, head, face, and oral cavity represent the most affected areas of the victim's body that routinely sustain physical trauma in child maltreatment cases. This literature review aimed to report the state of art of child abuse from the point of view of the dentist with focus on studies in dental aspects of child abuse and neglect of the last ten years. Considering the time slot, 20 papers were included with the following inclusion criteria: papers published in English, all keywords included in the title, articles available on PubMed. Many of the injuries are within the scope of dentistry or easily observed by the dental professional during routine dental treatment, and it is essential that the dentist recognizes them. Concerning neglect, it is appropriate to make a distinction between deliberate parental behavior that has the consequence of unavoidable and voluntary neglect towards their children and those conditions of involuntary carelessness determined by socio-economic and cultural factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health. Therefore, it is relevant that the dentist pays attention to the cases to report and those that only need help.

In Vitro Evaluation of Antioxidant and Anti-inflammatory Potentials of Herbal Formulation Containing Marigold Flower (Calendula officinalis L.) Tea

Aim To assess the anti-inflammatory and antioxidant properties of Calendula officinalis tea formulation. Materials and methods In this study, a formulation of 2 grams of dried marigold flower petals and 100 milliliters (ml) of distilled water was subjected to anti-inflammatory testing using albumin denaturation assay and anti-protease activity and antioxidant testing by DPPH (2,2-diphenyl-1-picryl-hydrazyl-hydrate) assay. An independent sample t-test was done to compare the anti-inflammatory and antioxidant potentials of marigold tea formulation and control using SPSS version 22.0 software (IBM Corp., Armonk, NY), and any p-value less than 0.05 was considered statistically significant. Results The highest anti-inflammatory and antioxidant activities of marigold extract were exhibited at 10 microliters (µl) and 20 µl (p-value = 0.002 and 0.000), respectively. The anti-inflammatory activity was higher than the control at all concentrations, whereas the antioxidant activity was higher at lower concentrations when compared to higher concentrations. Conclusion Marigold flower tea formulation exhibited better anti-inflammatory and antioxidant activities than the controls and therefore could be evaluated as a potential therapeutic agent.

The use of teledentistry in clinical oral and maxillofacial pathology practice: an institutional experience

Background

Although there has been a slight increase in dental professionals since 2011, 98 of North Carolina's 100 counties are designated as Dental Health Professional Shortage Areas by the Heath Resources and Service Administration. This shortage significantly increases disparities and access to primary and specialized oral health care. Also, dental professionals in these remote locations may feel the access and referrals to oral and maxillofacial pathologists cumbersome. In 2020, the COVID-19 pandemic prompted an inevitable surge in the use of digital technology due to the social distancing norms and lockdowns, which forced dental education institutions and practitioners to adjust to new ways of meeting, teaching, and providing dental care. In the present manuscript, we report our institutional experience delivering specialized dental care in rural areas.

Materials and methods

We conducted a retrospective case series of diagnosis, management, and outcomes of patients who underwent synchronous or asynchronous virtual and remote examination of oral lesions at ECU School of Dental Medicine and one satellite clinic over seven years. For those cases that concluded on surgical sampling, the clinical impressions, differential diagnoses, and the final diagnosis were compared to assess the accuracy of the clinical exam through teledentistry.

Results

The total study population consisted of 71 patients. Most of the remote consultations were done asynchronously. Also, most virtual clinical consultations were initiated due to clinical suspicion of malignancy and infectious/reactive conditions, accounting for 42% and 25.3% of all encounters.

Conclusions

The presented data suggest how teledentistry can support clinical practice in rural areas to achieve optimal care for the patient in rural or remote communities. Also, it significantly decreases the travel required, the number of appointments, and increases the speed of diagnosis. Teledentistry is an excellent tool available to all clinicians and can dramatically aid in diagnosing oral mucosa lesions.

