Oral health status among newly arrived refugees in Germany: a cross-sectional study

Background: The objectives of this study were to determine the status of oral health among newly arrived refugees in Germany and to explore their knowledge, attitude and practices on oral hygiene. Methods: All participants (n = 386) were adults, 18-60 years of age, coming from Syria and Iraq and registered as refugees in Germany within one year prior to the enrollment in the study. Clinical oral assessments in addition to a survey on knowledge, attitude and practice were carried out. The survey was conducted through a questionnaire translated into Arabic. Results: Eighty seven point 5 % of the participants had untreated caries. The mean DMFT score was 6.38 with DT, MT and FT showing mean scores of 4.00, 1.46 and 0.92 respectively. Seventy nine percent had bacterial plaque in all six sextants, 60 % had calculus in at least three sextants and 6 % showed various magnitudes of enamel fluorosis. DMFT score was significantly associated with age (Regression Coefficient 0.031, P-value <0.001) and with education (Regression Coefficient - 0.019, P-value 0.037) and females had significantly less missing teeth (Regression Coefficient-0.398, P-value 0.001) compared to males. The participants had in general high levels of knowledge and attitude on oral hygiene. The findings however showed a gap between their knowledge and practice. Conclusions: The findings show high prevalence of untreated caries and poor oral hygiene among newly arrived refugees in Germany. The study recommends to lay emphasis on motivation in oral health promotion campaigns among refugees and to provide them with adequate guidance, preferably in their native language, on how to access oral health care in the host country

Factors influencing the presence of Candida dubliniensis and other non-albicans species in patients with oral lichen planus: a retrospective observational study

Objectives: The epidemiologic distribution of non-albicans species in the oral cavity of oral lichen planus (OLP) patients remains uncertain. Therefore, the aim of this study was to identify factors associated with the presence of C. dubliniensis and other non-albicans species. Furthermore, independent risk factors for Candida superinfection in OLP should be identified. Material and methods: Epidemiologic data and microbiological findings from 268 symptomatic OLP patients who underwent continuous oral swab culture over a 5-year period (2015-2019) were retrospectively reviewed. Candida species identification and semi-quantification were obtained by culture on CHROMagar Candida, followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results: C. albicans was the most frequently isolated species (72.3%), followed by C. glabrata (7.3%), C. dubliniensis (5.8%), C. krusei and C. parapsilosis (both 2.6%). The presence of C. dubliniensis was significantly associated with tobacco smoking. Other non-albicans spp. were significantly more often detected in patients using removable dentures. Increasing age and the intake of psychotropic drugs were identified as independent risk factors of Candida superinfection in OLP. Conclusion: In OLP patients, certain local and systemic factors increase the risk of carrying potentially drug-resistant Candida species and the development of Candida superinfection of OLP lesions. Clinical relevance: Due to the frequent detection of non-albicans species in OLP, resistance or at least reduced sensitivity to azole antifungals should be expected, especially in smokers and patients using removable dentures. In the case of oral complaints, a superinfection with Candida should be considered, whereby older patients and patients taking psychotropic drugs have an increased risk for oral infection with Candida

Implants in patients with oral manifestations of autoimmune or muco-cutaneous diseases : a systematic review

To give an overview on implant survival rates in patients with oral manifestations of systemic autoimmune (oral Lichen planus (oLp), Pemphigus (Pe)), muco-cutaneous (Epidermolysis bullosa (EB)), autoimmune multisystemic rheumatic diseases (Sjögren´s syndrome (SjS), systemic Lupus erythematosus (sLE), or systemic Sclerosis (sSc)). Systematic literature review (PubMed/Medline, Embase) using MESH and search term combinations, published between 1980 and August 2018 in English language reporting on dental implant-prosthetic rehabilitation of patients with oLp, Pe, EB, SjS, sLE, sSc, study design, age, gender, follow-up period (? 12 months), implant survival rate. Implant-related weighed mean values of implant survival rate (wmSR) were calculated. After a mean follow-up period (mfp) of 44.6 months, a wmSR of 98.3 % was calculated from data published for patients with oLp (100 patients with 302 implants). Data of 27 patients (152 implants) with EB revealed wmSR of 98.7 % following mfp of 32.6 months. For 71 patients (272 implants) with SjS, wmSR was 94.2 % following a mfp of 45.2 months, and for 6 patients (44 implants) with sSc, wmSR was 97.7 % after mfp of 37.5 months. One case report on one patient each with Pe (two implants) as well as sLE (6 implants) showed 100 % SR following at least 24 months. Guidelines regarding implant treatment of patients with oLp, Pe, EB, SjS, sLE or sSc do not exist nor are contraindicating conditions defined. Implant survival rates of patients affected are comparable to those of healthy patients. For implant-prosthetic rehabilitation of patients with Pe and sLE no conclusions can be drawn due to lack of sufficient clinical data. Implant-prosthetic treatment guidelines regarding healthy patients should be strictly followed, but frequent recall is recommended in patients affected with oLp, SjS, EB, SSc, Pe or sLE

