Periodontitis and cardiovascular disease

Periodontal medicine has been studied and reviewed extensively since its introduction to the dental fraternity. The association of periodontal disease with and its effects on the cardiovascular system are amongst the many topics explored. A summary of the research into these associations and the possible mechanisms of any relationship is presented. Although a link between these two chronic inflammatory diseases is evident, the very heterogeneity of the relevant studies has not provided evidence sufficient to support an actual causal relationship. More stringent epidemiologic and intervention studies are required.Department of HE and Training approved lis

A descriptive analysis of oral lichen planus from tertiary diagnostic centres in the Western Cape

Magister Scientiae Dentium - MSc(Dent)Lichen planus is a systemic disease that follows a chronic course. The exact aetiology remains unknown but an immune mediated pathogenesis has been implicated. Oral lichen planus is a common form of this disease and can occur in isolation or it may include the skin, genitalia and lesions involving the scalp and hair follicles. Epidemiological studies on oral lichen planus are few. Those that have been conducted have been in developed nations such as North America and Europe as well as Asia and the Middle East. Few African studies report on the demographics of the affected patients. Factors such as patient demographics and trends of diseases are essential to investigate. Findings of such studies may be useful in determining additional patient based criteria that can assist in obtaining a definitive diagnosis and subsequently aid in the management protocols of the specific disease in question. This process is as essential for oral lichen planus as for other diseases. Oral lichen planus can have clinical similarities with other diseases of the oral mucosa. Similarities can also be seen histologically that may further complicate the process of defining the diagnosis. Oral lichen planus may not be commonly associated with frank morbidity, but severe discomfort can be experienced in some clinical variants. This disease has been described as “difficult to manage” Camacho-Alonso et al, 2007). Furthermore, there is an ongoing debate about its malignant potential (Sugerman & Savage; 2002; Scully and Carrozzo; 2008). These factors support the relevance of further investigation of oral lichen planus. This study will report the demographics of patients who have been diagnosed with oral lichen planus in a subset of the South African population, within the Western Cape. The description of the ethnic groups in South Africa was as described by Statistics South Africa, namely; “African” was used to describe Black individuals, “Coloured” was used to describe individuals of mixed ethnic origin, “Indian” was used to describe patients whose ethnic origin was of the Indian/Asian continent, the latter however excluded persons of Chinese decent and “White” described those persons of European origin. The ethnic distribution reported from within the literature will report on the terminology used by the respective authors and hence not follow the guidelines outlined above

An epidemiological analysis of patients diagnosed with periodontitis at a tertiary institution

An analysis of the epidemiological factors associated with the diagnosis of periodontitis is important baseline evidence for the study of this disease within our population. This evidence will be valuable baselineinformation to inform intervention protocols that are contextual to our society. There is a scarcity of studieson periodontitis in South Africans. To describe the epidemiological and clinical characteristics of periodontitis patients diagnosedbetween 2014-2019 at a tertiary institution in SA. A retrospective records-based study wasconducted. Data from 450 patients diagnosed with periodontitis were extracted. Data sets including age, sex, smoking, presence of diabetes, and other systemic diseaseswere analysed. Periodontal parameters such as plaquescore, plaque index, gingival bleeding score, gingivalindex, number of missing teeth, probing depths, andclinical attachment loss were included for analysis. Males had higher bleeding index (p=0.035), deeperpockets (p=0.003), and more attachment loss(p<0.001), compared to females. Deeper periodontalpockets were observed in patients with systemicdiseases (p=0.018). Smokers had a lower bleeding percentage (p=0.039). There was a higher plaque percentage (p=0.031), and bleeding index (p=0.043),deeper pockets (p<0.001) and more attachment loss(p<0.001) in patients with diabetes mellitus. Worse periodontal status was observed in males,and patients with diabetes or other general diseases.Additional research is required to elucidate the role ofsex and systemic conditions as predisposing factors to periodontiti

Oral medicine case book 67: Oral manifestations of Evans syndrome: a presenting feature of HIV infection?

