Sindrom pekućih usta – goruća enigma

Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by an intraoral burning sensation and an absence of oral mucosal lesions and disturbances in laboratory findings. Burning symptoms usually affect the anterior two-thirds of the tongue, its lateral borders, hard palate and labial mucosa, but other oral cavity sites may also be affected. Taste alterations and a decrease in the salivary flow rate frequently accompany the burning symptoms. This condition mostly affects peri- and postmenopausal women. To date, the etiology of BMS remains unclear. This unknown etiology means that no appropriate treatment is currently available. A large number of the treatments and medications have been tried for BMS, but treatment management remains unsatisfactory in some patients. The purpose of this article is to present current knowledge on the treatment of BMS.Sindrom pekućih usta (SPU) kronično je bolno stanje koje je karakterizirano osjećajem žarenja u usnoj šupljini bez vidljivih promjena na sluznici i poremećaja u laboratorijskim nalazima. Simptomi žarenja obično zahvaćaju prednje 2/3 trećine i lateralne površine jezika, tvrdo nepce, labijalnu sluznicu, ali može biti zahvaćena bilo koja regija u usnoj šupljini. Simptomi žarenja obično su praćeni promjenom osjeta okusa te smanjenim lučenjem sline. Ovo stanje najviše pogađa žene u peri- i postmenopauzi. S obzirom na to da je etiologija SPU-a nepoznata, ne postoji niti odgovarajuće liječenje. Dostupno je više različitih terapija i lijekova za SPU, međutim, liječenje kod pojedinih pacijenata i dalje je bezuspješno. Svrha ovog rada je prikazati trenutno znanje o liječenju SPU-a

Povezica narušenog periodontalnog zdravlja u mlađih bolesnika sa shizofrenijom s pogoršanjem simptoma tijekom remisije: prospektivno kohortno istraživanje

Objectives - The aim of this prospective cohort study was to investigate whether the association of periodontal status with schizophrenia treatment outcomes differs by patient’s age. Subjects and methods - The study was performed on the consecutive sample of 67 patients diagnosed with schizophrenia and discharged because achieving remission criteria. Papilla bleeding index (PBI) was measured at hospital discharge. Positive and negative syndrome scale (PANSS) total score, positive, negative and general symptoms subscales’ scores were measured at hospital discharge, after three, and after six months. Results: - After the adjustment for potential confounders, baseline PBI was significantly unfavorably associated with PANSS total score, negative and general symptoms subscales scores in the patients younger than 45 three and six months after the hospital discharge, and with the positive symptoms sub-scale in patients younger than 34. At youngest 10% of patients, a unit difference in baseline PBI resulted in the 8.12 (95% CI 2.78-13.47; p=0.004) points higher total PANSS score three months later. Our study showed that the younger patients with worse periodontal status are at higher risk for poorer schizophrenia treatment outcomes and faster worsening of remission. This study demonstrates the necessity of more rigorous and more frequent control of younger schizophrenia patients with worse periodontal status after hospital discharge to achieve overall improvement of the patients’ quality of life as well as the efficacy of psychiatric therapies aimed toward the primary mental disorder.Cilj ove prospektivne kohortne studije bio je istražiti postoji li razlika u povezanosti parodontnog statusa sa slabljenjem kvalitete remisije shizofrenije ovisno o dobi pacijenta. Ispitanici i metode: - Istraživanje je provedeno na susljednom uzorku od 67 pacijenata s dijagnosticiranom shizofrenijom koji su otpušteni iz bolnice radi ostvarenih kriterija remisije. Indeks krvareće papile (PBI, engl. papilla bleeding index) izmjeren je pri otpustu iz bolnice. Ispitanici su procijenjeni ljestvicom pozitivnih i negativnih simptoma (PANSS) pri otpustu iz bolnice, nakon tri i nakon šest mjeseci. Rezultati: - Nakon prilagodbe za potencijalne zbunjujuće varijable, indeks krvareće papile bio je značajno inverzno povezan s ukupnim PANSS rezultatom, te rezultatom subljestvica za negativne i generalne psihotične simptome kod pacijenata mlađih od 45 godina nakon tri i nakon šest mjeseci poslije otpusta iz bolnice, te s rezultatom subljestvice za pozitivne simptome kod pacijenata mlađih od 34 godine. Kod najmlađih 10% pacijenata, jedinična razlika u indeksu krvareće papile bila je za 8.12 (95% CI 2.78-13.47; p=0.004) viša za ukupni PANSS rezultat tri mjeseca nakon otpusta iz bolnice. Zaključci: Naše je istraživanje pokazalo da mlađi pacijenti s lošijim parodontnim statusom imaju povećan rizik za lošiju kvalitetu remisije shizofrenije, odnosno brže pogoršanje simptoma tijekom remisije. Ovo istraživanje ukazuje na potrebu za pojačanom i češćom kontrolom mlađih pacijenata sa shizofrenijom koji imaju lošiji parodontni status nakon otpusta iz bolnice kako bi poboljšali kvalitetu života pacijenta kao i pridonijeli učinkovitijoj terapiji primarnog mentalnog poremećaja