Effectiveness of Photobiomodulation in Reducing Pain of Oral Mucosal Diseases: A Case Series

Introduction

Pain management becomes important in the treatment of oral mucosal diseases since it can impair the quality of life. Photobiomodulation (PBM) as an alternative therapy, has potency in reducing pain through several mechanisms targeting peripheral nerves in the target tissue.

Purpose

To discuss the effectiveness of PBM in the management of four cases of oral mucosal diseases.

Case

Four patients, two females and two males, with an age ranging from 24 to 63 years came to the Oral Medicine Department complaining of painful lesions in their oral cavity. Three cases showed ulceration of the oral mucosa and had been diagnosed with recurrent aphthous stomatitis, recalcitrant chronic ulcer, and non-specific chronic sialadenitis. One patient who complained of intense pain and swelling on the right side of the face was diagnosed with post-herpetic neuralgia (PHN).

Case Management

PBM was administered in all four cases (976 nm diode laser, three cases with spot size 0.01 cm², fluency 10 J/cm², and one case with spot size 0.5 cm²; fluency 3 J/cm²). Visual analog scale (VAS) control was performed before and after the PBM at each visit. The recorded VAS results show a reduction in pain that started at the post-laser time, with VAS before PBM ranging from 5 to 7 and after PBM ranging from 0 to 4. Three patients were given triamcinolone acetonide 0.1%, chlorhexidine gluconate 0.2% mouthwash, petroleum jelly, and multivitamins. One patient was given mefenamic acid and multivitamins.

Conclusion

PBM can be a useful adjunctive treatment to relieve the pain of oral mucosal diseases due to its ability to reduce pain intensity.

Oral Lesions as the Primary Manifestations of Behçet's Disease: The Importance of Interdisciplinary Diagnostics-A Case Report

BACKGROUND

Behçet's disease (BD) is a rare chronic auto-inflammatory systemic disease with non-specific oral manifestations, categorised as generalised variable vessel vasculitis that requires an interdisciplinary approach to diagnose due to its phenotypic heterogeneity. Whilst the oral lesions that reoccur in BD underpin the complex diagnostic process, the crucial role of dental professionals is highlighted in a case report summarised herein. We present a case of a 47-year-old male referred to the Oral Medicine Department by a rheumatologist after previous hospitalization for thrombosis of the iliac vein and inferior vena cava. He had elevated inflammatory C-reactive protein biomarker and an increased erythrocyte sedimentation rate. Recurrent episodes of folliculitis, oral and genital ulcers were reported. Clinical examination revealed multiple ulcerations in the oral mucosa. The complementary, histopathological analysis performed to rule out other disorders, based on excisional biopsy, showed non-keratinised stratified squamous epithelium with areas of exocytosis and ulceration. The connective tissue presented an intense mixed inflammatory infiltrate, congested blood vessels, haemorrhage, vasculitis, and HLA-B genotyping identified the expression of HLA-B15, further supporting the BD diagnosis. Treatment was initiated with colchicine, prednisolone, and weekly subcutaneous administration of methotrexate and resulted in the complete remission of oral lesions and no recurrence of other manifestations.

CONCLUSIONS

This BD case report emphasizes the importance of a multidisciplinary approach in diagnosing BD, including the use of histopathological assessment and genetic profiling. It highlights the significance of thorough intraoral assessment and referral to a multidisciplinary team for diagnosis. The oral manifestations of BD as the primary symptoms often indicate underlying major systemic pathologies. The authors stress the need for a structured diagnostic algorithm to facilitate timely and effective management of BD.

Formulation and Evaluation of Chitosan-PLGA Biocomposite Scaffolds Incorporated with Quercetin Liposomes Made by QbD Approach for Improved Healing of Oral Lesions

The current research aims to develop and evaluate chitosan-PLGA biocomposite scaffolds in combination with quercetin liposomes to accomplish the desired impact in oral lesions where pharmacotherapeutic agent treatment through circulation could only reach the low content at the target. Optimization of quercetin-loaded liposomes was carried out using 32 factorial design. The preparation of porous scaffolds comprising produced quercetin-loaded liposomes by thin-film method was carried out in the current study using a unique strategy combining solvent casting and gas foaming procedures. The prepared scaffolds were tested for physicochemical properties, in vitro quercetin release study, ex vivo drug permeation and retention research using goat mucosa, antibacterial activity, and cell migration studies on fibroblast L929 cell lines. Improved cell growth and migration were seen in the order control < liposomes < proposed system. The proposed system has been examined for its biological and physicochemical features, and it has the potential to be utilized as an efficient therapy for oral lesions.

