Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases

Predictive Periodontitis: The Most Promising Salivary Biomarkers for Early Diagnosis of Periodontitis

The primary cause of tooth loss in the industrialized world is periodontitis, a bacterial anaerobic infection whose pathogenesis is characterized by composite immune response. At present, the diagnose of periodontitis is made by a complete status check of the patient’s periodontal health; full-mouth plaque score, full-mouth bleeding score, probing depth, clinical attachment level, bleeding on probing, recessions, mobility, and migration are evaluated in order to provides a clear picture of the periodontal conditions of a single patient. Chair-side diagnostic tests based on whole saliva could be routinely used by periodontists for a very early diagnosis of periodontitis, monitoring, prognosis, and management of periodontal patients by biomarker detection, whose diagnostic validity is related to sensitivity and specificity. Recent paper reviews and meta-analyses have focused on five promising host derived biomarkers as candidate for early diagnosis of periodontitis: MMP-8 (Metalloproteinase-8), MIP-1α (Macrophage inflammatory protein-1 alpha), IL-1 β (Interleukin-1 beta), IL-6 (Interleukin-6), and HB (Hemoglobin), and their combinations. Chair-side Lab-on-a-chip (LOC) technology may soon become an important part of efforts to detect such biomarkers in saliva medium to improve worldwide periodontal health in developed nations as well as in underserved communities and poor countries. Their applications in preventive and predictive medicine is now fundamental, and is aimed at the early detection of risk factors or the presence or evolution of the disease, and in personalized medicine, which aims to identify tailor-made treatments for individual patients. The aim of the present paper is to be informative about host derived periodontal biomarkers and, in particular, we intend to report information about the most important immune response derived biomarkers and Hemoglobin as candidates to be routinely utilized in order to obtain a chair-side early diagnosis of periodontal disease

Clinical characterization of gingival type of burning mouth syndrome:a cross-sectional study

The aim of this study is to investigate the prevalence of localized intraoral neuropathic pain in a cluster of patients who reported the involvement of gingival site as only clinical manifestation of dysesthesia, analysing type and distribution of symptoms. Burning mouth syndrome (BMS) patients were enrolled in the study. Patients were screened through laboratory test and a conventional oral examination with periodontal chart. A questionnaire to collect data on symptoms, oral site involved, quality of sleep, anxiety was submitted to all the patients. A total of 236 patients were recruited. Seventy-six patients (32.2%) presented generalized type, whereas 160 (67.8%) had localized type. In the localized BMS group, the gingiva was involved in 70 patients and in 33 of these it was the only site involved. In the gingival subgroup, 35 patients reported burning, 29 pain and 24 xerostomia. To best our knowledge, this study is the first that analyses gingival involvement as the only site in BMS and it could encourage further investigations to understand the etiopathogenesis of gingival BMS

Sexual desire, mood disorders and sleep disturbances in female BMS patients: A controlled study

Background: Burning mouth syndrome is a chronic orofacial pain with intraoral burning and other oral dysaesthetic symptoms that significantly affects the quality of life. The aim of this study is to evaluate the sexual desire in women with BMS and to investigate the possible related factors. Methods: A case-control study was performed. BMS patients were enrolled according to the International Classification of OroFacial Pain criteria. Demographic variables were collected. We evaluated pain with the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS) and Total Pain Rating Index (T-PRI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS-A e HADS-D), sleep disturbances with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and sexual desire using Sexual Desire Inventory (SDI). Results: A total of 50 BMS women and 50 healthy controls were enrolled. Compared with the controls, the BMS patients showed higher scores in the NRS (7,81 ± 1,71 vs. 0,14 ± 0.40; p < 0.0001), TPR-I (10,50 ± 4,86 vs. 0,36 ± 1,06; p < 0.0001), HADS-A (11,86 ± 2,85 vs. 3,90 ± 2,81; p < 0.0001), HADS-D (8,04 ± 3,18 vs. 1,42 ± 1,86; p < 0.0001) and PSQI (9,04 ± 2,62 vs. 4,64 ± 3,27; p < 0.0001). The mean SDI in the study group was significantly lower compared to healthy controls (32,36 ± 14,45 vs. 69,70 ± 19,94; p < 0.0001). No correlation was found between SDI and others items explored. Conclusion: In line with previous studies, anxiety, depression and sleep disturbances are more common in BMS patients than in healthy population. This pilot study demonstrates for the first time an association between BMS and low sexual desire

Zirconia-reinforced lithium silicate (ZLS) mechanical and biological properties: A literature review

Objectives: This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems.Data/Sources: An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers.Study selection: The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included.Conclusions: After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations. Clinical Significance: . As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/ in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials

Optical behaviors, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate (ZLS): A narrative review

Objectives: The present narrative review was focused on the optical properties, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate ceramics (ZLS) for Computer-aided design / Computer-aided manufacturing (CAD/CAM) technologies. Data/sources: A literature search was performed by 3 calibrated independent researchers on PubMed, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The criteria for inclusion were: 1) papers addressing at least one of the following variables about ZLS: optical properties, surface treatment, adhesion, and clinical indications; 2) in vitro, in silico, or in vivo studies; 3) case reports; 4) systematic reviews. The exclusion criteria were: 1) animal studies; 2) non-dental studies; 3) studies only focusing on ZLS used in the heat-pressed process. Study selection: 98 records among in vitro studies and case reports were included. Conclusions: Despite the promising microstructure characteristics of ZLS, increased translucency compared to lithium disilicate ceramics (LS2) was not proven, but acceptable color changes and stability were reported. Mechanical polishing was the most effective method to reduce surface roughness. Moreover, machinability and handling of ZLS resulted harder than LS2. Conventional acid etching procedures seemed effective in conditioning ZLS surface, but no protocol has been established yet. Besides, silane-coupling and dual-curing resin cements were recommended. Clinical significance: ZLSs can be used for anterior and posterior fixed single-unit CAD/CAM restorations onto both natural teeth and implants, but do not seem to represent a viable treatment option for endocrowns onto posterior teeth or fixed dental prostheses

Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature.

