Angina bullosa hemorrhagica an enigmatic oral disease

Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5th decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculobullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic. Although it is an uncommon disease, the angina bullosa hemorrhagica should be considered in the differential diagnosis of oral vesiculo-bullous processes. Acknowledging this entity will help in differentiating it from important mucocutaneous and hematological diseases such as pemphigus vulgaris, mucous membrane pemphigoid or coagulation disorders. In this review we analyze the main etiopathogenic, clinicopathological, diagnostic and therapeutic aspects of this enigmatic oral condition.peer-reviewe

Erosive tooth wear in children and adolescents

To determine the local prevalence of erosive tooth wear in the child population and to identify the degree to which local demographic and socioeconomic factors influence prevalence, a multi-stage cluster sample of three, five, eight, twelve and fifteenyear old Maltese school children were identified. The children were clinically examined under standardised conditions and provided a questionnaire to be filled directly (twelve and fifteen-year-olds) or by the parents/legal guardians (three, five and eight-year-olds). A total of 2508 children were examined. Of these, 232 three-year-old, 338 five-year-old children, 337 eight year-old children, 642 twelve-year-old children and 560 fifteen-year-old children returned a questionnaire and were analysed. The prevalence of erosive tooth wear was > 70% in all age cohorts. Erosion experience also increased in both extent and severity with age in each dentition. Significant higher incidences were observed in eight-year old males, eight-year old overweight children, eight and fifteen-year-olds attending public schools, locality (Gozo > Malta), history of vomiting in fifteen-year olds, and children from lower socioeconomic parental status in five, eight and fifteen-year-olds. The prevalence of erosive tooth wear is high in school aged Maltese children. This easily preventable tooth condition deserves targeted public health programmes to improve the oral health of future generations.peer-reviewe

Production of carcinogenic acetaldehyde by Candida albicans from patients with potentially malignant oral mucosal disorders

OBJECTIVES: Production of carcinogenic acetaldehyde by Candida has been suggested to contribute to epithelial dysplasia and oral carcinogenesis. Oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral leukoplakia (OL) are potentially carcinogenic oral diseases where colonisation by Candida is common, but acetaldehyde production by Candida has not been studied. STUDY DESIGN: Acetaldehyde production in ethanol (11 mM), glucose (100 mM), ethanol–glucose (11 mM and 100 mM) or red wine (1200 mM ethanol) incubation by Candida albicans from patients with OLL (n = 6), OLP (n = 16), OL (n = 6) and controls (n = 6) was measured by gas chromatography. Participants completed a questionnaire regarding their smoking habits and alcohol consumption. RESULTS: All Candida albicans isolates produced potentially carcinogenic levels of acetaldehyde (>100 lM) in all incubations containing ethanol. The control group isolates produced the highest acetaldehyde levels. Isolates from smokers produced more acetaldehyde in all incubations than those from non-smokers. The difference was significant in ethanol–glucose incubation. Isolates from patients who were both smokers and drinkers produced the highest amounts when incubated in ethanol, ethanol– glucose and wine. CONCLUSIONS: Candida albicans isolated from potentially carcinogenic oral diseases can produce mutagenic amounts of acetaldehyde. Cigarette smoking and alcohol consumption may favour adaptational changes resulting in the upregulation of candidal acetaldehyde metabolism.peer-reviewe

The oral health status of the Gozitan community

The objective of this study is to assess the oral health status and treatment needs of Gozo residents – a geographically isolated community. A cross-sectional study of 332 Gozitan attendees on the Mobile Dental Unit was carried out during a three-month period in 14 localities in Gozo. The participants attended for a dental check-up and indices were used to record caries, plaque, calculus, erosion, soft tissue pathologies and number of dental functional units. Of the 332 participants 76.8% presented with plaque deposits, 78% require either restorative or periodontal treatment while signs of erosive wear were present in 28% of participants. In younger age bands (0–9 and 10–19) untreated carious lesions amount to 1.34 and 1.0 (DT portion of DMFT) respectively, care index FT (filled teeth)/DMFT was 0.37 overall. Most participants in 50+ age bands had less than 10 remaining functional units. Thus, the oral health status of the Gozitan community shows a high level of unmet dental treatment needs. This underscores the need for provision of better dental services in Gozo, re-orientation of existing services to focus on prevention, and introduction of evidence-based preventive strategies in school-children.peer-reviewe

The role of microRNAs in oral lichenoid disorders. Systematic review

Background: Certain changes in the microRNA expression are considered to be associated with chronic inflammatory processes and with the malignant transformation of oral potentially malignant disorders. The purpose of this systematic review is to update the existing data on the aberrant microRNA expression profiles identified in oral lichenoid disease (OLD).Material and Methods: A search in PubMed-Medline and Scopus was performed on the English literature published between 2010 and August 2016 using the following keywords: oral lichenoid disease, oral lichen planus and microRNA. Results: Originally, 25 articles were considered, of which 12 case-control articles were selected according to the inclusion/exclusion criteria.Conclusions: OLD seems to have altered microRNA expression profile. Certain altered microRNAs (146a, 155) may be useful as biomarkers for this disorder. More studies including larger number of cases are needed in order to study further on the biological processes and on the regulation pathways of these altered microRNAs.peer-reviewe

Assessment of CD-105 as an Angiogenic Modulator in Odontogenic Myxomas and Dental Follicles

Aim. Odontogenic myxoma is a benign intraosseous neoplasm of the jaws, with a locally aggressive behavior and a high recurrence rate. CD-105 is a homodimeric cell membrane glycoprotein and is a component of the TGF-β1 growth factor receptor complex that modulates angiogenesis by regulating the proliferation, differentiation and cellular migration. The aim of this study is to quantify the microvascular density of the odontogenic myxoma based on the expression of CD-105. Materials and Methods. The analysis included 18 odontogenic myxoma and 18 dental follicles as controls. A standard immunohistochemical procedure was performed with the CD-105 antibody. Five representative fields (40×) of the odontogenic myxoma and the dental follicles were selected to determine the microvascular density, which was then followed by a descriptive and comparative statistical analysis. Results. Dental follicles presented a significantly higher microvascular density compared with odontogenic myxoma (P = .001). The odontogenic myxoma smaller than 3 cm showed a greater microvascular density than those larger than 3 cm in size (P > .05), and the microvascular density was lower in large odontogenic myxomas as compared with the dental follicles (P = .003). Conclusion. A weaker expression of CD-105 in odontogenic myxoma might indicate a lower angiogenic activity, suggesting that vascular proliferation has a limited role in the growth mechanisms and in the aggressive behavior of this neoplasm.peer-reviewe