Oral helath evaluation in the institutionalized elderly

Uvod: Udio starije populacije u svijetu ubrzano povećava, a povećava se i interes za oralno zdravlje starijih osoba. Oralno zdravlje predstavlja važan dio općeg zdravlja, a uključuje zdravlje cjelokupne usne šupljine odnosno zdravlje zuba, parodontnog tkiva, sluznice i žlijezda slinovnica. Cilj: Cilj istraživanja bio je utvrditi pojavnost bolesti oralne sluznice, analizirati i usporediti stanje parodonta zuba i način provoñenja oralno higijenskih postupaka, utvrditi i usporediti dentalni i protetski status, analizirati povezanost upotrebe stomatoloških materijala i pojave oralnih promjena te utvrditi povezanost izmeñu pojave sustavnih bolesti i terapije lijekovima s oralnim bolestima kod osoba u ustanovi za starije i nemoćne osobe i osoba koje žive samostalno. Ispitanici i postupci: U istraživanje su bilo uključeno 341 ispitanika, 280 osobe smještene u ustanovi i 61 osoba koja živi samostalno. Postupak obrade svakog ispitanika sastojao se iz uzimanja anamnestičkih podataka, kliničkog pregleda usne šupljine i dijagnostičkih postupaka. Rezultati: Kod osoba smještenih u ustanovi za starije i nemoćne zabilježen je značajno veći broj oralnih sluzničnih promjena (p=0,016). Kod osoba smještenih u ustanovi za starije i nemoćne zabilježen je značajno niži nivo lučenja sline (p=0,001) te je jače izražen osjećaj suhoće usne šupljine (p=0,001) i promjena okusa (p=0,035). Pored toga, kod većeg broja osoba iste skupine zabilježena je kolonizacija Candida species i oralna kandidijaza u usporedbi s osobama koje žive samostalno (p<0,001). Značajna razlika zabilježena izmeñu skupina u KEP indeksu (p<0,001). Takoñer je zabilježeno lošije parodontološko stanje ispitanika u ustanovi (p<0,017). Kod manjeg broja osoba u ustanovi provedena je protetska rehabilitacija (p=0,0009). Zaključci: osobe u ustanovi su značajno više zahvaćene oralnim sluzničnim bolestima, oralnim subjektivnim smetnjama, imaju lošije parodontološko stanje te su slabije protetski rehabilitirani nego osobe koje žive samostalno.Introduction: There is a growing interest in the oral health of elderly people as the size of this population is increasing around the world. Oral health is important part of general health and includes teeth, periodontal health, oral mucosal health and prosthetic rehabilitation. The aims of this study were to examine the prevalence of oral mucosal lesions and oral sensorial complaints, as well as periodontal health and oral hygiene level between the institutionalized and non-institutionalized elderly. Also, the aims were to determine dental status, prosthetic status and influence of dental material to oral tissue between groups. Material and methods: The study involved two groups of elderly subjects: the institutionalized residing in a nursing home in Rijeka and the non-institutionalized elderly. A total of 341 subjects were included, 280 institutionalized and 61 non- institutionalized. All patients underwent an oral examination to detect underlying oral diseases related to oral symptoms. The examination consisted of complete anamnesis and clinical status according to registration form designed for this purpose. Results: The prevalence of oral mucosal lesions was significantly higher in the institutionalized elderly compared with the non-institutionalized elderly (p=0,016). Low salivary flow was found to be more common in the institutionalized elderly than in the noninstitutionalized elderly (p=0,001), as well as dry mouth (p=0,001) and taste disturbance (p=0,035).Significantly higher level of oral colonization with Candida species and oral candidiasis were found in the institutionalized elderly comparing to the non-institutionalized elderly (p<0,001). A significant difference was observed between the groups in DMFT index (p<0,001). Institutionalized elderly had worse periodontal health (p<0,017). Lower number of prosthetic appliances was observed in the institutionalized elderly (p=0, 0009). Conclusions: It can be concluded that the institutionalized elderly are significantly affected with oral mucosal lesions and oral sensorial complaints. They also have worse periodontal health and lower number of prosthetic appliances compared with the non-institutionalized elderly