Summary Objectives To review the current literature on mucormycosis in immunocompentent/otherwise healthy individuals, to which five new cases with maxillary sinus involvement have been added. Methods We searched in the PudMed database all articles in the English language related to human infections caused by fungi of the order Mucorales , in immunocompetent/otherwise healthy patients, starting from January 1978 to June 2009. In addition, we updated the literature by reporting five new cases diagnosed and treated at the oral medicine unit of our institution. Results The literature review showed at least 126 articles published from 35 different countries in the world, to a total of 212 patients described. The most affected country was India with 94 (44.3%) patients and the most representative clinical form was the cutaneous/subcutaneous with 90 (42.5%) patients. Our five immunocompetent patients with a diagnosed infection of Mucorales localized at the maxillary sinus completely healed with lyposomial amphotericin B. Conclusions The literature analysis revealed that even in immunocompetent/otherwise healthy individuals mucormycosis infection has a worldwide distribution. What might be the real predisposing factors involved in its pathogenesis in such patients and the real causes of this peculiar geographic distribution still remains unknown. It is likely that, in our cases, a chronic insult of a well-defined and localized body area might have resulted in a local immunocompromission, thus fostering the development of an invasive fungal infection

Sleep Disturbance in Patients with Burning Mouth Syndrome: A Case-Control Study

AIM: To examine sleep complaints in patients with burning mouth syndrome (BMS) and the relationships between these disturbances, negative mood, and pain. METHODS: Fifty BMS patients were compared with an equal number of healthy controls matched for age, sex, and educational level. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) were administered. Descriptive statistics, including the Mann-Whitney U test and hierarchical multiple linear regression analyses were used. RESULTS: BMS patients had higher scores in all items of the PSQI and ESS than the healthy controls (P < .001). In the BMS patients, a depressed mood and anxiety correlated positively with sleep disturbances. The Pearson correlations were 0.68 for PSQI vs HAM-D (P < .001) and 0.63 for PSQI vs HAM-A (P < .001). CONCLUSION: BMS patients reported a greater degree of sleep disorders, anxiety, and depression as compared with controls. Sleep disorders could influence quality of life of BMS patients and could be a possible treatment target

Oral Mucosa and Nails in Genodermatoses: A Diagnostic Challenge

Genodermatoses represent a group of uncommon, hereditary, single-gene skin disorders, characterized by multisystem involvement, heterogeneous clinical manifestations and different degrees of morbidity and mortality. Some genodermatoses may have oral mucosa and nail involvement, since the oral cavity and cutaneous organ system, including nails, share a close embryologic origin. Nail disorders can manifest with nail hypoplasia or nail hypertrophy. Clinical pictures of affected oral mucosa can be extremely heterogeneous, ranging from asymptomatic papules to painful blisters, leukokeratosis, oral papillomas and fibromas to oral potentially malignant disorders and cancerous lesions. Oral mucosa and nails pathological features may occur synchronously or not and are usually associated with other systemic and skin manifestations. In some cases, oral mucosa and nails diseases may be distinct and constitute the principal sign of the genetic disorder, in other cases they represent only a part of the puzzle for the confirmation of the diagnosis. Continued awareness of the correlation between oral mucosa and nails findings can help physicians to diagnose genodermatosis in a timely manner, allowing more effective clinical management and prevention and/or early detection of complications. This article provides an overview of all specific genodermatoses affecting both oral mucosa and nails. Moreover, the correlation between teeth and nails is summarized in tabular form

Burning Mouth Syndrome and Hypertension: Prevalence, Gender Differences and Association with Pain and Psycho-Social Characteristics—A Case Control Study

Background: To assess the prevalence of hypertension (HTN) in burning mouth syndrome (BMS) patients and to investigate its relationship with sociodemographic factors, pain and the psychological profile. Methods: A case-control study was conducted by enrolling 242 BMS patients and 242 controls matched for age and gender. Sociodemographic and clinical characteristics were recorded, and all participants completed numeric rating scale (NRS), the short-form of the McGill pain questionnaire (SF-MPQ), the Hamilton rating scale for anxiety and depression (HAM-A, HAM-D), the Pittsburgh sleep quality index (PSQI) and the Epworth sleepiness scale (ESS). Results: The BMS patients presented with a statistically significant higher prevalence of HTN compared to that in the controls (55% versus 33.5%; p-value: <0.001) and higher median scores of the NRS, SF-MPQ, HAM-A, HAM-D, PSQI and ESS (p < 0.001). Multivariate regression analysis in the BMS patients indicated positive correlations between HTN and age, systemic diseases, drug consumption and anxiety (p-value: <0.001) and these predictors were responsible for 11.3% of the HTN variance in the BMS patients, when considered together. Conclusions: The prevalence of HTN was significantly higher in the BMS patients, since ageing, the presence of comorbidities, drug consumption and anxiety were potential predictors. Further studies are needed to better investigate the relationship between BMS and HTN