HPV-Related Oral Lesions: YouTube Videos Suitability for Preventive Interventions including Mass-Reach Health Communication and Promotion of HPV Vaccination

Given the need to improve patient knowledge about HPV-related oral lesions, awareness of HPV infection prevention measures, and compliance with vaccination, as well as patient demand for free and easy access to well-tailored and time-saving health information, the present cross-sectional study examined the accuracy of relevant YouTube videos and their suitability for mass-reach health communication and HPV vaccination promotion. A video search was performed, using keywords obtained from the Google Trends website, until 9 January 2023. Video selection and data collection were performed by independent, pre-calibrated examiners. Descriptive statistics were performed on videos' general characteristics, source reliability, popularity, information and quality, content topics, vaccination-encouraging/discouraging messages, and educational value. Pearson's correlation was calculated between educational value and all parameters. Mann-Whitney U test compared very low/low vs. medium/good/excellent educational value and HPV vaccination-encouraging vs. -discouraging videos. Most of the 97 YouTube videos analyzed were moderately accurate and reliable, 53% had moderate/good/excellent educational value, and 80% encouraged HPV vaccination, making them suitable for mass-reach communication. The limited role of oral healthcare providers in uploading relevant content, with the poor dissemination of information about HPV-related benign and malignant oral lesions, may be expanded by purposefully using YouTube and other mass media to improve patient knowledge of HPV-related oral lesions and promote HPV vaccination, which also underscores its potential beneficial oral effects.

Histopathological significance of necrosis in oral lesions: A review

Necrosis is a localized area of tissue death followed by degradation of tissue by hydrolytic enzymes released from the dead cells, resulting in swelling of organelles, rupture of the plasma membrane, eventual cell lysis, and leakage of intracellular contents into the surrounding tissue. It is always accompanied by an inflammatory reaction. Necrosis is caused by various factors such as hypoxia, physical factors, chemical agents, immunological agents, and microbial agents. Still now, there is no literature review regarding the necrotic lesions of the oral cavity. In this paper, the oral lesions associated with necrosis are categorized under the headings such as odontogenic cysts, odontogenic tumors, salivary gland pathology, and epithelial malignancies. In addition, the histopathological significance of necrosis in oral lesions has been discussed. By suggesting that spotting necrosis in the histopathology aids in determining the diagnosis, tumor behavior, and prognosis of oral lesions.

Reactivated herpetic gingivostomatitis with secondary herpes‐associated erythema multiforme and oral candidiasis post‐COVID infection: A case report

The presence and reactivation of oral lesions such as herpetic gingivostomatitis, erythema multiforme, and candidiasis in a COVID‐19 recovered patient could be related to COVID‐19s profound role in immune dysregulation or related therapies.

Localized CO2 laser treatment of a recalcitrant oral ulceration in pemphigus vulgaris

INTRODUCTION

Recalcitrant oral lesions of pemphigus vulgaris (PV), an autoimmune blistering disease, can result in significant discomfort, difficulty in eating, and maintaining oral hygiene. Increasing the dosage of systemic medications to control such localized lesions results in an increased risk of adverse effects.

CASE PRESENTATION

We describe a male patient diagnosed at age 51 with PV by oral biopsy that included a direct immunofluorescence examination. After further baseline laboratory testing, he was started on prednisone and mycophenolate. These medications were slowly tapered with adjustments guided by clinical signs. Mycophenolate was replaced with intravenous immunoglobulin monthly infusions due to adverse effects about 2 years after initiation. During the 4.5-year follow-up period after diagnosis, his oral and skin lesions were well-controlled apart from minor transient flares. However, a painful ulcerated lesion on the facial gingiva between #11 and 12 was nonresponsive, even with the use of topical clobetasol in trays. A carbon dioxide (CO₂ ) laser was used to vaporize the recalcitrant lesion under local anesthesia. The procedure resulted in complete healing of ulceration with no recurrence until the most recent examination, 2 years postlaser surgery.