The effect of fluconazole and amphotericin B on macrophage functions

Abstract: Background: Different antimicrobial drugs inhibit functions of the microbial cells but, unfortunately, some of these drugs can also affect the host cells, including macrophages. Since these cells represent the baseline defense against microbial agents, it is important that they are fully activated. Materials and Methods: In the present study we investigated the effect of amphotericin B and fluconazole on the functions of peritoneal macrophages from Balb/c mice treated with these antimycotics. For each antimycotic the therapeutic dose used in clinical practice (calculated on the mouse body weight) and two-fold higher doses were administered intraperitoneally once a day for three consecutive days. The control group was treated with saline in the same way. Four different tests, candidacidal assay, nitroblue tetrazolium test, adherence capability and phagocytic capability, were used to determine macrophage functions. Results: Our results confirmed positive effect of high dose amphotericin B on phagocytic capability (31.00 ± 4.46%), metabolic changes (27.93 ± 6.63%) and adherence capacity (59.24 ± 8.67%). Lower doses of drug amphotericin B (2 mg/kg) significantly increased the adherence index of macrophages (71.99 ± 5.55%) and intensity of the NBT intracellular reduction (30.20 ± 3.83%). Maximum dose of fluconazole expressed significantly higher phagocytic index (30.77 ± 2.17%), metabolic changes (24.00 ± 4.07%) and candidacidal activities (27.73 ± 6.73%), while lower doses of fluconazole (15 mg/kg) significantly increased the adherence index of macrophages (75.58 ± 5.47%) as well as the phagocytic index (29.23 ± 2.40%). Other results were similar as in control group. Conclusion: Positive immunomodulatory effects of fluconazole and amphotericin B may be clinically relevant especially in compromised patients who are predisposed to opportunistic fungal infections and require a long-term antimycotic therapy. Synergistic action of macrophages and antimycotics can influence the course of disorders related to immune suppression

Saliva as a diagnostic fluid

Abstract: Saliva is a readily available oral fluid with many functions, from digestion, maintenance of oral tissues’ integrity, to caries prevention. Changes regarding its secretion may be divided into qualitative and quantitative: both of them are a consequence of certain conditions/diseases (e.g. internal factors) or nutrients/ drugs ingested (e.g. external factors). During the last 15 years, technological advances gave a significant momentum to utilization of saliva as a diagnostic tool. Analysis of saliva, just like the blood analysis, has two main objectives: to identify the subjects suffering from a certain disorder, and to follow the development and progress of therapy. This paper provides an overview of possibilities for the use of saliva for diagnostic purposes and gives specific examples of some clinical investigations, with the final aim to stimulate the use of this noninvasive means for the health care promotion

The effect of fluconazole and amphotericin B on macrophage functions

Abstract: Background: Different antimicrobial drugs inhibit functions of the microbial cells but, unfortunately, some of these drugs can also affect the host cells, including macrophages. Since these cells represent the baseline defense against microbial agents, it is important that they are fully activated. Materials and Methods: In the present study we investigated the effect of amphotericin B and fluconazole on the functions of peritoneal macrophages from Balb/c mice treated with these antimycotics. For each antimycotic the therapeutic dose used in clinical practice (calculated on the mouse body weight) and two-fold higher doses were administered intraperitoneally once a day for three consecutive days. The control group was treated with saline in the same way. Four different tests, candidacidal assay, nitroblue tetrazolium test, adherence capability and phagocytic capability, were used to determine macrophage functions. Results: Our results confirmed positive effect of high dose amphotericin B on phagocytic capability (31.00 ± 4.46%), metabolic changes (27.93 ± 6.63%) and adherence capacity (59.24 ± 8.67%). Lower doses of drug amphotericin B (2 mg/kg) significantly increased the adherence index of macrophages (71.99 ± 5.55%) and intensity of the NBT intracellular reduction (30.20 ± 3.83%). Maximum dose of fluconazole expressed significantly higher phagocytic index (30.77 ± 2.17%), metabolic changes (24.00 ± 4.07%) and candidacidal activities (27.73 ± 6.73%), while lower doses of fluconazole (15 mg/kg) significantly increased the adherence index of macrophages (75.58 ± 5.47%) as well as the phagocytic index (29.23 ± 2.40%). Other results were similar as in control group. Conclusion: Positive immunomodulatory effects of fluconazole and amphotericin B may be clinically relevant especially in compromised patients who are predisposed to opportunistic fungal infections and require a long-term antimycotic therapy. Synergistic action of macrophages and antimycotics can influence the course of disorders related to immune suppression