Suvremeni pristup liječenju oralnog mukozitisa: pregledni rad

Oral mucositis (OM) is a serious inflammation of the mucosa and occurs in patients with head and neck cancer (HNC) who are being treated with radiotherapy (RT) and/or chemotherapy (CT), and in patients undergoing hematopoietic stem cell transplantation (HSCT). The inflammation accompanied with painful ulcerations inside the oral cavity impairs its function making the basic functions like eating and speech hard or even impossible. It usually occurs at the end of the first week of RT and lasts for several weeks after cessation. The intensity of OM can sometimes lead to discontinuation of RT. The degree of mucositis regarding chemotherapy depends on the type of antineoplastic drug, therapeutic procedure, duration of the therapy and dose, as well as previous exposure of the oral cavity to toxic agents. Prolonged or repeated administration of lower doses of chemotherapy is associated with a higher chance of developing oral mucositis comparing to a bolus, while chronomodulation of chemotherapy reduces the possibility of mucositis without affecting antineoplastic activity. The treatment of OM is symptomatic, as there is still no effective treatment. In this review paper, several contemporary options for alleviating the symptoms of oral mucositis are listed.Oralni mukozitis (OM) ozbiljna je upala sluznice i javlja se u bolesnika s karcinomom glave i vrata (HNC) koji se liječe radioterapijom (RT) i/ili kemoterapijom (CT) te u bolesnika koji su podvrgnuti transplantaciji hematopoetskih matičnih stanica (HSCT). Upala praćena bolnim ulceracijama unutar usne šupljine narušava njezinu funkciju, čineći osnovne funkcije poput prehrane i govora teškim ili čak nemogućim. Obično se javlja na kraju prvog tjedna radioterapije i traje nekoliko tjedana nakon prestanka. Intenzitet oralnog mukozitisa ponekad može dovesti do prekida radioterapije. Stupanj mukozitisa kod kemoterapije ovisi o vrsti antineoplastičnog lijeka, terapijskom postupku, trajanju terapije i dozi, kao i o prethodnoj izloženosti usne šupljine toksičnim agensima. Produljena ili ponovljena primjena nižih doza kemoterapije povezana je s većom šansom za razvoj oralnog mukozitisa u usporedbi s bolusom, dok kronomodulacija kemoterapije smanjuje mogućnost mukozitisa bez utjecaja na antineoplastično djelovanje. Liječenje oralnog mukozitisa je simptomatsko jer još uvijek nema učinkovitog lijeka. U ovom preglednom radu navodi se nekoliko suvremenih opcija za ublažavanje simptoma oralnog mukozitisa

Oral Side Effects of Head and Neck Irradiation

Head and neck irradiation is the standard treatment of advanced oral/oropharyngeal cancer. The treatment has severe side effects such as mucositis, xerostomia, irradiation caries, trismus, and osteoradionecrosis. Side effects can lead to treatment discontinuation, infection, increased drug consumption, and increased duration of hospital admission and can have negative impact on the quality of life and overall survival. Furthermore, some of them (mucositis and xerostomia) affect almost every (>90%) patient. Since nearly two‐thirds of oral/oropharyngeal cancers are diagnosed in advanced stage, one might conclude that the great majority of patients will be affected. However, these side effects can be prevented or at least reduced by proper oral/dental care. Therefore, every patient planned for head and neck irradiation should undergo dental evaluation before beginning of the treatment