CONCLUSION

Adjunctive procedures that can facilitate a decrease in the cumulative dosage of corticosteroids and immunosuppressants have great value in the management of PV. CO₂ laser vaporization is safe, with minimal morbidity and no long-term side effects. It should be considered an adjunctive treatment option for the management of recalcitrant lesions in patients with oral PV.

KEY POINTS

Why is this case new information? To our knowledge, this is the second report on the use of a CO₂ laser in the treatment of recalcitrant oral lesions of PV and the first report with a documented long-term resolution of the treated lesions. What are the keys to the successful management of this case? A localized recalcitrant lesion was treated with this approach. All other mucosal and cutaneous sites were well controlled on the patient's systemic medication regimen. What are the primary limitations to success in this case? This approach is only relevant for the management of recalcitrant lesions in patients whose disease activity is otherwise well controlled. The availability of specialized equipment and trained clinicians is necessary.

A cross-sectional study among Norwegian adolescents

OBJECTIVE

Use of snus, a moist, smokeless tobacco product, may lead to local changes in the oral mucous membrane in the area where the snus is placed. It can also cause irreversible gingival retraction. This cross-sectional study aimed to investigate the relationship between use of snus, oral mucosal lesions (snus induced lesions) and gingival retractions among adolescents in Norway.

MATERIAL AND METHODS

All 18-20 years olds visiting public dental health clinics in the south-eastern region of Norway between October 2015 and December 2016 were invited to participate. All participants (n = 1363) filled in an electronic questionnaire before a clinical examination. Of these, 216 used snus daily.

RESULTS

Snus induced lesions were observed in 79.2% of daily snus using participants. In adjusted regression analyses, the odds of having a more severe lesion as opposed to a less severe lesion were 1.12 times greater for each additional box of snus used in a month (p < .01). Women were 46% less likely to have a severe lesion than men (p = .03). Gingival retractions were observed in 18.4% of the participants. The odds for dental retraction were significantly higher by 34% for each year of snus use.

CONCLUSIONS

Most of the adolescents using snus had snus induced lesions, whereas approximately one-fifth had gingival retractions. The severity of the lesion and gingival retraction increased with the amount of snus boxes used and the duration of the snus use, respectively.

Oral Human Papillomavirus Benign Lesions and HPV-Related Cancer in Healthy Children: A Systematic Review

The present systematic review aimed to assess the prevalence of oral HPV-related lesions, categorized as benign (verruca vulgaris "VV", squamous cell papilloma "SP", condyloma acuminata "CA", and focal epithelial hyperplasia "FEH") and malignant (oral squamous cell carcinoma "OSCC"), in descending order of occurrence in pediatric subjects (≤18 years of age). The secondary objectives were to evaluate the frequency and types of oral lesions described in relation to HPV genotypes and the HPV vaccine type (if any). The study protocol, compliant with the PRISMA statement, was registered at PROSPERO (CRD42022352268). Data from 60 studies, of which quality was assessed using the ROBINS-I tool, were independently extracted and synthesized. Along with seven poorly described benign HPV-related oral lesions that could not be categorized, a total of 146 HPV-related oral lesions, namely 47.26% (n = 69) VV, SP, and CA, 51.37% (n = 75) FEH, and 1.37% (n = 2) OSSC, were diagnosed in 153 pediatric subjects (M:F ratio = 1:1.4) with a mean age of lesion onset of 8.46 years. The viral genotypes detected were HPV-13 (30.61%), -6 (20.41%), -11 (16.33%), HPV-2 (12.24%), -32 (10.20%), -57 (6.12%), and -16 (4.08%). No HPV vaccination was reported in any case. Further studies should be conducted to evaluate the prevalence of HPV-related benign and malignant lesions and the potential role of HPV and associated vaccination in oral carcinogenesis in pediatric subjects.

