Oral autoimmune vesicobullous diseases: Classification, clinical presentations, molecular mechanisms, diagnostic algorithms, and management

Mucocutaneous blistering autoimmune diseases are a group of systemic, rare, chronic disorders characterized by humoral-mediated immunologic mechanisms against epithelial, basement membrane, and subepithelial tissues. Morbidity and mortality can be completely different among these diseases, with outcome being dependent on an early and accurate diagnosis, systemic comorbidities, and the patient's response to treatment. Definitive diagnosis is based on clinical and histopathologic findings. Because clinical presentations among these diseases are often similar, different immunofluorescence tests and ELISAs are used to confirm the specific diagnosis. Oral mucosa may often be the first site of clinical manifestation from which the disease spreads to other mucosal surfaces and skin. Thus, often dentists and oral medicine specialists may be the first to encounter patients with such diseases. In this review we discuss the most frequent autoimmune vesicobullous disorders, namely pemphigus vulgaris, mucous membrane pemphigoid, bullous pemphigoid, and linear IgA disease

Current knowledge, attitude and practice among dental hygienists in oral cancer awareness: Systematic review

Objectives: Evidence on the awareness and knowledge level of oral cancer and its associated risk factors among dental hygienists is scarce; this systematic review aimed to synthesize their available evidence of the level of knowledge, attitude and practice. Methods: PubMed and Scopus were searched for publications from any year up to January 2021. Studies about knowledge and/or attitudes and/or practices of dental hygienists have been taken into account. Overall, 14 studies have been selected for the systematic review. Results: Excluding tobacco use (99.8%–100%), considerable variability were found among dental hygienists about important oral cancer risk factors such as alcohol consumption (30.0%–90.0%), human papilloma virus (23.0%–90.0%), oldness (37.7%–69.3%), diet (30.0%–42.2%) and betel quid chewing (5.0% and 98.0%). There was a good level of awareness among dental hygienists regarding leukoplakia (86.5%), instead less than half recognized erythroplakia as a precancerous lesion. Moderate knowledge was recorded about frequent sites of oral cancer development. Most of dental hygienists reported to perform intraoral screening (85.2%–100%). To regard attitude, a great variability was found about adequacy of undergraduate training (15.7%–75.0%) and most of dental hygienists expressed the need for continuing education (92.7%–99.0%). Conclusions: Dental hygienists play a key role in oral cancer detection. Low knowledge of oral cancer among dental hygienists is strongly associated with the low levels of early detection. These findings provide useful information to improve continuing education programmes pre- and post-graduation targeted at the prevention of oral cancer in order to reduce oral cancer morbidity and mortality

The association between burning mouth syndrome and urologic chronic pelvic pain syndrome: A case-control study

Background: The overlap between some painful conditions is widespread. The aim of this study was to evaluate the overlap between burning mouth syndrome (BMS) and urological chronic pelvic pain syndrome (UCPPS) in an outpatient clinic of a university hospital. Methods: A controlled clinical study was performed. BMS patients and healthy controls were enrolled in the study. Patients were screened through laboratory test and a complete urological examination. Two validated questionnaires were submitted to all the patients: National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptom Score (IPSS). Results: A total of 50 BMS patients and 50 healthy controls were enrolled in the study. Statistically significant differences between the two groups regarding the items of the IPSS questionnaire of Incomplete Emptying (U = 750, P <.001), Intermittency (U = 768.5, P <.001), QoL (U = 848, P <.002), and Total Symptom score (U = 1040, P =.05) were found. Moreover, the responses of NIH-CPSI showed statistically significant differences regarding Pain subscale (U = 714, P <.001), QoL Impact subscale (U = 1016.500, P =.05), and NIH-CPSI total score (U = 953.500, P =.002). Conclusion: To the best our knowledge, the reported data demonstrate for the first time an association between BMS and UCPPS. Further studies with a larger sample are needed to confirm the co-occurrence of urological symptoms in patients with burning mouth syndrome

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

Background: Cases of severe autoimmune blistering diseases (AIBDs) have recently been reported in association with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Aims: To describe a report of oropharyngeal Pemphigus Vulgaris (OPV) triggered by the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/ BioNTech) and to analyze the clinical and immunological characteristics of the AIBDs cases reported following the SARS-CoV-2 vaccination. Methods: The clinical and immunological features of our case of OPV were documented. A review of the literature was conducted and only cases of AIBDs arising after the SARS-CoV-2 vaccination were included. Case report: A 60-year old female patients developed oropharyngeal and nasal bullous lesions seven days after the administration of a second dose of the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/BioNtech). According to the histology and direct immunofluorescence findings showing the presence of supra-basal blister and intercellular staining of IgG antibodies and the presence of a high level of anti-Dsg-3 antibodies (80 U/ml; normal &lt; 7 U/ml) in the serum of the patients, a diagnosis of oropharyngeal Pemphigus Vulgaris was made. Review: A total of 35 AIBDs cases triggered by the SARS-CoV-2 vaccination were found (including our report). 26 (74.3%) were diagnosed as Bullous Pemphigoid, 2 (5.7%) as Linear IgA Bullous Dermatosis, 6 (17.1%) as Pemphigus Vulgaris and 1 (2.9%) as Pemphigus Foliaceus. The mean age of the sample was 72.8 years and there was a predominance of males over females (F:M=1:1.7). In 22 (62.9%) cases, the disease developed after Pfizer vaccine administration, 6 (17.1%) after Moderna, 3 (8.6%) after AstraZeneca, 3 (8.6%) after CoronaVac (one was not specified). All patients were treated with topical and/or systemic corticosteroids, with or without the addition of immunosuppressive drugs, with a good clinical response in every case. Conclusion: Clinicians should be aware of the potential, though rare, occurrence of AIBDs as a possible adverse event after the SARS-CoV-2 vaccination. However, notwithstanding, they should encourage their patients to obtain the vaccination in order to assist the public health systems to overcome the COVID-19 pandemic

