Gingival Papillomatosis as the Oral Sign of Cowden Syndrome: A Case Report

Cowden syndrome (CS) is a rare autosomal dominant, hereditary, multiorgan disease with higher risk for malignancies (breast, thyroid, endometrium). Mucocutaneous lesions occur in 90% of cases and are characterized by facial trichilemmomas, oral mucosal papillomas, and benign acral keratoses. We present the case of a 39-year-old female patient with the chief complaint of “white spots” on the upper and lower attached gingiva accompanied with skin changes on the face, hands, and soles. The patient’s family medical history revealed that her mother had an endometrial polyp and the sister had thyroid cancer. In the patient’s medical personal history she reported follicular thyroid adenoma, thyroid abnormalities (i.e. lymphocytic thyroiditis), fibrocystic changes and juvenile breast papillomatosis, lipoma, multiple fibromas, and genitourinary tumors. Based on extensive family and personal medical history, physical examination and histopathological findings, diagnostic criteria were fulfilled for the diagnosis of Cowden syndrome

Usefulness of Unstimulated and Stimulated Whole Saliva, Accuracy of Minor Labial Salivary Gland Biopsy in the Diagnosis of Primary Sjögren's Disease: A Croatian Single-Center, Cross-Sectional Study

The aim of this cross-sectional study was to determine the accuracy of minor labial salivary gland (MLSG) biopsy in the diagnosis of primary Sjögren' s disease (pSD); to study the correlation between the focus score (FS) and anti-SSA/Ro, anti-SSB/La, anti-SSA and -SSB antibodies, unstimulated whole saliva (UWS) and stimulated whole saliva (SWS); to determine the role of UWS and SWS in the clinical evaluation of pSD patients and patients with sicca symptoms. Methods. A total of 37 subjects were enrolled in the study and divided into two groups: the test group consisted of 15 patients diagnosed with pSD; the control group consisted of 22 patients who had sicca symptoms but did not meet the 2016 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) diagnostic criteria. Clinical and laboratory tests, including saliva collection, MLSG biopsy, autoantibody titers, were performed in all patients. Results. The median of the FS was 1.00 [IQR=1.00-1.50] in the test group, whereas in the control group, it was 0.00 [IQR=0.00-0.00] (p< 0.001). The sensitivity, specificity, and accuracy of MLSG biopsy were 86.7%, 100.0%, and 94.6%, respectively. The results showed a correlation between the FS and antinuclear antibodies (ANA) (p=0.002). In addition, Pearson’s correlation showed a weak negative correlation between UWS (r=-0.058, p=0.73) and SWS (r=-0.022, p=0.90) and the FS. In the test group, 73.3% of patients had abnormal UWS values, while 86.7% had abnormal SWS values; among them, values of 0.00 ml/min for UWS and SWS were found in 60.0% and 26.7% of patients, respectively. Conclusions. Although MLSG biopsy has great diagnostic value and accuracy in diagnosing pSD, it is not always definitive. Our study found a statistically significant association between the FS and ANA, and the greater utility of SWS in diagnosing pSS

KLINIČKI I PATOFIZIOLOŠKI PRIKAZ BOLESNIKA S OROFARINGEALNIM RAKOM PLOČASTIH STANICA POZITIVNIH NA HUMANI PAPILOMAVIRUS – ISTRAŽIVANJE U JUŽNOJ HRVATSKOJ