Case Series of HIV-Associated Oral Lesions Among Antiretroviral-Naive Patients During the COVID-19 Pandemic

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has a serious impact on HIV-infected individuals due to limited access to treatment services. This report aimed to describe four cases of oral lesions in HIV-infected antiretroviral-naive patients found during the COVID-19 pandemic.

Case

Four patients, males, with an age ranged from 29 to 53 years, came to Oral Medicine Department with chief complaints of lesions on their mouth. They had postponed their visit to healthcare services due to limited access during pandemic. Three patients had just been diagnosed with HIV and had not yet received anti-retrovirus, while 1 patient had not yet been detected with HIV. From the clinical examination and laboratory findings, we diagnosed the lesions with mucous patches, chronic atrophic candidiasis, angular cheilitis, necrotizing ulcerative gingivitis, linear gingival erythema, cytomegalovirus-associated ulcers, and oral hairy leukoplakia.

Case Management

We gave chlorhexidine gluconate 0.2% mouthwash for mucous patches, nystatin oral suspension for chronic atrophic candidiasis, miconazole cream 2% for angular cheilitis, debridement with hydrogen peroxide 1.5% and rinsed with normal saline for necrotizing ulcerative gingivitis, and diphenhydramine hydrochloride and 0.2% chlorhexidine gluconate for CMV ulcers. All patients showed good clinical improvement after the treatments.

Conclusion

Oral lesions are still commonly found in HIV-infected patients during COVID-19 pandemic. Dentists remain to have a crucial role in the early diagnosis and treatment of HIV-associated oral lesions during COVID-19 pandemic that will have an impact on HIV treatments, also in implementing the Bali Declaration on oral health in HIV/AIDS 2019 to support UNAIDS goal to end AIDS by 2030.

Relationship between oral lesions and severe SARS-CoV-2 infection in intensive care unit patients

OBJECTIVE

Oral lesions received increased attention as likely new signs or secondary manifestations of COVID-19. Therefore, we clinically examined oral cavity of patients with COVID-19 and investigated oral lesions and patient comorbidities as possible risk factors of COVID-19 disease outcome.

METHODS

From January to March 2022, a prospective study was conducted by recruiting all COVID-19 patients admitted to the Intensive Care Unit and Respiratory Intensive Care Unit of Maxi-Emergencies Hospital in Bari, Italy.

RESULTS

From the enrolled 103 COVID-19 patients, 46.6% were females and 53.4% were males. Findings show that risk of presenting with severe COVID-19 disease was higher in patients who developed oral lesions related to COVID-19 than those with no oral lesions (RR = 7.998, p = .002). Next, patients with concomitant autoimmune diseases were at higher risk of a negative COVID-19 disease outcome than those without comorbidities (OR = 8.838, p = .026).

CONCLUSIONS

COVID-19-related lesions of oral mucosa should not be ignored as they can be early and easily detectable signs of severe COVID-19 disease condition, thus, serving as a prevention measure for any potential unfortunate event. Findings of this study, without implying causation, offer a direction for future investigations that aim to confirm the presence of specific oral lesions in COVID-19 patients as signs of severe disease progression.

Assessment of Oral Lesions With Tobacco Usage: A Cross-Sectional Clinicopathological Study in Sri Ganganagar, Rajasthan, India

