Custom Thermoformed Trays in the Treatment of Denture Stomatitis

Svrha je istraživanja ispitati djelotvornost mikonazolskog gela primijenjenog pomoću individualne termoplastične udlage kao prekonoćnog držača lijeka u liječenju protetskog palatitisa, u usporedbi s klasičnom primjenom lijeka koju je propisao proizvođač. Sudjelovala su 44 nositelja mobilnih stomatoloških gornjih nadomjestaka s dijagnosticiranim protetskim palatitisom. Ispitna skupina (n = 22) liječena je 2-postotnim gelom mikonazolima, a nanosio se tijekom noći u individualnu udlagu. Kontrolna skupina (n = 22) liječena je unošenjem 2,5 ml istog lijeka u usta četiri puta na dan. Određivali su se intenzitet upale i infi ciranosti. Provedeni su sljedeći klinički testovi: intenzitet upale prema Newtonu, veličina eritematoznih lezija na sluznici nepca ispod ležišta nadomjestka, digitalna termometrija sluznice i bris za kulturu Candida albicans. Zabilježeni su i podaci o starosti, higijeni proteze i nosi li pacijent protezu tijekom noći. Rezultati su pokazali bržu i potpuniju sanaciju protetskog palatitisa u ispitnoj skupini bolesnika u odnosu prema kontrolnoj. U ispitnoj skupini zapažena je i veća redukcija kolonija kulture Candida albicans, što upućuje na njihovu djelotvorniju eliminaciju iz usta primjenom lijeka novom metodom. Ta metoda dodatno potiče bolesnika da slijedi upute o terapiji i higijeni nadomjestka. Individualna udlaga kao okluzijski zavoj pokazala se djelotvornijom i bolesniku ugodnijom od liječenja klasično ordiniranim antimikotikom, što bi klinički moglo biti vrlo važno u liječenju protetskog palatitisa.The aim of this study was to evaluate the effect of miconazole gel delivered on a custom thermoformed tray as an overnight drug holder appliance in denture stomatitis treatment, in comparison with classic application as recommended by manufacturer. The investigation included 44 upper denture wearers, diagnosed with denture stomatitis. The experimental group (n = 22) applied 2% miconazole gel in custom tray for overnight wear. The control group (n = 22) applied 2,5 ml of the same drug 4 times a day in their mouth. Intensity of infl ammation and infection was evaluated. The clinical tests that were used were: infl ammation intensity according to Newton, extent of palatal mucosal erythematous surface below denture, digital thermometry, and swabs for Candida albicans cultures. Oldness and hygiene status of dentures were recorded, as well as habit of overnight denture wearing. The investigation revealed that denture stomatitis healed faster and better in the experimental group compared to control group. Greater Candida albicans culture colony count reduction was observed in experimental group, which suggests more effi cient elimination of Candida albicans from the mouth with novel method. This method motivates patients to adhere to treatment and appliance hygiene instructions. Custom splint as occlusive drug delivery showed to be more effective and more convenient for the patients than the same antimicotic drug, classically delivered, which might be clinically relevant in treatment of denture stomatitis

Effects of Low-Level Laser Treatment on Mouth Dryness

Mouth dryness (MD) is usually followed by inadequate mechanical cleaning of the mouth and decrease in the levels of salivary antimicrobial proteins (including secretory immunoglobulin A (sIgA)). It is accompanied by difficulties during speaking and food swallowing, with an unpleasant taste, burning sensations in the mouth and higher susceptibility to oral diseases. Low-level laser treatment (LLLT) can intensify cell metabolism and its application on salivary glands could improve salivation. The purpose of this study was to evaluate the effects of LLLT on salivation of patients suffering from MD. The study included 17 patients with MD. Their major salivary glands were treated with low intensity laser BTL2000 on 10 occasions. The whole unstimulated and stimulated saliva quantities were measured just before the 1st, after the 10th and thirty days following the last (10th) treatment. In the samples of unstimulated saliva concentrations of sIgA were estimated by using ELISA method and its quantity in the time unit was calculated. The visual analogue scale (VAS) score was used to assess burning and/or pain intensity at these three time points. Statistical tests revealed significant salivation improvement quantitatively and qualitatively, i.e. increase in the quantity of saliva and sIgA. VAS score was also significantly improved and no side effects were observed. Conclusions: According to the results of this study, application of LLLT to xerostomic patients’ major salivary glands stimulates them to produce more saliva with better antimicrobial characteristics and improves the difficulties that are associated with MD. This simple non-invasive method could be used in everyday clinical practice for the treatment of MD

Međudjelovanje endokrinog sustava i imunosustava u osoba s posttraumatskim stresnim poremećajem: longitudinalno istraživanje

