Diferencijalna dijagnostika bolnih stanja sluznice usne šupljine

Orofacial pain is a common complaint and challenging diagnostic problem. Among numerous causes of orofacial pain, the most common are diseases of teeth and periodontium, followed by various diseases and lesions of the oral mucosa. Pain of the oral mucosa is an accompanying symptom of different mucosal lesions caused by local or systematic factors. This type of pain belongs to the category of superfitial somatic pain, termed mucogingival pain. However, the pain of oral mucosa may be present in the absence of pathological findings. This type of pain may be caused by lesion of the nervous system, and is termed neuropathic pain, or it may be result of psychogenic disturbances. Pain of the oral mucosa can be also reflected (refered pain) from other parts of the body. Given the multitude of possible causes of intraoral pain as a component of orofacial pain, the diagnostic process is complex and requires a multidisciplinary approach. A prerequisite for establishing an accurate diagnosis is thorough knowledge of a wide spectrum of diagnostic characteristics of orofacial pain which include the origin and type of pain (somatic, neurogenic and psychogenic), duration (acute or chronic) and mechanisms of pain onset (nociceptive, neuropathic, psychosomatic) and their differentiation. The emphasis in this article is on differential diagnosis of the most common painful conditions of oral mucosa in respect to their clinical features.Orofacijalna bol česta je i dijagnostički zahtjevna tegoba. Među brojnim uzrocima orofacijalne boli najčešći su bolesti zuba i parodonta, a po tom i različite bolesti sluznice usne šupljine. Bol sluznice usne šupljine prateći je simptom različitih oštećenja sluznice uzrokovanih lokalnim ili sustavnim čimbenicima. Bol oštećene sluznice spada u kategoriju somatske površinske boli i naziva se mukogingivna bol. Međutim, bol sluznice može biti prisutna i u odsutnosti patološkog nalaza. Tada je riječ o neuropatskoj boli koja je posljedica oštećenja dijela živčanog sustava ili je bol psihogenog podrijetla. Bol sluznice usne šupljine može biti i odražena (refleksna bol) iz drugih dijelova tijela. S obzirom na mnoštvo mogućih uzroka orofacijalne boli, dijagnostički je postupak složen i zahtijeva multidisciplinarni pristup. Preduvjet za postavljanje točne dijagnoze jest poznavanje širokog spektra dijagnostičkih karakteristika orofacijalne boli, koje uključuje podrijetlo i vrstu boli (somatska, neurogena i psihogena), trajanje (akutna i kronična) i mehanizme nastanka boli (nociceptorska, neuropatska, psihosomatska) te njihovo razlikovanje. U ovome radu prikazana su različita bolna stanja sluznice usne šupljine i njihove diferencijalnodijagnostički bitne karakteristike

Diferencijalna dijagnostika bolnih stanja sluznice usne šupljine

Orofacial pain is a common complaint and challenging diagnostic problem. Among numerous causes of orofacial pain, the most common are diseases of teeth and periodontium, followed by various diseases and lesions of the oral mucosa. Pain of the oral mucosa is an accompanying symptom of different mucosal lesions caused by local or systematic factors. This type of pain belongs to the category of superfitial somatic pain, termed mucogingival pain. However, the pain of oral mucosa may be present in the absence of pathological findings. This type of pain may be caused by lesion of the nervous system, and is termed neuropathic pain, or it may be result of psychogenic disturbances. Pain of the oral mucosa can be also reflected (refered pain) from other parts of the body. Given the multitude of possible causes of intraoral pain as a component of orofacial pain, the diagnostic process is complex and requires a multidisciplinary approach. A prerequisite for establishing an accurate diagnosis is thorough knowledge of a wide spectrum of diagnostic characteristics of orofacial pain which include the origin and type of pain (somatic, neurogenic and psychogenic), duration (acute or chronic) and mechanisms of pain onset (nociceptive, neuropathic, psychosomatic) and their differentiation. The emphasis in this article is on differential diagnosis of the most common painful conditions of oral mucosa in respect to their clinical features.Orofacijalna bol česta je i dijagnostički zahtjevna tegoba. Među brojnim uzrocima orofacijalne boli najčešći su bolesti zuba i parodonta, a po tom i različite bolesti sluznice usne šupljine. Bol sluznice usne šupljine prateći je simptom različitih oštećenja sluznice uzrokovanih lokalnim ili sustavnim čimbenicima. Bol oštećene sluznice spada u kategoriju somatske površinske boli i naziva se mukogingivna bol. Međutim, bol sluznice može biti prisutna i u odsutnosti patološkog nalaza. Tada je riječ o neuropatskoj boli koja je posljedica oštećenja dijela živčanog sustava ili je bol psihogenog podrijetla. Bol sluznice usne šupljine može biti i odražena (refleksna bol) iz drugih dijelova tijela. S obzirom na mnoštvo mogućih uzroka orofacijalne boli, dijagnostički je postupak složen i zahtijeva multidisciplinarni pristup. Preduvjet za postavljanje točne dijagnoze jest poznavanje širokog spektra dijagnostičkih karakteristika orofacijalne boli, koje uključuje podrijetlo i vrstu boli (somatska, neurogena i psihogena), trajanje (akutna i kronična) i mehanizme nastanka boli (nociceptorska, neuropatska, psihosomatska) te njihovo razlikovanje. U ovome radu prikazana su različita bolna stanja sluznice usne šupljine i njihove diferencijalnodijagnostički bitne karakteristike