Oral Human Papilloma Virus (HPV) Infection in a HIV Infected Patient - a Case Report

Autori prikazuju slučaj pacijenta s HIV infekcijom i oralnim papilomatoznim lezijama koje upozoravaju na HPV infekciju. Dijagnostičke su procedure uključivale oralnu kliničku dijagnozu, patohistologiju i imunohistokemiju oralne lezije (ustanovljavanje HPV-a), ustanovljavanje imunostatusa pacijenta i ocjenu sustavskih bolesti koje su povezane s HIV infekcijom. Rezultati su pokazali da je pacijent anti-HIV pozitivan i asimptomatičan za bolesti koje su vezane za HIV. Budući da je pacijent homoseksualac, spada u skupinu visokoga rizika za HIV infekcije. Pacijentove stanice CD4+ (1000/il) nisu smanjene. Oralna je dijagnoza upućivala na multiple papillome mandibularne vestibu- larne sluznice (mandibular vestibular mucosae), patohistologiju papi- larne hiperplazije i kroničnu upalu, a imunohistokemijski je potvrđena HPV infekcija s HPV-om tipa 6,11 i 18. Zaključeno je da bi dijagnostička procedura oralnih apilomatoznih lezija koje su u svezi s HIV-om trebala uvijek uključivati prikaz vrsta HPV-a, od kojih su neke svojstvene za lezije vezane za HPV u HIV infekcijama.A case of a patient with HIV disease and oral papillomatous lesions indicating HPV infection is reported. Diagnostic procedures included oral clinical diagnosis, histopathology and immunohistochemi- stry of the oral lesion (HPV identification), determination of the patient\u27s immune status and evaluation of systemic diseases related to HIV infection. Results showed the patient to be anti-HIV positive and asymptomatic for HIV-associated diseases. As a homosexual, the patient belonged to the high risk group for HIV infection. The patient\u27s CD4+- cell-count was not reduced (1000/pl). Oral diagnosis pointed to multiple papillomas of the mandibular vestibular mucosa, histopathology to papillary hyperplasia and chronic inflammation, whereas immuno- histochemistry confirmed HPV infection with HPV types 6, 11 and 18. It is concluded that the diagnostic procedure of HIV-related oral papillomatous lesions should always include demonstration ofHPV-types, some of which are particular for HPV-related lesions in HIV-infection

Oral Human Papilloma Virus (HPV) Infection in a HIV Infected Patient - a Case Report

Autori prikazuju slučaj pacijenta s HIV infekcijom i oralnim papilomatoznim lezijama koje upozoravaju na HPV infekciju. Dijagnostičke su procedure uključivale oralnu kliničku dijagnozu, patohistologiju i imunohistokemiju oralne lezije (ustanovljavanje HPV-a), ustanovljavanje imunostatusa pacijenta i ocjenu sustavskih bolesti koje su povezane s HIV infekcijom. Rezultati su pokazali da je pacijent anti-HIV pozitivan i asimptomatičan za bolesti koje su vezane za HIV. Budući da je pacijent homoseksualac, spada u skupinu visokoga rizika za HIV infekcije. Pacijentove stanice CD4+ (1000/il) nisu smanjene. Oralna je dijagnoza upućivala na multiple papillome mandibularne vestibu- larne sluznice (mandibular vestibular mucosae), patohistologiju papi- larne hiperplazije i kroničnu upalu, a imunohistokemijski je potvrđena HPV infekcija s HPV-om tipa 6,11 i 18. Zaključeno je da bi dijagnostička procedura oralnih apilomatoznih lezija koje su u svezi s HIV-om trebala uvijek uključivati prikaz vrsta HPV-a, od kojih su neke svojstvene za lezije vezane za HPV u HIV infekcijama.A case of a patient with HIV disease and oral papillomatous lesions indicating HPV infection is reported. Diagnostic procedures included oral clinical diagnosis, histopathology and immunohistochemi- stry of the oral lesion (HPV identification), determination of the patient\u27s immune status and evaluation of systemic diseases related to HIV infection. Results showed the patient to be anti-HIV positive and asymptomatic for HIV-associated diseases. As a homosexual, the patient belonged to the high risk group for HIV infection. The patient\u27s CD4+- cell-count was not reduced (1000/pl). Oral diagnosis pointed to multiple papillomas of the mandibular vestibular mucosa, histopathology to papillary hyperplasia and chronic inflammation, whereas immuno- histochemistry confirmed HPV infection with HPV types 6, 11 and 18. It is concluded that the diagnostic procedure of HIV-related oral papillomatous lesions should always include demonstration ofHPV-types, some of which are particular for HPV-related lesions in HIV-infection

