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

The prevalence and impact of oral lesions on the quality of life in persons with epidermolysis bullosa

Magister Chirurgiae Dentium (MChD)Introduction:Hereditary Epidermolysis bullosa (EB) is a group of rare mechanobullous dermatological disorders in which blisters develop following gene mutations. These genes encode structural proteins that anchor the epidermis to the underlying dermis.There are four main types of Epidermolysis bullosa, with more than 20 subtypes. The medical, physical and psychosocial aspects of Epidermolysis bullosa are well documented (Lucky et al, 2005; Mellerio et al, 2005). Many studies have documented case reports of associated oral lesions (Silva et al, 2004; Pacheco and de Sousa Araugio 2008; Siqueira et al, 2008). However, no assessment of the impact of these oral lesions on the affected person's everyday life has been made. The morbidity of the oral lesions associated with EB is expected to have an impact on the quality of life of these patients.Aim:To assess the prevalence and impact of oral lesions on daily activities in persons with Epidermolysis bullosa in Cape Town, South Africa, utilizing the Oral Impact on Daily Performance (OIDP) measure. Research Design and Methodology A case-controlled, descriptive analysis of the way in which oral lesions impact on quality of life in persons with Epidermolysis bullosa was carried out using semi-structured interviews. Fourteen persons with a confirmed diagnosis of hereditary Epidermolysis bullosa who attended the dermatology clinics at the Red Cross and Groote Schuur hospitals participated in the study. The control group comprised eighteen persons closely matched for gender, age, and dental status. Three persons with EB were unavailable for inclusion in the study.Results and Discussion Fourteen persons with Epidermolysis bullosa and eighteen controls were included in the study. Epidermolysis bullosa Simplex comprised the largest sub-group (n=9). Two persons had Junctional Epidermolysis bullosa, two had recessive Dystrophic Epidermolysis bullosa and one person had Kindler syndrome. The oral manifestations observed were consistent with those reported in the literature(Chimenos et al, 2003; Silva et al, 2004; Pekinar et al, 2005). No significant oral lesions (other than tooth decay) were seen in persons in the Epidermolysis bullosa Simplex group. Oral ulcers, atrophy of the dorsal surface of the tongue and gingival erythema were seen in persons with Junctional Epidermolysis Bullosa. The two individuals with Dystrophic Epidermolysis bullosa had a maximal oral opening of 15mm and 24mm. Ankyloglossia, depapillation of the dorsal tongue, absence of palatal rugae and poor oral hygiene was seen in these two persons. The patient with Kindler syndrome presented with erythematous and inflamed gingiva and cratering in the maxillary anterior interdental area. The gingiva appeared desquamative, fragile and bled with even the slightest provocation. Healing peri-oral blisters and angular cheilitis was also seen. His mouth opening was restricted to a maximal oral aperture of 13mm and his tongue extrusion was limited to only the tip of the tongue passing over the lower anterior incisor teeth.Defects in the tooth enamel was recorded in both participants with Junctional Epidermolysis bullosa and one person with dystrophic Epidermolysis bullosa, as well as excessive occlussal tooth wear (attrition), which may have been secondary to enamel hypoplasia. The dental caries status of the Epidermolysis bullosa and control groups varied according to age. The dmf for persons with Epidermolysis bullosa (all of whom had Epidermolysis bullosa Simplex), was lower than in the control group. The DMF in EB persons (15.3) was higher than in the control group (10.1).Toothache and tooth decay were the most common perceived complaints in both the Epidermolysis bullosa and control participants, accounting for the high overall OIDP score in both groups (87.5%). No statistically significant difference was found between the two groups (85.7% and 88.9% for Epidermolysis bullosa and control group persons respectively).Conclusion:The results of the study show that oral lesions (particularly tooth decay and toothache) in persons with Epidermolysis bullosa do affect their daily activities and the impact thereof is high. Other oral manifestations, irrespective of the subtype, had little impact on the OIDP score. This may be because the EB persons become tolerant of and “learn to cope” with them.Recommendations:Epidermolysis bullosa is a rare condition and not all persons with EB will present with lesions. However, all health personnel (including oral health profession) must be cognizant of this condition, in order to manage these persons safely, without incurring harm inadvertently. Thus, the overall management of persons with Epidermolysis bullosa must encompass ways to minimize and prevent trauma; provide an optimum wound healing environment; provide pain management and judicious checks for the development of premalignant lesions. This necessitates a multidisciplinary and holistic approach, with emphasis on patient involvement. To this end, an oral health care programme should form an integral part of their management because of the risk of dental disease. Periodic recall visits will enable the monitoring of home care and minimize the need for advanced restorative procedures. In this way, one may reduce the impact any oral problems may have, so that they do not further influence the patients well being

Oral medicine case book 74: marijuana-induced Oral Leukoplakia

A 55-year-old male presented at the Oral Medicine Clinic of the University of the Western Cape, Oral Health Centre, Tygerberg Campus, for the evaluation of a persistent white patch on his right edentulous mandibular ridge. He had been referred from the Prosthodontics Clinic where he was seen for complete denture rehabilitation. The patient had no significant medical history and informed us that he had been smoking marijuana five times a day for more than twenty years and consumed alcohol occassionally. He had never worn a dental prosthesis and did not use tobacco in any form.DHE

Oral medicine case book 76: Methotrexate induced mucosal erosions and ulcerations

A 71-year-old male was referred from his general practitioner to the Oral Medicine Clinic at the University of the Western Cape, Oral Health Centre, Tygerberg campus, on account of a six-week history of recurrent oral ulceration

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

Determining an average distance from the external mandibular cortex to the inferior alveolar canal using cone beam computed tomography (CBCT) imaging: An aid to harvesting mandibular ramus autogenous grafts.