Kserostomija – dijagnostika i liječenje

The aim of this report is to summarize the current state of the evidence from the scientific literature regarding xerostomia. Xerostomia is a subjective complaint-symptom of dry mouth. It may be or may be not associated with objectively measured hyposalivation (reduction of saliva secretion). The variety of local and systemic conditions, treatments and medications alter salivary secretion and composition. The degree of salivary glands dysfunction as well as the accompanying oral morbidity as a complication of dry mouth, make xerostomia therapy complex and often refractory. Treatment of xerostomia essentially is carried out in regard to the cause and is divided in four main categories: palliative or symptomaic, local and systemic stimulation and prevention of complications. Which category will be applied, depends primarily on whether salivary glands can still produce saliva or not. In patients with residual salivary gland function, the use of salivary stimulans appears to be more beneficial than salivary substitutes. When saliva is absent, treatment remains palliative and must include salivary substitutes. During anticancer radio-and chemotherapy xerostomia is the earliest and the most prominent consequence which significantly affects the quality of life and lead to severe and long-term complications. Because management of xerostomia is rarely effective, prevention is paramount. Preventive measures should include acting on causes of xerostomia, maintaining salivary function and prevention of complications that arise in already developed xerostomia. Therapy of xerostomia depends on whether salivary glands function is preserved or not and includes local treatment and systemic medications as well as non-medication salivary stimulation such as low level laser, acupuncture and electrostimulation.Kserostomija je subjektivan osjećaj suhoće usta koji nastaje zbog smanjenog lučenje sline ili hiposalivacije. Smanjeno lučenje sline je posljedica oštećenja žlijezda slinovnica koje uzrokuju određeni sustavni poremećaji, brojni lijekovi i liječenje zračenjem tumora u području glave i vrata. Raznolikost uzroka hiposalivacije, stupanj oštećenja slinovnica te popratni oralni morbiditeti kao komplikacije suhoće usta, čine terapiju kserostomije složenom, a često i refraktornom. Liječenje kserostomije ovisi o uzroku i stupnju oštećenja slinovnica i obuhvaća simptomatsko liječenje, lokalnu i sustavnu stimulaciju žlijezda slinovnica i prevenciju komplikacija. Izbor liječenja ovisi o stanju slinovnica i mogućnosti stvaranja sline. U osoba u kojih je funkcija slinovnica očuvana, provodi se stimulativna terapija dok se u osoba u kojih su slinovnice ireverzibilno oštećene i koji nemaju sline provodi nadomjesno liječenje umjetnom slinom i simptomatsko liječenje. Kserostomija je jedna od prvih i teških komplikacija liječenja zračenjem raka glave i vrata i kemoterapije. Prevencija kserostomije obuhvaća djelovanje na uzrok kserostomije i održavanje salivarne funkcije i prevenciju komplikacija. U prevenciji radijacijske kserostomije razvijeno je nekoliko strategija liječenja koje uključuju sofisticirane kirurške tehnike, citoprotektivna sredstva i posebne tehnike ozračivanja pri čemu se štedi tkivo slinovnica a istodobno ne ugrožava onkološko liječenje. Međutim, ovi preventivni postupci ne mogu se primjeniti u svih pacijenata pa u konačnici jedini izbor je liječenje suhoće usta. Dostupni načini liječenja kserostomije obuhvaćaju više kategorija, a izbor terapijskog postupka ovisi o tome da li slinovnice mogu stvarati slinu ili ne. U nemogućnosti stvaranja sline primjenjuju se nadomjestci sline i umjetna slina. Terrapija kserostomije uz lokalnu i sustavnu terapiju uključuje i fizikalne metode stimulacije slinovnica kao što su laser, akupunktura i elektrostimulacija