Application of Photodynamic Therapy in the Treatment of Osteonecrosis of the Jaw

Osteonecrosis as term represents the death of bone tissue in the body and causes of necrosis can be different. Medication-related osteonecrosis of the jaws (MRONJ) is nowadays known as an inability of the alveolar bone to respond to a local trauma and it can result in severe local and systemic complications. In the etiology of medication-related osteonecrosis there are antiangiogenic and antiresorptive agents which have great effect on alveolar bone, producing an imbalance between resorption (osteoclastic activity) and deposition (osteoblastic activity). The exact mechanisms of development are not todays completely resolved. It is thought that it is a result from combination of medication interactions, microbiological contamination of the area and local tissue trauma. Typical signs and symptoms are painful mucosal lesions, swelling, exposed necrotic bone in the jaws, discomfort and dysesthesias. There is currently no gold standard or clearly defined treatment protocol for the disease itself. Process of treatment is demanding and main goal is to eliminate pain, control infection of soft and hard tissue and minimize progression of osteonecrosis. Besides the conventional surgical treatment, photodynamic therapy can be a viable supportive tool of initial and advanced stages of osteonecrosis and may contribute to improvements of patient′s quality of life

Clinical and Salivary Findings in Patients with Different Types of Orthodontic Brackets

Cilj: Podatci o kliničkim i salivarnim nalazima pacijenata s različitim vrstama ortodontskih bravica i vezanja (ligacije) doista su oskudni. Zbog toga je cilj ove studije bio usporediti kliničke i salivarne nalaze pacijenata s različitim vrstama fiksnih ortodontskih naprava. Ispitanici i postupci: Indeks karioznih i ekstrahiranih zuba te zuba s ispunom (KEP indeks), indeks plaka, količina sline, pH sline i prevalencija bijelih mrlja određena je za 83 pacijenta s različitim vrstama ortodontskih bravica i vezanja (metalne pasivne samovezujuće bravice, konvencionalne metalne bravice, monokristalne bravice i polikristalne aktivne samovezujuće bravice), prije početka ortodontske terapije i poslije toga tretmana. Pacijenti su, u razdoblju od dvije godine, birani u privatnoj stomatološkoj ordinaciji. Skupinu su činila 83 pacijenta (srednja dob 15,14 ± 1,66 godina) – 52 žene (srednja dob 15,8 ± 1,68) i 31 muškarac (srednja dob 15,24 ± 1,64). Statistička analiza rađena je primjenom t-testova za zavisne i nezavisne uzorke te jednosmjernog testa ANOVA-e, Wilcoxonova signed rank testa i Kruskal-Wallisova testa. P-vrijednost manja od 0,05 (p < 0,05) smatrana je statistički značajnom. Rezultati: KEP indeks i količina sline pokazali su značajan porast, a pH sline značajno se snizio u promatranom razdoblju kod svih pacijenata, neovisno o vrsti bravica i ligacije. Nije nađena statistički značajna razlika u promatranim parametrima među pacijentima s različitim ortodontskim bravicama. Zaključak: Iako je količina salivacije povećana kod pacijenata s fiksnim ortodontskim napravama, što može imati protektivni protukarijesni učinak, KEP indeks također raste, a pH sline pada šest mjeseci nakon početka tretmana, neovisno o materijalu bravica i načinu vezanja. Svi pacijenti trebali bi dobiti detaljne pute o oralnoj higijeni i prehrambenim navikama prije početka fiksne ortodontske terapije i na svakom kontrolnom pregledu.Aim: Data regarding different types of orthodontic brackets and ligation and various clinical and salivary findings are scarce. Therefore, the aim of this study was to compare clinical and salivary findings in patients with different types of fixed orthodontic appliances. Subjects and methods: Decayed, missing and filled teeth index (DMFT) and plaque index, salivary flow rate, salivary pH and prevalence of white spot lesions were determined in 83 patients with different types of orthodontic brackets and ligation (metal passive self-ligating brackets, conventional metal brackets, mono-crystal brackets and polycrystalline active self-ligating brackets), before and six months after the beginning of fixed orthodontic treatment. The patients were recruited in a private dental office, in the period of two years. The group comprised 83 patients (mean age: 15.14 ± 1.66 years), including 52 women (mean age: 15.08 ± 1.68) and 31 men (15.24 ± 1.64). Statistical analysis was performed by use of dependent and independent samples t-test as well as one way ANOVA, Wilcoxon signed rank test and the Kruskal Wallis test. P-values below 0.05 (p<0.05) were considered significant. Results: DMFT and salivary flow have shown a significant increase, while salivary pH has shown a significant decrease in the observed time interval, in all patients irrespective of type of brackets and ligation. Among patients with different bracket material, no significant differences were found in any of the observed parameters. Conclusion: Although salivary flow rate is increased in patients with fixed orthodontic appliances which can have caries-protective effect, DMFT also increases and salivary pH decreases six months after the beginning of the treatment independently of bracket material or ligation type. All patients should receive instructions for precise oral hygiene and dietary habits before the beginning of fixed orthodontic therapy and at every dental check-up