Aseptic Meningitis in Oral Medicine: Exploring the Key Elements for a Challenging Diagnosis: A Review of the Literature and Two Case Reports

Aseptic meningitis (AM) is a potentially severe and life-threatening disease characterized by meningeal inflammation, usually with mononuclear pleocytosis. It represents a challenging and controversial issue in medicine for multiple etiologies, classification, and difficult diagnosis in the face of nonspecific sets of signs and symptoms. In the area of interest of oral medicine, in specific clusters of patients, even if rare, the occurrence of aseptic meningitis can pose a diagnostic and management dilemma in the following potential etiologies: (i) systemic diseases with oral and meningeal involvement, which include Behçet’s disease and Sjögren syndrome; (ii) drug-induced aseptic meningitis; (iii) aseptic viral meningitis, mostly related to herpes simplex virus infection and hand, foot, and mouth disease, caused by enteroviruses. In this review, clinical manifestations, diagnostic methodologies, incidence, treatment, and prognosis for each of these clinical entities are provided. Furthermore, two illustrative case reports are described: a patient suffering from recurrent oral ulcers, in which a sudden onset of AM allows us to diagnose Neuro Behçet’s disease, and a patient affected by pemphigus vulgaris, manifesting a drug-induced AM. Exploring this complex clinical entity scenario, it is clear that an oral medicine specialist has a place on any multidisciplinary team in making such a challenging diagnosis

Diagnostic aids in the screening of oral cancer

The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required

Human Papilloma Virus Vaccination and Oropharyngeal Cancer: Knowledge, Perception and Attitude among Italian Pediatric Dentists

Background: Pediatric dentists could play a key role in the prevention of human papilloma virus (HPV)-related oropharyngeal cancer (OP-cancer). The aim of this study was to assess knowledge, perception, and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccination among Italian pediatric dentists. Methods: A cross-sectional study was conducted. Pediatric dentists received, by email, a link to participate in the questionnaire online. The questionnaire comprised four parts: (i) demographic information, (ii) knowledge on HPV-related OP-cancer, HPV infection, and HPV vaccine, (iii–iiii) perceptions and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccine. Data were statistically analyzed with Kruskal–Wallis and Mann–Whitney test and Pearson’s chi-square test. Results: A total of 271 pediatric dentists completed the questionnaire. Results showed a good overall knowledge; a positive perception of their role in HPV disease prevention; a good attitude in discussing sensitive topics; a need for acquiring more information about HPV’s connection to cancer, HPV infection, and HPV vaccine. Conclusions: Improving educational training programs, as well as informing about prevention of HPV-related OP-cancer, will place pediatric dentists in the front line of HPV diseases primary prevention

Parallel processing technique for acoustic tomography for multilayers

Computerized tomography (CT) is one of the most efficient tools for the nondestructive inspection of a material specimen. Depending on the nature of the application (e.g. in medicine, mechanics or geophysics) and of the particular requirements of the situation, different types of radiation (waves) may be used, thus giving different information about the material properties. For example in diagnostic medicine, x-ray transmission CT gives an attenuation map, which allows different tissues to be distinguished. In the case of x-rays, this type of wave passes through an entire material structure in an almost straight line

Effects of the COVID-19 lockdown on glycaemic control in subjects with type 2 diabetes: the glycalock study

Aim: To assess the effect of the coronavirus disease 2019 (COVID-19) lockdown on glycaemic control in subjects with type 2 diabetes (T2D). Materials and Methods: In this observational, multicentre, retrospective study conducted in the Lazio region, Italy, we compared the differences in the HbA1c levels of 141 subjects with T2D exposed to lockdown with 123 matched controls with T2D who attended the study centres 1 year before. Basal data were collected from 9 December to 9 March and follow-up data from 3 June to 10 July in 2020 for the lockdown group, and during the same timeframes in 2019 for the control groups. Changes in HbA1c (ΔHbA1c) and body mass index (ΔBMI) during lockdown were compared among patients with different psychological well-being, as evaluated by tertiles of the Psychological General Well-Being Index (PGWBS). Results: No difference in ΔHbA1c was found between the lockdown and control groups (lockdown group −0.1% [−0.5%−0.3%] vs. control group −0.1% [−0.4%−0.2%]; p =.482). Also, no difference was found in ΔBMI (p =.316) or ΔGlucose (p =.538). In the lockdown group, subjects with worse PGWBS showed a worsening of HbA1c (p =.041 for the trend among PGWBS tertiles) and BMI (p =.022). Conclusions: The COVID-19 lockdown did not significantly impact glycaemic control in people with T2D. People with poor psychological well-being may experience a worsening a glycaemic control because of restrictions resulting from lockdown. These findings may aid healthcare providers in diabetes management once the second wave of COVID-19 has ended