Comparison of five-year survival rates among patients with oral squamous cell carcinoma with and without association with syphilis: a retrospective case-control study

Background: Syphilis is an infectious disease that is at least discussed to be premalignant. This potential, combined with its general pathological impact, raises the question if syphilis increases mortality in oral cancer patients. The aim of the study was to assess if the five-year survival rates among patients suffering from oral squamous cell carcinoma (OSCC) with (cohort I) and without association with syphilis (cohort II) differ. Methods: Retrospective clinical data of patients diagnosed with OSCC (International Classification of Diseases [ICD]-10 codes C01-06) within the past 20 years from the access date September 25, 2021 were retrieved from the TriNetX network (TriNetX, Cambridge, Massachusetts, USA) to gain initial cohort 0. Subjects also diagnosed with syphilis (ICD-10 codes A51-53) were assigned to cohort I. Cohort II was comprised of the remaining individuals of cohort 0 by creating a group with the same number of patients as cohort I, and by matching for age and gender. Subsequently, Kaplan-Meier analysis and Cox proportional hazards regression were performed, and risk, odds and hazard ratios were calculated. Results: Of a total of 73,736 patients in cohort 0, 199 individuals were each assigned to cohort I and II. During the five-year period after tumor diagnosis, 39 and 30 patients in cohort I and II died. The five-year survival probabilities did not significantly differ between the cohorts (I vs. II = 74.19% vs. 75.01%; p = 0.52; Log-Rank test), nor the risk of dying (I vs. II = 19.6% vs. 15.08%; risk difference = 4.52%; p = 0.23). The calculated risk, odds and hazard ratios were 1.3 (95% confidence interval [CI] = 0.84; 2.00), 1.37 (95% CI = 0.81; 2.31) and 1.17 (95% CI = 0.73; 1.88), respectively. Conclusions: The obtained results indicate that the survival rate of individuals with OSCC might not be negatively influenced if syphilis is present/associated. However, the results need to be interpreted cautiously due to limitations related to the retrospective approach, especially as data on the tumor staging were not accessible

Experimentelle Untersuchungen zur Pathogenese und Therapie der oralen Candidiasis bei Immundefizienz