Objective: The objective of this study was to analyze the influence of human papilloma virus (HPV) in patients with oropharyngeal squamous cell carcinoma (OPSCC) from southern Croatia on survival, clinical outcomes, and pathological features. Methods: We analyzed HPV DNA presence and p16 immunohistochemistry staining in 68 formalin-fixed paraffin-embedded samples from patients diagnosed with OPSCC at the Split University Hospital Center between 2013 and 2017. Histologic features were analyzed using a light microscope. Clinical data were retrospectively collected from patient records and analyzed for HPV status. Results: In this study, 10.29% of patients were HPV positive (HPV+). Lymphocyte invasion was more prominent in p16 positive OPSCC. Overall survival (OS) was better in HPV+ and p16+ patients. HPV status is a significant prognostic variable for patients from south Croatia with OPSCC. Conclusion: HPV seems to have a minor influence on OPSCC in south Croatia in comparison to other Western European countries and the USA. Although the influence of HPV on survival was significant, traditional risk factors were more important in the carcinogenesis of OPSCC in our population.Cilj: Svrha ovog istraživanja bila e analizirati utjecaj humanog papilomavirusa (HPV) na preživljavanje, kliničke pokazatelje i patohistološke značajke u ispitanika oboljelih od orofaringealnog raka pločastih stanica (OPSCC) u južnoj Hrvatskoj. Metode: Istražili smo prisutnost HPV DNK i imunohistokemijsko bojanje na p16 u 68 u parafinske blokove uklopljenih uzoraka tkiva ispitanika oboljelih od OPSCC-a i liječenih u Kliničkom bolničkom centru Split u razdoblju od 2013. do 2017. godine. Svjetlosnim mikroskopom utvrđene su histološke značajke tkiva. Retrospektivno smo prikupili kliničke podatke ispitanika i proučili ih s obzirom na HPV status. Rezultati: U ovom je istraživanju 10,29% pacijenata pozitivno na HPV (HPV+). Invazija limfocita značajnija je u ispitanika s p16 pozitivnim (p16+) OPSCC-om. Ukupno preživljavanje (OS) bolje je u HPV+ i p16+ ispitanika. HPV je značajan prognostički čimbenik u ispitanika koji boluju od OPSCC-a iz južne Hrvatske. Zaključak: Čini se da je HPV manje utjecajan uzročni čimbenik nastanka OPSCC-a u južnoj Hrvatskoj u usporedbi sa zapadnoeuropskim zemljama i SAD-om. Iako je HPV značajan čimbenik preživljavanja, tradicionalni čimbenici rizika pokazali su se važnijim karcinogenima za nastanak OPSCC-a u našoj populaciji

Inflammatory Markers and Incidence of other Autoimmune Diseases in Patients with Oral Lichen Planus

Uvod: Oralni lihen planus (OLP) kronična je imunosna upalna bolest sluznice usne šupljine još nerazjašnjene etiologije. Materijali i metode: U istraživanju su sudjelovala 63 ispitanika s dijagnozom oralnoga lihena planusa i 63 bez patoloških promjena na oralnoj sluznici – oni su svrstani u kontrolnu skupinu. Svim ispitanicima uzeti su anamnestički podatci o prisutnosti druge autoimune bolesti te im je izvađen uzorak venske krvi za određivanje brzine sedimentacije (SE-a), broja leukocita (L-a) i koncentracije C-reaktivnog proteina u serumu (CRP-a). Statistička analiza: U statističkoj obradi korištene su metode deskriptivne statistike, χ2-test , Fisherov egzaktni test te Studentov t-test. Rezultati su interpretirani na razini značajnosti P < 0,05. Rezultati: Za sva tri mjerena upalna markera nije bilo statistički značajne razlike u broju ispitanika s povišenim vrijednostima između ispitne i kontrolne skupine (P = 0,364 za SE; P = 1,000 za CRP i P = 0,219 za L). Promatrajući druge autoimune bolesti, statistički je značajno bila veća učestalost u ispitnoj skupini, a najčešće su to bili kožni lihen kod devet ispitanika (14,29 %) i celijakija kod sedam (11,11%). Zaključci: Rezultati su pokazali da nema značajne razlike u prosječnim vrijednostima ispitivanih upalnih markera u krvi između oboljelih od OLP-a i ispitanika u kontrolnoj skupini te je dokazana značajno veća učestalost drugih autoimunih bolesti kod oboljelih od OLP-a, najčešće kožni lihen i celijakija.Introduction: Oral lichen planus (OLP) is a chronic immune, inflammatory disease of the oral cavity of a still unknown etiology. Materials and methods: The study involved 63 subjects diagnosed with oral lichen planus and 63 subjects without pathologic changes in the oral mucosa who were classified as controls. All subjects were given a detailed medical history at first screening. The medical history of the presence of other autoimmune disease in all subjects was supported by medical records. A sample of venous blood was taken from each subject in order to determine sedimentation rate (SE) and leukocyte count (L) using standard laboratory procedures, and serum C-reactive protein (CRP) concentration values were determined as well. Statistical analysis: The methods of descriptive statistics, χ2-test, the Fisher’s exact test, and the Student’s t-test were used in the statistical processing of the results. The results were interpreted at a significance level of P <0.05. Results: For all three measured inflammatory markers, there were no statistically significant differences in the number of subjects with elevated values between the test and control groups (P = 0.364 for SE; P = 1.000 for CRP and P = 0.219 for L). The prevalence of other autoimmune disease in the OLP group was higher than in the control group, with statistical significance, and the most common was cutaneous lichen in nine subjects (14.29%) with OLP and celiac disease seven subjects (11.11%). Conclusions: The results showed that there was no significant difference in the average values of the investigated inflammatory markers in blood (SE, CRP and L) between patients with OLP and control subjects, while a significantly higher incidence of other autoimmune diseases in patients with OLP was demonstrated

