Unmet diagnostic needs in contact oral mucosal allergies

The oral mucosa including the lips is constantly exposed to several noxious stimuli, irritants and allergens. However, oral contact pathologies are not frequently seen because of the relative resistance of the oral mucosa to irritant agents and allergens due to anatomical and physiological factors. The spectrum of signs and symptoms of oral contact allergies (OCA) is broad and a large number of condition can be the clinical expression of OCA such as allergic contact stomatitis, allergic contact cheilitis, geographic tongue, oral lichenoid reactions, burning mouth syndrome. The main etiological factors causing OCA are dental materials, food and oral hygiene products, as they contain flavouring agents and preservatives. The personal medical history of the patient is helpful to perform a diagnosis, as a positive history for recent dental procedures. Sometimes histology is mandatory. When it cannot identify a direct cause of a substance, in both acute and chronic OCA, patch tests can play a pivotal role in the diagnosis. However, patch tests might have several pitfalls. Indeed, the presence of metal ions as haptens and specifically the differences in their concentrations in oral mucosa and in standard preparation for patch testing and in the differences in pH of the medium might result in either false positive/negative reactions or non-specific irritative reactions. Another limitation of patch test results is the difficulty to assess the clinical relevance of haptens contained in dental materials and only the removal of dental materials or the avoidance of other contactant and consequent improvement of the disease may demonstrate the haptens’ responsibility. In conclusion, the wide spectrum of clinical presentations, the broad range of materials and allergens which can cause it, the difficult interpretation of patch-test results, the clinical relevance assessment of haptens found positive at patch test are the main factors that make sometimes difficult the diagnosis and the management of OCA that requires an interdisciplinary approach to the patient.     

Accuracy of Perceived Treatment Needs Among Geriatric Denture Wearers1

Patient satisfaction with and accuracy in assessing condition of dentures and oral tissue were related to their clinical evaluation and several psychological factors in 50 denture wearers 60 years of age or older. Seventy percent of those examined wore clinically inadequate dentures and 34% had unsatisfactory oral tissue. Few respondents were dissatisfied when clinical examination revealed satisfactory conditions but 70% were satisfied with inadequate dentures and 50% with unsatisfactory oral tissue. Contrary t o expectation, accuracy was not found significantly related to clinical evaluation or to psychological factors. However, satisfaction with dentures was related to their clinical evaluation: dissatisfied respondents had technically superior dentures as compared with those satisfied. These findings suggest that psychological factors are not related to denture patient assessment of their oral condition and that dissatisfaction may be of benefit to their oral health. The high proportion of those unaware of denture inadequacies indicates the need for patient education directed toward over-, as well as under-, adapters.     

Aetiology and therapeutics of burning mouth syndrome: an update

doi: 10.1111/j.1741‐2358.2010.00384.x Aetiology and therapeutics of burning mouth syndrome: an update Objective: To provide a review on the aetiology and therapeutic options for the management of patients with burning mouth syndrome (BMS). Background: BMS is a chronic disorder that frequently affects women and is characterised by burning symptoms of the oral mucosa without clinical signs. This syndrome has a complex and multifactorial characteristics, but its aetiology remains unknown and this makes it difficult with regard to the treatment and management of such patients. Despite not being accompanied by evident organic changes and not presenting risks to health, BMS can significantly reduce the quality of life for patients. Methods and materials: The article reviews the literature regarding aetiologic factors, clinical implications and treatment of BMS. Conclusion: The involvement of neurological, emotional and hormonal alterations is proposed in BMS aetiology. However the mechanisms of its development are complex and not completely understood. Tricyclic antidepressants, benzodiazepines and antipsychotic drugs are the most accepted options in treatment and show variable results. The correct diagnosis of BMS and the exclusion of possible local or systemic factors that can be associated with the symptoms are fundamental. It is also important to evaluate the quality of life for these patients to recognise the potential impact of this condition on their lives.     