Ziel der vorliegenden Arbeit war anhand eines Tiermodells zu untersuchen, 1. ob eine Dosis-Wirkungsbeziehung zwischen der Keimmenge und der Entstehung einer oralen C. albicans Infektion besteht, 2. welche zelluläre Immunantwort auf definierte inokulierte Keimmengen stattfindet, 3. ob sich die Adhärenz von C. albicans an murine Epithelzellen durch Spaltprodukte von Muzin (Glykopeptide) verhindern läßt. Material und Methode: Immunkompetente Inzuchtmäuse (Balb/c) (n=27) und Mäuse mit kombiniertem B- und T-Zelldefekt (SCID) (n=30) wurden mit Keimmengen von10^4 bis 10^8 C. albicans-Zellen/10 mikrol des Stammes DSM 3454 oral inokuliert. Darüber hinaus wurden Balb/c Mäuse (n=8) mit 10^8 C. albicans-Zellen in Kombination mit Glykopeptiden und SCID Mäuse (n=8) mit 10^5 C. albicans-Zellen mit Glykopeptiden inokuliert. Eine Zungenhälfte wurde histologisch mittels Periodic-Acid-Schiff (PAS) Reaktion auf Invasion von Hyphen untersucht. Die andere Hälfte wurde mittels Immunperoxidase-Technik auf die Verteilung immunkompetenter Zellen (CD4, CD13, ICAM-1, E-Selectin, CD74, CD80, CD86, CD103) im Epithel und subepithelialen Bindegewebe untersucht. Ergebnisse: Eine Woche post inoculationem fanden sich weder bei Balb/c noch bei SCID Mäusen klinische Zeichen einer oralen Candidiasis. Die histologischen Ergebnisse mittels PAS-Methode zeigten jedoch, daß eine Inokulationsmenge von 10^8 C. albicans-Zellen bei Balb/c Mäusen und 10^8 Keime bei SCID Mäusen zu einer Infektion der Zungenmukosa führte. Das Ausmaß der immunologischen Reaktion war abhängig von der Inokulationsdosis sowie vom Immunstatus der Tiere. Die Ergebnisse der Inokulation von 10^8 C. albicans-Zellen zusammen mit Glykopeptiden zeigten bei 2/8 Balb/c Mäusen eine Hypheninvasion in das Zungenepithel. Bei 0/8 SCID Mäusen wurde nach Inokulation von 10^4 C. albicans-Zellen zusammen mit Glykopeptiden eine Hypheninvasion in das Zungenepithel beobachtet. Die immunhistochemischen Ergebnisse zeigten, daß die Reaktionen des Wirtes auf die Gabe der Keim-Glykopeptidlösung denen ohne Inokulation entsprachen. Schlußfolgerung: Obwohl bei den eingesetzten C. albicans-Mengen keine klinisch manifeste orale Candidiasis vorhanden war, fanden sich in beiden Tierstämmen inapparente Infektionen des Zungenepithel (Hypheninvasion), die immunologische Reaktionen der Zungenmukosa auslösten. Da nach Inokulation von C. albicans-Zellen zusammen mit Glykopeptiden weniger häufig Infektionen nachgewiesen werden konnten als bei Inokulation derselben Keimmenge ohne Glykopeptide und Nebenwirkungen dieser antiadhäsiven Wirkstoffe bisher nicht nachgewiesen wurden, wäre der unterstützende Einsatz von Muzinen oder deren Spaltprodukten bei Patienten mit erhöhtem Candidiasisrisiko zu erwägen.This study applied an animal model to address the following questions: 1. Does a dose/effect relationship exist between C. albicans load and the emergence of an oral C. albicans infection, 2. which cellular immune response takes place following inoculation with defined pathogen loads, 3. is it possible to inhibit C. albicans adhesion to murine epithelium cells through the local application of mucine metabolites (glycopeptides). Material and methods: Immunocompetent inbred mice (Balb/c) (n=27) and mice with combined B- and T-cell defects (SCID) (n=30) were orally inoculated with pathogen loads between 10^4 and 10^8 C. albicans cells/10 microl (strain DSM 3454). Moreover, Balb/c mice (n=8) were inoculated with 10^8 C. albicans cells in combination with glycopeptides; SCID mice (n=8) were inoculated with 10^5 cells, also in combination with glycopeptides. One half of the tongue tissue was histochemically examined with the Periodic Acid Schiff (PAS) Method for displaying the invasion of hyphae. The other half of the tissue was examined by immune peroxidase technique for analysing the distribution of immunocompetent cells (CD4, CD13, ICAM-1, E-Selectin, CD74, CD80, CD86, CD103) in the epithelial layers and subepithelial connective tissue. Results: One week following the inoculation, neither group's tissue showed clinical signs of oral candidiasis. Following histochemical preparation (PAS-Reaction) the tongue mucosa showed signs of infection (hyphae) with the inoculation dose of 10^8 C. albicans cells in the case of Balb/c mice and a load of 10^5 pathogens in the case of SCID mice. The extent of the immunologic reaction depended both on the inoculation dose given to the animals and on their immune status. The results of an inoculation of 10^8 C. albicans cells in combination with glycopeptides showed hyphae invasion of the tongue epithelium in 2/8 Balb/c mice. Following an inoculation of 10^5 pathogens in combination with glycopeptides hyphae invasion could be demonstrated in 0/8 SCID mice. The results of immunohistochemical studies showed that the host's reaction to combined glycopeptide-pathogen-inoculation correspond to the reaction without inoculation. Conclusion: Despite the lack of clinical signs of oral candidiasis in neither group's tissue, non-apparent infections of the tongue epithelium were evident leading to immunologic reactions of the tongue mucosa. Inoculation of C. albicans cells in combination with glycopeptides resulted in decreased infection rate compared to a corresponding inoculation dose without glycopeptides. As no side effects have been documented for the oral application of these antiadhesive agents, their use as complimentary therapy for patients at an increased risk for oral candidiasis should be considered

[Oral medicine: a specialty placed between medicine and dentistry]

Oral medicine is a dental specialty that bridges the traditional areas of health between dentistry and medicine. International descriptions reflect this and oral medicine is defined as "the dental speciality placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region." Oral medicine specialists provide clinical care to patients with a wide variety of orofacial conditions, including oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases. There is a growing need to implement this specialty globally: due to the rapid progress in both medicine and dentistry, and to the growing percentage of senior citizens in many countries, the adequate diagnosis and treatment of oral diseases will become even more complex in the future. In this article, the authors' intention is to point out that oral medicine is neither a recognized specialty nor a distinct field of study in Germany, Austria, or Switzerland; thus, the need for postgraduate training in this field in countries where oral medicine is not a specialization is emphasized