Polarized Light as an Adjuvant to Drug Therapy for the Treatment of Refrectory Oral Erosive Lichen Planus: A Case Report

Oral lichen planus is a chronic inflammatory disease of unknown etiology, associated with a malignant transformation in 1.2% of cases. It can be predominantly white and therefore almost always asymptomatic, or with the presence of large erosions in different areas of the oral cavity. In this case the pathology can be disabling, causing severe chewing difficulties and compromising the patient's quality of life. The gold standard for the treatment of this pathology is the use of topical cortisones combined with nystatin. The use of photodynamic therapy for the treatment of these lesions is also documented in the scientific literature. Polarized light is a light with a very wide wavelength variability, created for the treatment of erosive and ulcerative skin lesions and then also introduced in other fields, such as in oral medicine. It has an excellent analgesic and bio stimulating effect. We propose a case of erosive lichen planus refractory to systemic cortisone therapy, present for 4 years without remission, successfully treated with 6 15-minute sessions of phototherapy with polarized light, using a Bioptron device at 25 watts of power. After an important improvement, the therapy was concluded with gel based on ozonated olive oil (Ialozon, Gemavip, Cagliari, Italy) and topical cortisone, due to the impossibility of continuing the therapies in the study (lockdown). Polarized light is very easy to use, has no side effects, does not require special eye protection and has proven to be very effective in the clinical resolution of refractory lesions to drug therapy

PHOTODYNAMIC THERAPY AS SUPPORT OF PHARMACOLOGICAL THERAPY IN A CASE OF PARTICULAR REFRACTORY ORAL LICHEN PLANUS: A CASE REPORT.

Aim: Lichen planus (LP) is a chronic autoimmune mucocutaneous condition, primarily affecting the oral and genital mucous membrane, skin, nails, and scalp. The oral lichen planus (OLP) affects approximately 2% of the population. OLP, in general, may arise in > 70% of persons with skin lesions. The frequency of malignant change ranges from 0.4% to 3.3%. OLP is seen worldwide, mostly in the fifth to sixth decades of life, and is twice as prevalent in women as in men. OLP has demonstrated numerous systemic connotations such as diabetes mellitus (DM), hypertension, metabolic syndrome (MS), thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The treatment options for OLP are numerous and include topical and systemic agents. Topical corticosteroids remain the mainstay of therapy. Case report: A 62-year-old woman came to our observation for a lesion present for about 1 year extended to the hard palate and the upper vestibular gingival mucosa. In the anamnesis she reported osteoporosis and gastro-esophageal reflux. On objective examination there were erosion areas of different width and depth interspersed with erythematous and rare areas white patterns. The patient also reported the formation of bubbles that in a very short time exploded. The negative Nickolsky sign on physical examination did not testify for a diagnosis of vesicular-bullous disease. An incisional biopsy was performed in the palatine area. The subsequent histological evaluation and immunofluorescence were significant for the diagnosis of lichen planus bullous. Topical therapy prescribed with Clobetasol 0.05% 2 times a day and topical Nystatin (100.000 ul/ ml) 3-4 times a day for 3 weeks brought an evident improvement; however an erosive lesion persisted in the area 22-23. It was decided to proceed with a photodynamic support therapy with 460 nm diode light, 4 watts (FlashMax P4 CSM Dental, Copenhagen, Denmark) and 3% hydrogen peroxide. Mucous surface was wetted with hydrogen peroxide then illuminated with diode light 20 times for 3 seconds, subsequently the hydrogen peroxide was removed with a sterile gauze. This treatment was repeated 3 times every 7 days. Results: One week later there was an important clinical improvement, the subsequent therapeutic sessions allowed an almost complete remission of the lesion unresponsive to corticosteroid treatment. Numerous invasive and non- invasive therapeutic methods including local and systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested. Extended use of corticosteroids for chronic OLP may have certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes. To surmount the side effects of steroid therapy, photodynamic therapy (PDT) has been proposed as an alternative treatment strategy for OLP. PDT uses a photosensitizing agent which, when activated by the energy of light, creates a photodynamic reaction that is cytotoxic. A systematic review of the literature assessed the effectiveness of PDT in the management of OLP. PDT also showed an increase in the bactericidal activity of hydrogen peroxide in a case of refractory hairy tongue. Conclusions: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with standardized PDT parameters are needed

Morphological Changes in Dental Surfaces Suggest Health Status and Alimentary Habits in the Subjects Belonging to the Copper Age in Sardinia Island (III Millennium BC)

The aim of this multidisciplinary study, which involved a team of archaeologists, odontologists, biologists, is to examine a set of dental health indicators, including caries, tooth wear, and enamel hypoplasia of a III millennium BC sample from the burial site of Scaba ’e Arriu (Siddi, South Sardinia), in order to evaluate the dental health status and the diet. Our purpose is to depict a timeline of dental health in Sardinia from prehistory to the present day, starting with a focus on a Copper Age population. Caries, dental wear, and enamel hypoplasia of 259 permanent teeth were evaluated. It was not possible to assign sex and age of each tooth because of the lack of bony support, lost due to taphonomy factors. 14,7% of Scaba‘e Arriu’s samples were affected by carious lesions, with greater involvement of the posterior teeth (12,7% against 1,9% of anterior ones). Interproximal caries was the most frequent. Dental wear affected 77,8% of the teeth, and its presence is preponderant over caries’ rate. The high percentage of dental wear suggests a diet based on abrasive foods. Further studies are necessary to delineate more accurately the modus vivendi, the nutrition, and, consequently, the health status of this sample

Oil Essential Mouthwashes Antibacterial Activity against Aggregatibacter actinomycetemcomitans: A Comparison between Antibiofilm and Antiplanktonic Effects

The aim of this work is to determine the antibacterial activity of three marketed mouthwashes on suspended and sessile states of Aggregatibacter actinomycetemcomitans. The efficacy of two commonly used products in clinical practice, containing essential oils as active ingredients (menthol, thymol, methyl salicylate, and eucalyptol) in association with or without alcohol, has been evaluated in comparison with a chlorhexidine-based mouthwash. The microtiter plate assay, in order to obtain a spectrophotometric measurement of bacterial responses at growing dilutions of each antiseptic, was used for the study. The analysis revealed that a good antibacterial activity is reached when the abovementioned mouthwashes were used at concentration over a 1/24 dilution and after an exposure time of 30 seconds at least. In conclusion, the alcoholic mouthwash appears to have a better biofilm inhibition than its antiplanktonic activity while the nonalcoholic product demonstrates an opposite effect with a better antiplanktonic behavior

A new technique for the study of periapical bone lesions: ultrasound real time imaging

Cotti E, Campisi G, Garau V, Puddu G. A new technique for the study of periapical bone lesions: ultrasound real time imaging. International Endodontic Journal, 35, 148–152, 2002. Aim This study describes the use of a real time-ultrasound imaging technique (echography) for the study of periradicular lesions. Methodology Twelve patients with periapical lesions of endodontic origin, diagnosed with conventional clinical and radiographic examination, were examined further using echography at the site of the diagnosed lesions. Each lesion was echographically characterized and described by an expert echographist together with an endodontist. Once the major echographic features were identified, information on the size of the lesion, its content, and its vascular supply was obtained and recorded. A tentative differential diagnosis between a cyst and a granuloma was made based on the data. Results In all cases it was possible to obtain an echographic image. It was also possible to measure the lesions, to evaluate their content and to view their vascularization in different regions of the mouth. Conclusions Ultrasound real time imaging is a promising diagnostic technique in endodontology, but further work is required to refine the process