Burning mouth in Parkinson's Disease sufferers

Objective . The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced. Design. Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non-respondents. Main outcome. BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers. Conclusion. Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.     

One-stage full-mouth disinfection to overcome intra-oral transmission of periodontopathogens

The oral cavity offers a range of different niches where periodontopathogens can adhere and survive (e.g. the mucosa, the tongue, the tonsils, the saliva and all intra-oral hard surfaces such as teeth, dentures, oral implants). Transmission of bacteria from one niche to another is likely to occur. Recent studies, for example, illustrated that initially sterile abutments of oral implants were rapidly colonized by bacteria from the subgingival environment around teeth. This transmission of bacteria can occur spontaneously via the saliva, or by means of oral hygiene aids and/or dental instruments. Such an intra-oral transmission, if it occurs at a high speed, could jeopardize the outcome of periodontal therapy. To overcome a bacterial transmission, a 'one-stage full-mouth disinfection' was recently introduced for the treatment of periodontal infections. This new treatment strategy resulted in significant clinical and microbiological improvements when compared with the standard sequential treatment.     

Exfoliative cytology of the oral mucosa in burning mouth syndrome: a cytomorphological and cytomorphometric analysis

doi:10.1111/j.1741‐2358.2009.00319.x
Exfoliative cytology of the oral mucosa in burning mouth syndrome: a cytomorphological and cytomorphometric analysis Objective: The aim of this study was to evaluate oral epithelial cells by exfoliative cytology in burning mouth syndrome (BMS). Material and methods: Oral smears were collected from clinically normal‐appearing mucosa by liquid‐based exfoliative cytology in 40 individuals (20 BMS patients and 20 healthy controls matched for age and gender) and analysed for cytological and cytomorphometric techniques. Results: Mean values of nuclear area (NA) for experimental and control groups were, respectively, 67.52 and 55.64 μm² (p < 0.05). Cytoplasmic area (CA) showed the following mean values: 1258.0 (experimental) and 2069.0 μm² (control). Nucleus‐to‐cytoplasm area ratio for the experimental group was 0.07, besides the control group was 0.03 (p < 0.05). Morphologically, oral smears exhibited normal epithelial cells in both experimental and control groups. There was a significant predominance of nucleated cells of the superficial layer in the smears of BMS patients (p = 0.00001). Conclusion: This study revealed that oral mucosa of BMS patients exhibited significant cytomorphometric changes in the oral epithelial cells. These changes probably are associated with epithelial atrophy and a deregulated maturation process that may contribute to the oral symptoms of pain and discomfort in BMS.     

Xerostomia in the Elderly: Prevalence,Diagnosis, Complications and Treatment1

The prevalence of xerostomia was evaluated in 259 volunteers 70 ± 4.5 years old. Seventy–two (27.7%) complained of dry mouth. In 31 (11.8%) salivary secretion was under 0.1 ml/min. The xerostomic patients were compared to an age–matched control group. The main complaints of xerostomia were dry mouth during the day, dry throat, burning sensation of the tongue, difficulty in swallowing, and taste disturbances. Systemic diseases frequent in the xerostomic patients were heart failure and hypertension. Chronic renal failure, depression, rheumatoid arthritis, and hypothyroidism were also encountered. The medications most frequently used by the xerostomic patients were parasympatholytics, sympatholytics, and diuretics. A higher frequency of active caries, gingivitis, and dryness of the mucosa was detected in the xerostomic patients. A significantly higher response to stimulation, elevated salivary calcium, and lowered oral pH were found in this group. Xerostomia was found to be related o t systemic diseases, medications, or a combination of these factors. The importance of saliva for maintaining oral health was also observed. Twenty–nine patients suffering from xerostomia were treated with an artificial saliva. On reexamination after one month, most of them reported improvement, and a significant increase in salivary flow rate was found.     