A 19 year old female presented with spontaneous intra - oral bleeding of two days duration. The patient reported that she was, until recently, in good general health and also that she had an uncomplicated parturition three years ago. She recently started noticing blood in her stools and felt increasingly lethargic. There was no history of trauma or intra-oral intervention that may have initiated the bleeding. The clinical examination revealed marked pallor of the facial skin and multiple small petechiae were seen on both of her forearms. The intra-oral examination identified marked halitosis and multiple haemorrhagic lesions with a variable appearance, being plaque-like on the lip, nodular on the tongue and fungating and exophytic on the palate and in the retromolar regions. Even delicate manipulation of the tissues produced profuse bleeding.DHE

Oral medicine case book 46: squamous cell carcinoma of the tongue

A 38-year-old-female presented at the Oral Medicine Clinic complaining of pain under her tongue that became worse during chewing, and radiated to her right ear. The pain started two months earlier and gradually increased in intensity. The patient reported that she smoked about twelve cigarettes per day, a habit that she maintained for the last twenty years. She also admitted that she consumed alcohol as a social habit, mainly over the weekends. Her medical history revealed no other abnormalities and she was not using any chronic medication.Department of HE and Training approved lis

Oral medicine case book 47: oral neurofibroma

A 29-year-old male patient presented at the Oral Medicine Clinic with the complaint of slow-growing growths on his tongue, causing discomfort. Extra-oral examination revealed several painless soft tissue nodules on his face (Figure 1 and 2), trunk (Figure 3), back (Figure 4) and arms. The patient reported that the lesions had appeared during childhood and had since increased in size and number. He was unaware of any family history of the disease. Intra-oral examination showed two soft tissue nodules on the midline of the dorsal surface of the tongue, 3,5cm and 0,5 cm in diameter respectively (Figure 5).Department of HE and Training approved lis

More men than women make mucosal IgA antibodies to Human papillomavirus type 16 (HPV-16) and HPV-18: a study of oral HPV and oral HPV antibodies in a normal healthy population

BACKGROUND: We have previously shown the high prevalence of oral anti-human papillomavirus type 16 (HPV-16) antibodies in women with HPV-associated cervical neoplasia. It was postulated that the HPV antibodies were initiated after HPV antigenic stimulation at the cervix via the common mucosal immune system. The present study aimed to further evaluate the effectiveness of oral fluid testing for detecting the mucosal humoral response to HPV infection and to advance our limited understanding of the immune response to HPV. METHODS: The prevalence of oral HPV infection and oral antibodies to HPV types 16, 18 and 11 was determined in a normal, healthy population of children, adolescents and adults, both male and female, attending a dental clinic. HPV types in buccal cells were determined by DNA sequencing. Oral fluid was collected from the gingival crevice of the mouth by the OraSure method. HPV-16, HPV-18 and HPV-11 antibodies in oral fluid were detected by virus-like particle-based enzyme-linked immunosorbent assay. As a reference group 44 women with cervical neoplasia were included in the study. RESULTS: Oral HPV infection was highest in children (9/114, 7.9%), followed by adolescents (4/78, 5.1%), and lowest in normal adults (4/116, 3.5%). The predominant HPV type found was HPV-13 (7/22, 31.8%) followed by HPV-32 (5/22, 22.7%). The prevalence of oral antibodies to HPV-16, HPV-18 and HPV-11 was low in children and increased substantially in adolescents and normal adults. Oral HPV-16 IgA was significantly more prevalent in women with cervical neoplasia (30/44, 68.2%) than the women from the dental clinic (18/69, 26.1% P = 0.0001). Significantly more adult men than women displayed oral HPV-16 IgA (30/47 compared with 18/69, OR 5.0, 95% CI 2.09–12.1, P < 0.001) and HPV-18 IgA (17/47 compared with 13/69, OR 2.4, 95% CI 0.97–6.2, P = 0.04). CONCLUSION: The increased prevalence of oral HPV antibodies in adolescent individuals compared with children was attributed to the onset of sexual activity. The increased prevalence of oral anti-HPV IgA in men compared with women was noteworthy considering reportedly fewer men than women make serum antibodies, and warrants further investigation