Helicobacter pylori on oral mucosa - topographic distribution

Svrha rada bila je ispitati topografsku distribuciju bakterije Helicobacter pylori na oralnoj sluznici u upalnim, ulceroznim i keratotičnim lezijama, kandidijazi i sindromu pečenja usta i usporediti s nalazom na zdravoj sluznici. Primijenili smo nested PCR na citološkim uzorcima uzetim s 9 topografski različitih mjesta oralne sluznice i s različitih oralnih lezija. Od ukupno 426 ispitanika njih 66 (15,49 %) imalo je pozitivan nalaz H. pylori na oralnoj sluznici, bez predilekcije po spolu, ali s većom čestoćom nalaza u starijih ispitanika u usporedbi s mlađima te gotovo jednakom distribucijom na svim ispitanim topografskim stranama oralne sluznice. H. pylori otkriven je u svim ispitanim lezijama i sindromu pečenja usta osim u kandidijazi s većom prevalencijom na sluznici dorzuma jezika i u ulceroznim lezijama, premda bez statistički znatne razlike između lezija i zdrave sluznice (p = 0,059). H. pylori nije patogen za oralnu sluznicu jer kolonizira gotovo s istom čestoćom zdravu i oboljelu oralnu sluznicu. Također ne postoje preferirana mjesta na oralnoj sluznici za naseljavanje H. pylori.The purpose of this study was to examine the topographic distribution of Helicobacter pylori on oral mucosa in various oral lesions such as inflammation, oral ulceration, keratosis, candidiasis and burning mouth syndrome in comparison with healthy oral mucosa. We applied nested PCR on cytologic specimens collected from 9 topographic sites of the healthy oral mucosa and from various oral lesions. Of a total 426 patients 66 (15.49 %) were positive for H. pylori,with no predilection for sex but with higher frequency in older patients, and with almost equal distribution on all examined topographic sites of the oral mucosa. H. pylori was detected in all examined diseases, except in candidiasis, with prevalence on tongue mucosa and in ulcerous lesions although without significant differences between lesions and healthy oral mucosa (p = 0.059). H.pylori is non-pathogenic for oral mucosa since it colonizes almost with the same frequency healthy and diseased oral mucosa. There is no preferential oral site or lesion for colonization of H. pylori

Collocations in the Language of Dental Medicine: Examples in Oral Medicine

U stomatologiji, točnije u oralnoj medicini kao jednoj od njezinih specijalističkih grana, ili u bilo kojem drugom području struke, postoje određeni pojmovi ili riječi o kojima nastavnici trebaju podučiti studente, a studenti ih moraju naučiti. Štoviše, ti se stručni pojmovi i nazivi često trebaju prevesti. Budući da je engleski postao najrašireniji jezik komunikacije na svijetu, potrebno je određene stručne pojmove i nazive izreći na engleskome i obratno: nazivi na materinskom jeziku, u našem slučaju hrvatskome, trebaju se prevesti na engleski. Poučavanje, učenje i prevođenje posebnih stručnih riječi i kolokacija, kao primjera leksičkih jedinica, vjerojatno predstavlja veliki problem svim sudionicima koji ih rabe u svojem radu. Kolokacije su riječi ili nazivi koji se često i predvidivo zajedno pojavljuju u sintagmatskom nizu i tako mijenjaju značenja pojedinih riječi ili pojmova kad se prevode odvojeno. U ovom su radu u središtu pozornosti kolokacije iz područja oralne medicine. Svrha rada: Ispitati značenja pojedinih riječi koje čine kolokaciju i na taj način pokazati kako se prototipno značenje izraženo u jednom jeziku prenosi i u drugi jezik, te kako se kolokacije razlikuju u dvama jezicima. Materijal i metoda: U ovom istraživanju navedeni su primjeri kolokacija iz područja oralne medicine te raščlanjeni primjenom metode kontrastivne analize. Rezultati: Navedeni primjeri jasno upućuju na određene sličnosti, ali i razlike kojima se mora posvetiti pozornost kod prevođenja, kako bi se postigla istoznačnost i na taj način izbjeglo pogrešno tumačenje kolokacije. Iz analize je jasno da među jezicima ne postoji simetrija. Zaključak: prepoznavanje kolokacija u stručnom jeziku važno je za njihovo bolje razumijevanje i što točnije prevođenje na drugi jezik.Introduction: In dental medicine, that is, in oral medicine as one of its subspecialties, as in any other scientific discipline, there are some specific terms that should be taught and learnt. Moreover, these concepts and terms should be expressed in a foreign language. Since the English language has become the most widespread language of communication in the world, there is a need to express all these concepts ideas and insights in English and vice versa: terms expressed in mother language, in our case Croatian, should be translated into English. Teaching, learning and translating special words and collocations, as the examples of lexical units, are probably major problem areas in this respect. Collocations appear when a sequence of words or terms co-occur more often than would be expected by chance, thus changing the meanings of previously isolated words. In this paper collocations in oral medicine are the focus of interest. The aim was to investigate into meanings of particular words that form a collocation thus showing how the prototypal meaning expressed in one language is communicated into another, and how the collocations differ in the two languages analyzed. Material and methods: In this study examples of collocations used in oral medicine are analysed by employing the method of contrastive analysis. Results: The illustrative examples point to certain differences in the two analyzed languages to which attention must be payed when translating in order to preserve the meaning thus avoiding a misrepresentation of collocation. The results also show that there is no symmetry between the structures of languages. Conclusion: Identifying collocations in technical language is essential for their understanding and accurate translation into another language