Knowledge of Oral Cancer among the Fourth and Fifth Year Dental Students

Uvod: Podatci iz literature pokazuju nedovoljno znanje i svijest o raku usne šupljine među studentima dentalne medicine i medicine. Cilj: Željelo se procijeniti znanje i svjesnost studenata završnih godina studija dentalne medicine o raku usne šupljine, njegovoj prevenciji i ranom otkrivanju. Također se željela utvrditi učestalost studenata pušača među studentima dentalne medicine i koliko njihov pušački status utječe na stajalište prema pušenju kao rizičnom čimbeniku za razvoj raka usne šupljine. Ispitanici i metode: Ispitna skupina sastojala se od ukupno 83 studenta četvrte i pete godine studija dentalne medicine koji su odgovarali na 16 pitanja iz izvornog upitnika. Rezultati: Više od polovine studenata smatra da je njihovo znanje o raku usne šupljine dobro, četvrtina da je loše, a samo su dva studenta ocijenila svoje znanje izvrsnim. Više studenata pete godine pušači su u odnosu prema studentima četvrte godine (39, 5 % vs. 22, 5 %). Veći postotak studenata nepušača u odnosu prema studentima pušačima označio je prestanak pušenja kao važnu preventivnu mjeru (nepušači 91, 2 %, pušači 84, 3 %, p = 0, 01). Zaključak: Većina studenata četvrte i pete godine studija procjenjuje svoje znanje o raku usne šupljine dobrim, iako velik broj studenata obiju godina smatra benignu vlasastu leukoplakiju potencijalno malignim stanjem. Studenti nepušači smatraju prestanak pušenja važnom preventivnom mjerom, za razliku od studenata pušača

Koncentracija vitamina D u serumu oboljelih od oralnoga lihen planusa

Objectives: The vitamin D receptor is involved in immunologically mediated diseases such as oral lichen planus. Some studies suggest an association between lower vitamin D concentrations and a higher risk of inflammatory conditions such as oral lichen planus. The aim of this study was to investigate 1) whether there is a difference in serum vitamin D concentration in patients with oral lichen planus compared to patients in the control group, 2) whether there is a difference in serum vitamin D concentration in patients with erosive compared to non-erosive forms of oral lichen planus, 3) whether there is a difference in serum vitamin D concentration in patients with developed oral cancer and those without cancer. Material and Methods: The study included 68 patients, 34 with oral lichen planus and 34 healthy controls. Fasting venous blood was taken from each participant to determine serum concentrations of vitamin D. Results: The T-test results confirmed a statistically significant lower serum vitamin D concentration in patients with oral lichen planus compared to the control group (p=0.001). According to the results, a statistically significant lower serum vitamin D concentration was found in patients with erosive form OLP. All five patients with oral cancer, which was developed from erosive OLP, had low serum vitamin D concentrations. Conclusions: Determination of serum vitamin D concentration could be important for monitoring OLP patients to prevent the development of severe clinical manifestations of erosive OLP and the conversion of symptomatic lesions to oral cancer.Svrha rada: Vitamin D receptor je uključen u imunosno posredovane poremećaje kojima pripada i oralni lihen planus (OLP). Provedena istraživanja sugeriraju moguću povezanost smanjene koncentracije vitamina D i povećanog rizika za neke upalne bolesti, pa tako i za oralni lihen planus. Svrha istraživanja bila je ispitati postoji li razlika u serumskoj koncentraciji vitamina D između bolesnika s različitim kliničkim oblicima oralnoga lihen planusa (erozivni vs. neerozivni) i zdravih ispitanika u kontrolnoj skupini. Ispitanici i postupci: U istraživanje je bilo uključeno ukupno 68 ispitanika koji su došli na prvi specijalistički pregled u Ambulantu oralne medicine Odjela za dentalnu medicinu Zavoda za maksilofacijalnu kirurgiju Kliničkoga bolničkoga centra Split. Ispitnu skupinu činila su 34 ispitanika s neerozivnim ili erozivnim oblikom OLP-a, a kontrolnu skupinu također 34 ispitanika bez patoloških promjena na oralnoj sluznici. Rezultati: Rezultati t-testa potvrdili su statistički znatno nižu serumsku razinu vitamina D kod bolesnika s OLP-om u usporedbi sa zdravim ispitanicima iz kontrolne skupine (p = 0,001). Rezultati su pokazali i statistički znatno nižu serumsku koncentraciju vitamina D kod bolesnika s erozivnim oblikom OLP-a. Kod svih pet ispitanika kojima se pojavio karcinom usne šupljine iz erozivnog oblika OLP-a zabilježene su snižene serumske vrijednosti vitamina D. Zaključak: Određivanje serumske razine vitamina D važno je u praćenju bolesnika s OLP-om kako bi se prevenirao mogući utjecaj njegova deficita na razvoj teže kliničke slike erozivnih oblika bolesti