Antimicrobial peptide control of pathogenic microorganisms of the oral cavity: a review of the literature

Antimicrobial peptides, molecules produced in many different organisms, have high biocidal activity against several microorganisms. However, several questions about these molecules remain unclear. Therefore, this report details a systematic survey of the literature on the use of antimicrobial peptides against oral pathogens and indicates which peptides and microorganisms are most extensively studied. Articles were located using the PubMed and Science Direct databases with the following inclusion criteria: publication date between 2002 and 2011; keywords "biofilm OR biological film OR biological layer OR bacterial growth" AND "peptide" AND "oral cavity OR mouth OR buccal mucosa OR oral mucosa OR mouth mucosa"; and abstract in English. A total of 73 articles were selected after refinement of the data. An increase in publications focusing on the use of antimicrobial peptides against oral microorganisms was observed. In addition, the peptides produced by cells of the oral mucosa (defensins, LL-37 and histatins) as well as Streptococcus mutans (among cariogenic bacteria) and Porphyromonas gingivalis (among periodontal bacteria) were the most studied subjects. It was concluded that the use of antimicrobial peptides as a tool for microbial control is of increasing importance, likely due to its widespread use, mechanism of action, and low rates of bacterial resistance.     

Ventilation and the origin of jawed vertebrates: a new mouth

This study investigates the origin of jaws by re-assessing homologies between the oropharyngeal regions of Agnatha and Chondrichthyes. In accordance with classical theory, jaws are interpreted as the most anterior arches of the ventilatory branchial basket. It is proposed that jaws first enlarged for a ventilatory function, i.e. closing the jaws prevented reflux of water through the mouth during forceful expiration. Next, they enlarged further to grasp prey in feeding. As they enlarged, the jaws tilted forward, squeezing the ancestral oral cavity in front of them ('old mouth') into a slit between the jaws and lips. Simultaneously, the anterior part of the pharynx behind the jaws was pulled forward and became a 'new mouth' (the buccal part of the buccopharyngeal cavity of gnathostomes). During the transition to gnamostomes, the premandibular cheeks and lips of the old mouth remained in place, and are represented in ammocoete lampreys, chimaeroids, and sharks. The stages in the evolution of gnathostomes, driven by selection for increasing activity, are modelled as: ancestral vertebrate (with unjointed branchial arches) to early pre-gnathostome (jointed internal arches and stronger ventilation) to late pre-gnadiostome (with mouth-closing, ventilatory 'jaws') to early gnathostome (feeding jaws).     

Significance of saliva for the denture‐wearing population

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the dry mouth' and its associated problems. Aims: to study factors affecting mucous and serous salivary gland secretion, the aetiology of the ‘dry mouth’ and its associated problems, causative factors for hyposalivation and it's treatment Setting : two university dental hospitals. Subjects: 587 denture wearers and 521 control subjects, and autopsy material Interventions : exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion theiapy, biopsy of the minor glands Main outcome measures : Palatal secretion (PAL, μL/cm²/min) and parotid salivary flow (PAR), subjective complaints and clinical findings. Results: resting flow rates for PAL between 0 and 65 μl/cm²/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL≤6.0 μl/cm² suffer from a ‘dry mouth’ and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, ladiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion. Conclusions: Variation in palatal salivary secretion occurs and is clinically important.     

Chewing disability in older adults attributable to tooth loss and other oral conditions