Clinicopathologic correlation of oral lichen planus and oral lichenoid lesions: a preliminary study

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are clinically and histologically similar lesions but their treatment planning and prognosis are different. The review of the literature indicates numerous criteria to distinguish these two lesions; however there is a lot of inconsistency. Thus, the aim of this study was to determine the correlation of histopathology and clinical OLP and OLL diagnosis and to clarify which histopathologic criteria could best distinguish these two diagnoses. A retrospective study showed that clinically diagnosed 92 OLPs and 14 OLLs have been confirmed histopathologically in 52.2% and 42.9% of cases, respectively. In addition, histopathology showed statistically significant more eosinophils (P<0.0005), plasma cells (P<0.0005), and granulocytes (P<0.05) in OLL than OLP. To establish histopathological diagnosis of OLP and OLL it should be mandatory to define the type of cells in mononuclear infiltrate, which can be associated more accurately with clinical feature and patient history. Therefore, currently accepted diagnostic criteria for OLP and OLL should be modified and validated on a larger number of patients taking into account particular distinguishing histopathological features

Uloga salivarnog i serumskog CA125 i rutinskih nalaza krvi kod bolesnica sa zloćudnim tumorima jajnika

The use of routine blood tests has recently been shown to be promising in determining disease-free and overall survival in patients with various malignancies, and also in gynecologic malignancies. The aim of this study was to evaluate whether salivary and serum CA125 levels correlate and whether salivary and serum CA125, C-reactive protein and routine blood tests might serve as a prognostic factor in malignant ovarian tumors, and whether they might differentiate between benign and malignant ovarian tumors. A total of 98 women were included (48 with benign ovarian tumors and 50 with malignant ovarian tumors), in whom routine blood tests were made and salivary and serum CA125 levels were determined by use of ELISA. Increase in serum CA125 and amylase decreased overall survival, whereas increase in salivary CA125, potassium levels and hemoglobin increased overall survival. Significant correlation of serum CA125 and C-reactive protein was found in the group with malignant tumors. In conclusion, significant increase in the levels of serum CA125 and amylase correlated with decreased survival, whereas increased salivary CA125, hemoglobin and potassium levels significantly correlated with increased survival.U posljednje vrijeme pokazalo se da su rutinski testovi krvi obećavajući u određivanju razdoblja bez bolesti i ukupnog preživljenja bolesnika s različitim zloćudnim bolestima, uključujući i ginekološke malignitete. Cilj ovoga istraživanja bio je procijeniti koreliraju li razine CA125 u slini i serumu te mogu li CA125, C-reaktivni protein u slini i serumu i rutinske pretrage krvi poslužiti kao prognostički čimbenik u malignim tumorima jajnika te mogu li razlikovati dobroćudne i zloćudne tumore jajnika. U istraživanje je uključeno 98 žena (48 s dobroćudnim tumorima jajnika i 50 sa zloćudnim tumorima jajnika), kod kojih su izvedene rutinske analize krvi i razine CA125 u slini i serumu primjenom testa ELISA. Povećanje serumskog CA125 i amilaze smanjuje ukupno preživljavanje, dok povećanje salivarnog CA125, razine kalija i hemoglobina povećava ukupno preživljavanje. U skupini sa zloćudnim tumorima zabilježena je značajna korelacija serumskog CA125 s C-reaktivnim proteinom. Može se zaključiti da su značajno povišene razine CA125 i amilaze u serumu bile u korelaciji sa smanjenim preživljenjem, dok je povišena razina CA125, hemoglobina i kalija značajno povezana s povećanim preživljenjem