Impact of Smoking on Oral Health: Knowledge and Attitudes of Dentists and Dental Students

Svrha: Željele su se procijeniti pušačke navike te razina znanja i stajališta u vezi s pušenjem i ulogom stomatologa u prevenciji pušenja među studentima Stomatološkog fakulteta Sveučilišta u Zagrebu i hrvatskim stomatolozima. Materijali i metode: Istraživanje je provedeno među studentima prve i šeste godine te stomatolozima zaposlenima u ordinacijama primarne prakse diljem Hrvatske i na Stomatološkom fakultetu Sveučilišta u Zagrebu. Sudjelovalo je ukupno 159 ispitanika (51 student 1. godine, 53 studenta 6. godine i 55 stomatologa). Rezultati : Prevalencija pušenja bila je najveća među studentima šeste godine (39,6 %) te nešto manja kad je riječ o stomatolozima (34,5 %), a među studentima prve godine bilo je najmanje pušača (7,8 %). Veći udjel studenata koji puše želi s tom ovisnošću prestati (66,7 % studenata pušača 1. godine i 76 % studenata pušača 6. godine), a to želi i manje od polovine stomatologa (45,8 %). Studenti i prve i šeste godine, u odnosu prema stomatolozima, pokazali su statistički značajno veći stupanj želje za edukacijom o štetnim učincima pušenja i za savjetovanje pacijenata o prestanku pušenja. Sve navedeno upućuje na to da je nužno povećati svijest struke o opasnostima pušenja kad je riječ o općem i oralnome zdravlju, te među pacijentima isticati važnost zdravstvenih radnika kao promicatelja zdravih životnih navika.Objective: The aim of this study was to evaluate smoking habits, the level of knowledge and attitudes towards smoking, as well as the role of dental professionals in prevention of smoking among students of the School of Dental Medicine, University of Zagreb and compare them to attitudes of practicing Croatian dentists. Materials and methods: The study was carried out among 1st and 6th year dental students at the School of Dental Medicine, University of Zagreb and dentists employed in primary practice throughout Croatia. A total of 159 subjects (51 1st and 53 6th year dental students and 55 dentists) participated in the study. Results: The prevalence of smoking was highest among 6th year dental students (39, 6%). It slightly decreased among dentists (34, 5%), while least smokers were found among first year dental students (7, 8%). The majority of dental student smokers expressed a desire to stop smoking (66, 7% of 1st year dental student smokers and 76% of 6th year dental student smokers), while less than half of dentist smokers had the desire to stop - only 45, 8% of them. Dental students of the 1st and 6th year of the study showed a statistically significantly higher level of desire for education about harmful smoking effects and patients counselling to quit smoking compared to dentists. The data gathered in this study indicate that it is necessary to increase awareness among dental professionals about harmful effects of smoking on oral and general health. Also, their awareness about the central role of healthcare workers as promoters of a healthy lifestyle among patients should be raised