Background Tobacco usage in the form of smoking or chewing has increased the risk of oral potentially malignant disorders (OPMDs) and oral cancer. These deleterious habits are also related to changes in dentition and the oral mucosa. Aim The aim of our study was to evaluate the oral changes associated with tobacco usage among residents of Sri Ganganagar. Materials and methods This study was conducted among the residents of Sri Ganganagar, Rajasthan, India, using stratified cluster random sampling, prestructured questionnaires, and detailed oral examination. A total of 100 patients with a previous history of tobacco usage were enrolled in this study after obtaining informed consent. Age- and gender-matched controls were also evaluated to correlate the findings. Clinical details were documented, including the Oral Hygiene Index-Simplified (OHI-S), Decayed-Missing-Filled Teeth (DMFT) index, Community Periodontal Index (CPI), loss of attachment, dental findings, and oral mucosal changes. Suspicious lesions were stained with toluidine blue, and a biopsy was performed for histopathological evaluation. The tabulated results were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM SPSS Statistics, Armonk, NY, USA) for significance. Results Attrition, abrasion, and erosion of teeth were more frequent in tobacco users than in controls. Smoker's palate, tobacco pouch keratosis, and leukoplakia were commonly noted mucosal lesions. The mean values of the parameters of the DMFT score (3.560), CPI score (2.190), and loss of attachment score (0.542) were higher among tobacco users, and it was statistically significant (P value < 0.05). Out of 100 patients, 17 had suspicious lesions. It included seven cases of oral submucous fibrosis (OSMF), two cases of tobacco pouch keratosis, and eight cases of leukoplakia. Toluidine blue staining and biopsy were performed. Histopathological examination of suspicious lesions revealed hyperkeratosis, various grades of epithelial dysplasia, and differing inflammatory responses. Out of 17 biopsied cases, there were two cases of hyperkeratosis with severe epithelial dysplasia, four cases of hyperkeratosis with moderate epithelial dysplasia, two cases of hyperkeratosis with mild dysplasia, two cases of superficially invasive squamous cell carcinoma, five cases of advanced OSMF, and two cases of moderately advanced OSMF. Conclusion Tobacco usage produces visible changes in dentition and latent alterations in the oral mucosa. Suspicious lesions should always be referred for histopathological examination to identify oral potentially malignant disorders and oral cancer so that prompt treatment could be initiated. Patient education is mandatory to avoid the usage of tobacco in any form.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice

The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.

Idiopathic lingual mandibular sequestration and its relationship to medication-related osteonecrosis of the jaws (MRONJ): mini review

OBJECTIVE

Idiopathic lingual mandibular sequestration is an uncommon condition that affects the lingual aspect of the mandible and may result in a necrosis of the jaw that is clinically indistinguishable from medication-related osteonecrosis of the jaw. This condition, however, is not associated with the intake of antiresorptive medication and may not require the same safeguards for extended periods of time. The etiology of idiopathic lingual mandibular sequestration is still unknown although trauma has been shown to play an important role.

METHOD AND MATERIALS

PubMed and the Cochrane Library were used to retrieve papers written in English through the years 1970 to 2021 using the key words "idiopathic osteonecrosis," "lingual sequestration," and "idiopathic jaw sequestration." In addition, clinical presentation of the lesion was included.

RESULTS

Idiopathic lingual mandibular sequestration is a benign, mostly self-limiting condition distinct from medication- related osteonecrosis of the jaw.

CONCLUSION

The dental clinician should be familiar with this condition and include it in their differential diagnosis when exposed bone is present with no history of radiation to the area or intake of antiresorptive medication. The course of the condition is usually very mild and may be self-limiting and usually does not require surgical intervention.

Cancer causing chewing habits and related oral lesions - A comparative study among females of socio-culturally different areas of West Bengal

Background

Smokeless tobacco, as well as areca-nut both, causes cancerous and precancerous lesions of the oral cavity. The traditional value of India, as well as West Bengal do not allow females for smoking, but there is no such disapproval for using smokeless tobacco or areca nut. Geographically and socio-culturally, the Northern part of West Bengal differs from its Southern part.

Aims

This study aimed to assess the prevalence of different chewing habits, habit products, and habit-related different oral lesions among females in two socio-culturally different areas of West Bengal.

Methods

A total of 222 women from areas of North Bengal and 173 women from areas of South Bengal aged 15 years and above were selected. A face-to-face interview was conducted using a structured questionnaire. An oral cavity examination was done to rule out any oral mucosal alterations caused by cancer-causing habits.