OBJECTIVES: To provide average measurements relating the external mandibular cortex (EMC) to the inferior alveolar canal (IAC) using CBCT. METHODS: 100 CBCT images from UWC Dental hospital patient database were analysed using CBCT software (NewtomVGi Image works Corps) to produce coronal slices at four defined points along the IAC. Each point was measured from the IAC to the outer aspect of the mandibular buccal cortex and to the alveolar ridge crest (edentulous mandibles) or buccal cortical plate crest (dentate mandibles). The paired t-test was used to analyse right and left side measurements in order to test for differences in right and left side means. RESULTS: A mean width of 5.891mm (±1.09) from the IAC to the EMC in the horizontal plane and a mean height of 13.068mm (±2.963) from IAC to the alveolar crest or buccal cortical plate was demonstrated. Mean height was lower in edentulous mandibles (11.142mm in females; 13.490mm in males) than in dentate mandibles (12.916mm in females; 14.102 in males). There was no significant difference in width values. Height values were greater in males (14.102mm) than in females (12.916mm), being marginally significant (p-value of 0.00948:p<0.05). CONCLUSIONS: These measurements are clinically applicable when harvesting mandibular autogenous block grafts.DHE

Oral Medicine Case Book 56: Oral Manifestations of aplastic anaemia

A 22-year old female patient was referred to the Oral Medicine Clinic from the Haematology Ward at Groote Schuur Hospital for evaluation of a painful oral ulcer, which had been present for three weeks. The patient reported that, six weeks ago, she had sought treatment from her own dentist for painful and bleeding gingivae. The dentist performed a scale and polish and prescribed a combination of amoxicillin and metronidazole, at normal adult doses, for seven days. The gingival bleeding had not resolved by the time she presented for her recall visit, two weeks later. The patient also reported the presence of 'small, purple spots' on her lower limbs and trunk.DHE

Prevalence and distribution of HPV infection and subtypes in oral squamous cell carcinoma in Africa: A systematic review protocol

Human papillomavirus (HPV) is an established risk factor for oropharyngeal squamous cell carcinoma, regardless of a history of other known risk factors such as alcohol and tobacco. While cases of HPV-related oral squamous cell carcinoma (OSCC) are increasing in the USA, Europe and South Central Asian countries, little is known about the impact of the disease on the African continent. s We describe a protocol for a systematic review to synthesise the best current evidence to assess the disease burden in Africa. Electronic databases including EBSCOhost, MEDLINE, CINAHL, ACADEMIC SEARCH COMPLETE, ScienceDirect, Web of Science, Scopus, SciCENTRAL, Cochrane Library

Diagnostic Potential of Salivary Exosomes in Oral Cancer

“Omics” based concepts and techniques are gaining momentum in the field of oral medicine, spurred on by rapid advancements within the field of precision diagnostics and therapeutics. Oral cancer, specifically oral squamous cell carcinoma is the most common head and neck cancer, posing both diagnostic and prognostic challenges globally. Saliva offers several advantages as a diagnostic tool and has gained recognition as a biological medium for liquid biopsy. Salivary biomarkers, such as exosomes not only contain the full spectrum of genomic, lipidomic and proteomic material from its cell of origin, but are also more stable and consistently measurable in saliva due to their phospholipid structural protection of their merchandise/contents. Salivary exosomes are mediators in communication and transfer of contents between cancer and normal cells and thus key role players in mediating the tumor environment. Even though exosomes have been widely employed to investigate systemic diseases including head and neck cancers, unraveling the biologic mechanisms, scope of application of salivary tumor-derived exosomes and overcoming restrictions in this emergent field of saliva-exosomics warrants further investigation

Oral medicine case book 49: plasmablastic lymphoma

A 25-year-old male patient presented at the Oral Medicine Clinic with a painful bleeding lesion on the palate causing him discomfort during speech, mastication, and sleep. The lesion started approximately five months earlier as a small growth that gradually increased in size. The patient was rather vague about his medical history and habits but he did reveal that he smoked two cigarettes per day as well as using cocaine, a habit for which he was receiving therapy, for drug-induced hallucinations, at a local psychiatric hospital. He was not aware of any other medical conditions or allergies. The extraoral examination revealed nothing of note, however, on intraoral examination a large and firm pedunculated exophytic soft tissue mass was seen on the hard palate. It covered a large portion of the hard palate extending from the back of the upper incisors posteriorly onto the anterior part of the soft palate and into the right vestibule. It extended laterally to the gingival margins of all the teeth in the first quadrant, resulting in an appearance of gingival hyperplasia. The growth had an erythematous appearance with surface patches of necrosis and other areas that easily bled on touch (Figure 1).Department of HE and Training approved lis