Posttraumatic stress disorder (PTSD) has been associated with increased medical morbidity, particularly with the autoimmune and cardiovascular diseases. It is assumed that stress-related changes in the endocrine and immune systems are key mediators involved in the development of diseases. Despite extensive research in the field, there is no conclusive evidence linking specific changes in the endocrine and immune systems to PTSD. Some evidence suggests that those changes might be realated to the duration od the PTSD. The aim of our study was to investigate weather hormones (cortisol and prolactin), proinflammatory cytokines (interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)), lymphocyte expression of glucocorticoid receptor (GR), immune function (NKCC, natural killer cell cytotoxicity) and peripheral blood percentages of various lymphocyte subpopulations (T cells, helper T cells, cytotoxic T cells, B cells, natural killer (NK) cells, memory T cells and memory helper T cells) change in patients with PTSD over time. We also wanted to investigate mutual interactions of above mentioned variables and their relation to PTSD symptoms. We assessed 39 Croatian war veterans with PTSD and 37 (25 in the second time point) sex and age matched healthy volunteers in two time points separated by 5.6 years (median; interquartile range: 5.4-6.3). Hormones were measured by radioimmunoassay and cytokines were determined by enzyme-linked immunosorbent assay (ELISA). Immune function was assessed with the in vitro natural killer cell cytotoxicity (NKCC) toward 51Cr-labeled K562 target cells. Lymphocyte counts, immunophenotye and intracellular glucocorticoid receptor expression were determined by threecolor flow cytometry. In the first time point serum levels of cortisol, prolactin, and TNF-α, NKCC, lymphocyte count, total T cells, helper T cells, total memory cells, and helper memory T cells were increased, while glucocorticoid receptor expression was decreased in all lymphocyte subpopulations in PTSD patients compared to controls. In the second time point only prolactin levels and lymphocyte counts remained elevated and no significant differences in other variables have been observed. We can conclude that changes in the endocrine and immune systems are not static in persons with PTSD but rather depend on duration of alostatic load posed by the disorder and its impact on interactions between endocrine and immune systems involved in stress response

Circulating Lymphocyte Subsets, Natural Killer Cell Cytotoxicity, and Components of Hypothalamic-Pituitary-Adrenal Axis in Croatian War Veterans with Posttraumatic Stress Disorder: Cross-Sectional Study

Aim: To determine peripheral blood lymphocyte subsets – T cells, helper T cells, cytotoxic T cells, B cells, and natural killer cells, natural killer cell cytotoxicity, serum cortisol concentration, and lymphocyte glucocorticoid receptor expression in Croatian combat veterans diagnosed with chronic posttraumatic stress disorder (PTSD); and to examine the relationship between the assessed parameters and the time passed since the traumatic experience. Methods: Well-characterized group of 38 PTSD patients was compared to a group of 24 healthy civilians. Simultaneous determination of lymphocyte subsets and the expression of intracellular glucocorticoid receptor was performed using three-color flow cytometry. Natural killer cell cytotoxicity was measured by 51Cr-release assay and the serum cortisol concentration was determined by radioimmunoassay. Results: We found higher lymphocyte counts in PTSD patients than in healthy controls (2294.7 ± 678.0/μL vs 1817.2 ± 637.0/μL, P = 0.007) and a positive correlation between lymphocyte glucocorticoid receptor expression and the number of years that passed from the traumatic experience (rs = 0.43, P = 0.008). Lymphocyte glucocorticoid receptor expression positively correlated with serum cortisol concentration both in PTSD patients (r = 0.46, P = 0.006) and healthy controls (r = 0.46, P = 0.035). Conclusion: This study confirmed that the immune system was affected in the course of chronic PTSD. Our findings also indicated that the hypothalamic-pituitary-adrenal axis profile in PTSD was associated with the duration of the disorder. Due to the lack of power, greater sample sizes are needed to confirm the results of this study

Baseline level of platelet-leukocyte aggregates, platelet CD63 expression, and soluble P-selectin concentration in patients with posttraumatic stress disorder: a pilot study

Platelets may have an important role in the development of cardiovascular disease (CVD) as a result of chronic stress. We conducted a pilot study to evaluate the effect of posttraumatic stress disorder (PTSD) on baseline platelet activation. Platelet-leukocyte aggregates (PLA) and CD63 expression were measured by flow cytometry, and soluble (s)P-selectin concentration was determined in sera of 20 Croatian male combat veterans with PTSD and 20 healthy civilians. Groups were matched in sex, age, body mass index (BMI) and traditional CVD risk factors. Our data showed no differences in measured parameters. Other platelet activation markers should be determined and a larger sample size used in future studies