Statistical Analysis

Chi-square test or Fischer's exact tests were used to compare unpaired proportions as appropriate.

Results

In areas of the northern part of Bengal, 42.34% of females were chewers, and in areas of the southern part of Bengal 18.50% of females were chewers. Younger female chewers were more from areas of the northern part of Bengal. Women, residing in different areas of the northern part of Bengal had more habit-related oral lesions, compared to the southern part of Bengal.

Conclusion

Special attention should be given to increasing awareness regarding chewing habit-related health hazards among females, especially in areas of North Bengal.

Differences in Oral Lesions Associated with Tobacco Smoking, E-Cigarette Use and COVID-19 Infection among Adolescents and Young People in Nigeria

COVID-19 infection is associated with oral lesions which may be exacerbated by tobacco smoking or e-cigarette use. This study assessed the oral lesions associated with the use of e-cigarettes, tobacco smoking, and COVID-19 among adolescents and young people in Nigeria. A national survey recruited 11-23-year-old participants from the 36 States of Nigeria and the Federal Capital Territory, Abuja. Data were collected using Survey Monkey^®. Binary logistic regression analysis was conducted. Statistical significance was set at p-value less than 0.05. There were 2870 participants, of which 386 (13.4%) were tobacco smokers, 167 (5.8%) e-cigarette users, and 401 (14.0%) were both e-cigarette and tobacco users; and 344 (12.0%) had ever tested positive to COVID-19. Adolescents and young people who smoked tobacco had more than twice the odds of reporting gingival inflammation, oral ulcers, dry mouth, and changes in taste than those who did not smoke. Those who used e-cigarettes had 1.5 times higher odds of reporting oral lesions. Respondents who had COVID-19 infection had higher odds of reporting gingival inflammation and lower odds of reporting dry mouth than those who did not have COVID-19 infection. These findings were significant, and may help clinicians to screen for tobacco use and COVID-19 among adolescents and young people in Nigeria.

Oral Lesions Following Anti-SARS-CoV-2 Vaccination: A Systematic Review

Increasing evidence relate anti-SARS-CoV-2 vaccinations to orofacial adverse reactions, therefore, the present systematic review aimed to evaluate primary oral lesions diagnosed in adult subjects, following the WHO Emergency Use Listing approved and EMA authorized vaccines, also in relation to cases' age, gender, comorbidities, and history of COVID-19, and in relation to vaccine type and doses. The study protocol, registered on PROSPERO (CRD42022339032) and compliant with the PRISMA statement, included an electronic search across Scopus, MEDLINE/PubMed, BioMed Central databases, and PROSPERO, ended on 18 June 2022 and succeeded by a manual search, an independent data extraction, and arisk of bias evaluation through ROBINS-I tool. Qualitatively synthesized data from the 13studies included showed an overall low prevalence (16 cases), though higher in females (68.8%), of oral lesions, mainly erosions and ulcers (34.5%). Nine cases were diagnosed following Pfizer-BioNTech, two Moderna, and one AstraZeneca, Serum Institute of India, Sinopharm, and Johnson&Johnson vaccines, respectively; specifically, eight after the first dose and seven after the second. In one case, vaccine type and dose were not specified. Considering newly developing vaccines, presented findings may be updated and further studies needed to highlight factors affecting oral lesion occurrence and specific macro-microscopic phenotypes in relation to cases' and vaccines' characteristics.