Histopathologic and Morphometrie Parameters in the Assessment of Oral Lichen Ruber

Kod 30 ispitanika s OLR uzeti su biopsijski uzorci s oralne sluznice u svrhu određivanja histopatoloških obilježja. Uzorci su obrađeni klasičnom histološkom preparatornom tehnikom. Studija je pokazala karakteristične promjene za OLR: hiperparakeratozu kod 53,3% ispitanika uz pojačan nalaz keratohijalinih granula kod 23,3%, akantozu epitela kod 50% uz nalaz papilomatoze kod 66,6%, vakuolarnu degeneraciju citoplazme bazalnih stanica kod 50%, te infiltraciju limfocitima u lamini propriji kod 60% i povećan nalaz makrofaga subbazalno u 40% uzoraka. Na temelju prisutnih histopatoloških obilježja predloženi su detaljniji histopatološki kriteriji za oralni lichen ruber koji mogu biti od dijagnostičke vrijednosti u histološkoj evaluaciji oralnih lezija klinički sličnih oralnom lichen ruberu.Biopsies were taken from thirty examinees with oral lichen ruber in order to establish histopathologic criteria. Specimens were prepared by means o f routine histopathologic procedures. In this study results have shown characteristic changes for OLR: hyperparakeratosis in 53,3% specimens with increased finding o f keratohyaline granules in stratum granulosum in 23,3%, acanthosis in 50% with papillomatosis in 66,6%, vacuolar degeneration o f basal cells cytoplasm in 50%, and subepithelial lymphocytes infiltrate in 60% with increased macrophage finding in 40% o f specimens. On the basis o f present histopathologic characteristics histopathologic criteria for O LR are suggested which can be o f diagnostic value in the histological evaluation o f oral lesions that are clinical similar to OLR

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

Human Papillomavirus in the Lesions of the Oral Mucosa According to Topography

Background. The association between human papillomavirus (HPV) types and oral lesions has been shown in many studies. In light of the possibility of early detection of HPV genotypes in oral epithelium, and considering the significance which HPV has in the development of malignant and potentially malignant disorders of oral mucosa, the purpose of this study was to investigate the prevalence of HPV DNA in different oral lesions in the Croatian population. In addition, we wanted to elucidate whether HPV infection is associated predominantly with either the lesion or particular anatomic site of the oral cavity. Methodology/Principal Findings. The study included 246 subjects with different oral lesions, and 73 subjects with apparently healthy oral mucosa (controls). Oral lesions were classified according to their surface morphology and clinical diagnosis. Epithelial cells were collected with the cytobrush from different topographic sites in the oral cavity of oral lesions and controls. The presence of HPV DNA was evaluated by consensus and type-specific primer-directed polymerase chain reaction. The HPV positivity was detected in 17.7% of oral lesions, significantly more than in apparently healthy mucosa (6.8%), with a higher presence in benign proliferative mucosal lesions (18.6%). High-risk HPV types were predominantly found in potentially malignant oral disorders (HPV16 in 4.3% and HPV31 in 3.4%), while benign proliferative lesions as well as healthy oral mucosa contained mainly undetermined HPV type (13.6 and 6.8%, respectively). Conclusions/Significance. Distribution of positive HPV findings on oral mucosa seems to be more associated to particular anatomical site than diagnosis itself. Samples taken from vermilion border, labial commissures, and hard palate were most often HPV positive. Thus, topography plays a role in HPV prevalence findings in oral lesions. Because of the higher prevalence of the high-risk HPV types in potentially malignant oral disorders, these lesions need to be continuously controlled and treated