doi: 10.1111/j.1741‐2358.2010.00412.x Chewing disability in older adults attributable to tooth loss and other oral conditions Background: This study evaluates associations between oral health‐related factors and chewing ability, and quantifies the risk contributed by each factor. Materials and methods: Chewing ability and information on number of teeth, dentures and dental problems over the last 12 months were collected by mailing questionnaires to a random sample of 60‐ to 71‐year‐olds from Adelaide, South Australia. Logistic regression was used to model oral status and oral symptoms as predictors of chewing disability, and to estimate the population‐attributable fraction. Results: A total of 444 persons responded (response rate = 68.8%). Among dentate subjects, 10.3% were chewing‐deficient, with chewing disability more prevalent (p < 0.05) among those with <21 teeth (26.4%), dentures (20.4%), painful aching in the mouth (25.4%), pain in the face (16.7%), broken/chipped teeth (15.6%), sensitive teeth (14.1%), loose teeth (37.1%), and sore gums (18.0%). Adjusted Odds ratios (OR) showed inadequate dentition (OR = 4.20), painful aching in the mouth (OR = 4.88), and presence of loose teeth (OR = 4.70) were associated with chewing disability (p < 0.01), and their population attributable fractions were 18.5%, 15.1% and 7.8% respectively. Conclusions: Loose teeth, number of teeth and pain in the mouth were associated with chewing disability, with an inadequate dentition and pain in the mouth contributing most to chewing disability in this population.     

Oral health-related quality of life--associations with oral health and conditions in Swedish 70-year-old individuals

doi: 10.1111/j.1741‐2358.2011.00495.x Oral health–related quality of life – associations with oral health and conditions in Swedish 70‐year‐old individuals Objective: The aim of this study was to evaluate oral health–related quality of life (OHRQoL) in relation to different chronic oral conditions and perception of oral health among elderly individuals. Background: Health‐related quality of life is important to assess and understand the impact of different diseases and conditions on individuals’ well‐being. Material and methods: Randomly selected 70‐year‐old individuals (N = 561) were included in this analysis. They were clinically examined and answered a questionnaire. Variables used were perceived oral health, satisfaction with appearance of teeth, problems with chewing and dry mouth, burning mouth syndrome, dental anxiety and dental visiting habits. To measure the participants′ perception of the impact of oral conditions on their well‐being, the Oral Health Impact Profile (OHIP‐14) was used. Results: The OHIP‐14 distribution of sum of scores showed a floor effect but revealed acceptable psychometric properties with regard to reliability and validity. Multivariable logistic regression revealed three highly predictive variables for individuals with high OHIP‐14 scores: using dentures, having chewing problems and being dissatisfied with appearance of teeth. Conclusion: Use of dentures, having chewing problems and being dissatisfied with appearance of teeth are associated with high OHIP‐14 sums, indicating strong influence on OHRQoL.     

Cytological response of palatal epithelium to TiN-coated CoCr alloy denture

The aim of this study was to assess the impact of titanium nitride coatings on CoCr alloy metal parts in framework dentures on human palatal epithelium cytology compared to framework dentures made with the same alloy but without titanium nitride coating, and to acrylic dentures. Every prosthetic restoration introduced into the oral cavity and remaining in direct contact with the palate exhibits a varied and harmful effect on the state of the palatal epithelium by disturbing its keratinization. CoCr alloy dentures produce a significantly greater perturbation of keratinization compared to acrylic dentures. There is no evidence showing that a titanium nitride coating of the CoCr alloy plays a protective role in the environment of the oral cavity.     

Benefits of the CO2 laser in oral hemangioma excision

Twenty-one patients with small localized oral cavity hemangiomas of the lips, tongue, and buccal mucosa are reported in this series. Although the lesions were not massive or high-flow/high-pressure vascular tumors, the simultaneous cutting and coagulation capabilities of the CO2 laser were demonstrated, rendering such excisional surgery more precisely and easily accomplished with a great deal less bleeding and a marked reduction in postoperative pain and edema. Many of the patients in this series were done as outpatients under local anesthesia. Results were acceptable and complications were minimal. Thus this laser is recommended both for the patient care and comfort aspects and the ability to render oral cavity hemangioma excisional surgery much more safely and easily done with a significant decrease in hospital utilization and overall medical expenses.     