Bioelectrical Impedance Analysis of Oral Cavity Mucosa in Patients with Lichen Planus and Healthy Controls

Objectives: Oral lichen planus (OLP) is an inflammatory disease. Bioelectrical impedance analysis (BIA) is a method for assessing tissue composition. Based on a combination of reactance and resistance data, a phase angle is calculated that may range from 90° to 0°, and that correlates with body cell mass. There is evidence to suggest that neoplastic tissue has a lower phase angle than normal tissue. The aim of the present experimental study was to establish whether OLP patients have a different tissue phase angle from healthy controls. Materials and Methods: Bioelectrical impedance measurements were obtained for the buccal mucosa, tongue, hard palate and upper anterior gums using an ad hoc device in a sample of 57 consecutive patients with OLP and 60 healthy controls, and their phase angles were calculated. Results: The mean resistance, reactance, and phase angle of the hard palate and gums were higher in the OLP group than in the controls, and the differences were statically significant. The resistance and reactance recorded for the adherent gingiva and hard palate were always higher in the OLP group (p = 0.044; p = 0.020; p = 0.054), and so was the phase angle for the adherent gingiva. No statistically significant differences emerged for the other areas of the oral cavity (p < 0.05). Conclusion: These findings confirm differences between the bioelectrical impedance of OLP lesions and that of healthy oral tissues. Clinical relevance: Bioelectrical impedance analysis could be useful in the diagnosis of OLP.

Oral lesions and periodontal status in diabetics and non-diabetics: A hospital based study

Background

Diabetes mellitus, a chronic hyperglycemic disorder has been associated with several manifestations in the body including the oral cavity. The oral manifestations are of importance and may significantly contribute to the detection of undiagnosed diabetes.

Objective

To find out the prevalence of oral diseases in type 1 and type 2 diabetics, to evaluate and compare the periodontal status of diabetics and non-diabetics.

Materials and Methods

This was a cross sectional study conducted on 110 diabetic subjects of >5 years duration at the M.V. Hospital for Diabetes, Diabetes Research Centre, Chennai. One hundred apparently healthy non-diabetic subjects in the age group of 40-60 years were studied as control. The oral cavity was examined by using a mouth mirror and periodontal status was assessed by utilizing oral hygiene index - simplified (Greene and Vermillion), Miller's mobility index and Ramjford's periodontal disease index.

Results

Subjects with diabetes were found to have significant association with xerostomia (P < 0.003) and chronic periodontitis (P < 0.026). However, no significant association was found forleukoplakia, traumatic ulcer, frictional keratosis, smoker's melanosis, mucocele, aphthous ulcer, fissured tongue, lichen planus, parotid enlargement, parulis, chronic gingivitis, fibroma, and periodontal abscess.

Conclusion

The study reaffirmed higher prevalence of xerostomia and periodontal disease among diabetic subjects. However, contrary to previous studies, no significant differences were found in the prevalence of traumatic ulcer, fissured tongue, lichen planus, and parotid enlargement.

Prevalence, Features and Degree of Association of Oral Lesions in COVID-19: A Systematic Review of Systematic Reviews

Regardless of rapidly emerging findings on oral lesions described in adult SARS-CoV-2-positive subjects, the evidence level remains quite low and rather contrasting; therefore, the present systematic review of systematic reviews primarily aims to point out the overall prevalence of diagnosed cases. Secondary aims are to estimate the degree of association between oral lesions and SARS-CoV-2 infection and to grade, based on the reported frequency, the primary oral lesions, with related clinical presentations and microscopic features, in relation to COVID-19 forms. A study protocol compliant with the PRISMA statement was developed. Twelve studies were included, reporting highly heterogeneous and incomplete findings, thus precluding a meta-analysis. Further studies should be conducted to assess the overall prevalence of cases diagnosed with oral lesions among adult SARS-CoV-2-positive subjects, especially considering novel viral variants, and to determine their degree of association with SARS-CoV-2 infection and COVID-19 forms. Moreover, the reported findings noticed the need to evaluate the putative role both of SARS-CoV-2 in oral lesions genesis and of periodontitis and periodontal microbiome in COVID-19 worsening and re-activations. Deeper insights into oral lesions in adult SARS-CoV-2-positive subjects could enhance the comprehension of illness pathogenesis, natural history and clinical presentation, thus improving the preparedness of health professionals in the inter-disciplinary management of COVID-19.

Oral Manifestations of Coronavirus Disease 2019 (COVID-19): A Comprehensive Clinicopathologic and Immunohistochemical Study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.