The Oral Cavity State in Renal Transplant Recipients

Svrha: Bolesnicima s transplantiranim čvrstim organom mogu se pojaviti mnogobrojne i različite komplikacije u ustima zbog oslabljene imunosti i nuspojava na lijekove. Svrha ovog istraživanja bila je ispitati učestalost i vrstu oralnih lezija kod bolesnika s transplantiranim bubregom, odrediti stanje zuba i oralne higijene, oralne lezije povezane s lijekovima koje pacijenti uzimaju prije transplantacije i nakon te operacije, te koliko često pacijenti u poslijetransplantacijskom razdoblju posjećuju stomatologa. Ispitanici i postupci: Istraživanje je trajalo dvije godine, a uključeno je bilo 100 ispitanika s transplantiranim bubregom tijekom njihovih redovitih kontrola u Zavodu za nefrologiju i dijalizu KBC-a Zagreb i u Zavodu za oralnu medicinu Stomatološkog fakulteta Sveučilišta u Zagrebu te 100 nasumce odabranih kontrolnih ispitanika iz Zavoda za endodonciju i restaurativnu stomatologiju Stomatološkog fakulteta Sveučilišta u Zagrebu. Rezultati: Rezultati su pokazali značajno veću učestalost oralnih lezija kod bolesnika s transplantiranim bubregom (31 %) u usporedbi s kontrolnim ispitanicima. Najčešće promjene bile su eritem, keratotične lezije na sluznici i hiperplazija gingive. Prosječna vrijednost KEP indeksa bila je značajno niža kod bolesnika s transplantiranim bubregom negoli u kontrolnoj skupini. Trećina bolesnika imala je subjektivni osjećaj suhoće usta. Oralna higijena sveukupno je bila loša i samo malobrojni ispitanici koristili su se dodatnim proizvodima za higijenu usta. Većina pacijenata nakon transplantacije nije posjetila stomatologa. Zaključak: Bolesnici s presađenim bubregom trebaju sveobuhvatnu i redovitu stomatološku skrb prije transplantacije i nakon nje, a doktor dentalne medicine neizostavno treba biti član multidisciplinarnog tima medicinskih stručnjaka.Aim: Patients with a solid organ transplant can have many different complications in the mouth, as a result of immunosuppression and side effects of drugs. The aim of this study was to examine the frequency and type of oral lesions in renal transplant patients, dental status, oral hygiene, oral lesions related to drugs which patients take and the time of transplantation as well as the frequency of patient’s visits to the dentist in the post-transplant period. Material and methods: The study was performed in a period of two years and included 100 subjects with a renal transplant during their regular control visits to the Department of Nephrology and Dialysis, Clinical Hospital Centre Zagreb and the Department of Oral Medicine, School of Dental Medicine, University of Zagreb and 100 randomly selected control subjects at the Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb. Results: Results showed a significantly higher incidence of oral lesions in patients with renal transplant (31%) compared to control subjects. The most frequent were erythematous (inflammatory changes), keratotic lesions and gingival hyperplasia. The average DMFT index was significantly lower in patients with renal transplant than in the control group. One third of patients had a subjective feeling of dry mouth. Oral hygiene was poor overall, and only a small number of subjects used the additional sustainers for oral hygiene. Most patients did not visit the dentist after the transplantation. Conclusion: Renal transplant patients need a comprehensive and regular dental care during the pre- and post-transplant period and a doctor of dental medicine should be part of a multidisciplinary team of medical specialists

DEPRESSION AND SERUM INTERLEUKIN-6 LEVELS IN PATIENTS ON DIALYSIS

Background: Depression is a common psychiatric problem in patients undergoing dialysis. Several studies have been performed to validate the association between depression and inflammation in haemodialysis patients. The levels of proinflammatory cytokines are increased in chronic renal failure patients, as in depression. The objective of this study was to compare the incidence of depression in the patients on dialysis (on hemodialysis /HD/ and on continuous ambulatory peritoneal dialysis /CAPD/), and a relationship between depression and the presence of inflammation. Subjects and methods: 88 patients (52 on HD and 36 on CAPD) were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI). The BDI is a 21-item self-report instrument, and the elevated symptoms of depression were defined as a BDI score ≥16. HD patients were treated with high-flux polysulphone biocompatible dialyzers and CAPD patients were treated with usual dwell time (4-6 hours during the day and 8–10 hours at night). The presence of an inflammatory state was assesded by determinations of plasma interleukin-6 (IL-6) levels. Results: Depression (BDI ≥ 16) was present in 28.4% of dialysis patients, 35% of patients on hemodialysis (HD) and 18.1% of patients on continous ambulatory peritoneal dialysis (CAPD). The BDI score was significantly lower in CAPD patients comparing to HD patients, as well as the levels of albumin, C-reactive protein (CRP) and interleukin-6 (IL-6). IL-6 serum levels were similar in patients with depression and patients without depression in the whole group, as in HD patients. In CAPD patients without depression IL-6 levels were significantly lower. Conclusions: The prevalence of depression was higher in HD comparing to CAPD patients. Although IL-6 level was higher in HD compared to CAPD patients, the relationship between depression and presence of inflammation parametars were observed in CAPD, but not in HD patients