Impact of Cabin Ozone Concentrations on Passenger Reported Symptoms in Commercial Aircraft

Due to elevated ozone concentrations at high altitudes, the adverse effect of ozone on air quality, human perception and health may be more pronounced in aircraft cabins. The association between ozone and passenger-reported symptoms has not been investigated under real conditions since smoking was banned on aircraft and ozone converters became more common. Indoor environmental parameters were measured at cruising altitude on 83 US domestic and international flights. Passengers completed a questionnaire about symptoms and satisfaction with the indoor air quality. Average ozone concentrations were relatively low (median: 9.5 ppb). On thirteen flights (16%) ozone levels exceeded 60 ppb, while the highest peak level reached 256 ppb for a single flight. The most commonly reported symptoms were dry mouth or lips (26%), dry eyes (22.1%) and nasal stuffiness (18.9%). 46% of passengers reported at least one symptom related to the eyes or mouth. A third of the passengers reported at least one upper respiratory symptom. Using multivariate logistic (individual symptoms) and linear (aggregated continuous symptom variables) regression, ozone was consistently associated with symptoms related to the eyes and certain upper respiratory endpoints. A concentration-response relationship was observed for nasal stuffiness and eye and upper respiratory symptom indicators. Average ozone levels, as opposed to peak concentrations, exhibited slightly weaker associations. Medium and long duration flights were significantly associated with more symptoms compared to short flights. The relationship between ultrafine particles and ozone on flights without meal service was indicative of ozone-initiated chemistry.     

Penetration of the oral mucosa by parasite-like sperm bags of squid: a case report in a Korean woman

We report a case of oral stings by spermatophores of the squid Todarodes pacificus . A 63-yr-old Korean woman experienced severe pain in her oral cavity immediately after eating a portion of parboiled squid along with its internal organs. She did not swallow the portion, but spat it out immediately. She complained of a pricking and foreign-body sensation in the oral cavity. Twelve small, white spindle-shaped, bug-like organisms stuck in the mucous membrane of the tongue, cheek, and gingiva were completely removed, along with the affected mucosa. On the basis of their morphology and the presence of the sperm bag, the foreign bodies were identified as squid spermatophores.     

The dental awareness and needs of a Parkinson's disease population

The dental awareness and needs of a population with Parkinson's disease were assessed by means of postal questionnaires sent to members of Parkinson's disease societies of Belfast and London. A total of 228 valid replies were received representing a response rate of 31%. Results showed that dental problems were reported often, xerostomia and burning sensation being at least twice that of the general population. Satisfaction with dental care was high although it was significantly reduced in those with loose dentures and burning sensation. The results of this study support a greater participation by dentists in the planning and provision of healthcare for sufferer of Parkinson's disease.     

Studies on the tardigrades. I. Fine structure of the anterior foregut of Milnesium tardigradum Doyère

The fine structure of the anterior foregut of the tardigrade Milnesium tardigradum is presented. The oral region consists of a terminal mouth opening surrounded by six plate-like lips lying within a circlet of six prominent papillae. The buccal cavity is enclosed within a thick cuticular tube which possesses appendage structures, the stylet sheaths, stylet supports and paired protrusible stylets. Two large salivary glands envelop the buccal structures and contain voluminous amounts of secretory product. The arrangement, possible functions and phyletic significance of these structures are discussed.     

Artificial Saliva in the Management of Patients Suffering from Xerostomia

Hyposalivation results in the sensation of a dry mouth “subjective xerostomia.” Besides the sensation of a dry mouth in serious conditions, distressing clinical symptoms are observed, e.g. difficulties in oral functioning, mucositis, progressive dental caries and nocturnal oral discomfort. A mucin-containing artificial saliva to relieve patients'complaints from xerostomia has been developed. Its chemical and physical properties are demonstrated. In a 3-year retrospective study the efficacy of this substitute and a CMC-containing saliva has been evaluated for a total of 137 patients. Patients were free in choosing a mucin- or CMC preparation. Ninety-six patients reported a considerable relief of their complaints with mucin-saliva, one patient wished to continue using the CMC product. To increase efficacy of the saliva substitute on intra-oral saliva reservoir has been developed for dentate and edentulous persons.