Pyostomatitis Vegetans Associated with Inflammatory Bowel Disease – Report of Two Cases

Pyostomatitis vegetans (PV) is a rare, chronic mucocutaneous disorder associated with inflammatory bowel disease (IBD). Oral lesions of PV are distinct and present as multiple white or yellow pustules with an erythematous base that coalesce and undergo necrosis to form a typical »snail tracks« appearance. Two cases of PV associated with IBD – one with Crohn\u27s disease (CD) and the other with ulcerative colitis (UC) are reported. In the first case, adalimumab therapy brought the oral and gastrointestinal manifestations to complete remission. In the second case, the remission was achieved with systemic steroid therapy, but the disease relapsed after therapy discontinuation. Azathioprine was added leading to sustained remission of PV. Because of persistent active intestinal manifestation of UC, in spite of immunosuppressive therapy, infliximab was introduced. With the therapy remission of intestinal manifestation of UC was achieved as well. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of oral lesions

Sialochemistry in Patients with Oral Lichen Planus

Svrha: Zna se da određeni sastojci sline mogu biti poremećeni kod bolesnika koji pate od oralnoga lichen planusa (OLP-a), no rezultati objavljenih istraživanja nisu konzistentni. Svrha ovog istraživanja bila je odrediti koncentraciju salivarnih analita u sklopu salivarnih enzima koji održavaju integritet oralnih sluznica, a on je oštećen kod oboljelih od oralnoga lichen planusa. Ispitanici i postupci: Skupini od 25 bolesnika s OLP-om (73±1,4 godine) i 24 kontrolna ispitanika (24±3,7 godina) određeni su u slini ukupni proteini, amilaza, magnezij, kalcij, bakar, klorid, fosfat i kalij. Ukupni proteini određeni su kolorimetrijskom metodom uz pirogalol. Natrij, kalij i klorid izmjereni su indirektnom potenciometrijom, bakar i magnezij atomskom apsorpcijskom spektrofotometrijom, a fosfat kolorimetrijskom uz pomoć molibdata. Statistička analiza obavljena je uz pomoć χ2 testa, Mann–Whitneyeva U-testa, analizom kovarijance i Spearmanovom korelacijom. Rezultati: Znatno povišene vrijednosti salivarnog klorida pronađene su kod oboljelih od OLP-a u odnosu prema sudionicima u kontrolnoj skupini (p=0,025). Nakon toga, kada su dobiveni rezultati prilagođeni s obzirom na količinu izlučene sline, ustanovljene su povišene vrijednosti salivarnog kalija, natrija, klorida i ukupnih proteina kod oboljelih od oralnoga lichen planusa u odnosu prema kontrolnoj skupini (p=0,622; p=0,504; p=0,00; p=0,586). Koncentracija salivarnih analita nije bila povezana s pušenjem. Zaključak: Povišene vrijednosti salivarnog natrija, kalija i klorida vjerojatno su posljedica velikih razlika u količini izlučene sline između oboljelih od OLP-a i sudionika u kontrolnoj skupini i ne upućuju na pojačanu antimikrobnu aktivnost kod bolesnika s OLP-om.Objective: It is well known that certain salivary constituents might be disturbed in patients suffering from oral lichen planus (OLP), however, the results of the published studies are inconsistent. The aim of this study was to assess the concentrations of salivary analytes because most of them are part of salivary enzymes which maintain integrity of the oral mucosa which is compromised in OLP patients. Materials and Methods: In 25 patients with OLP (73±1.4 yrs) and in the 24 controls (24±3.7yrs) levels of total proteins, amylase, salivary magnesium, calcium, copper, chloride, phosphate, potassium and sodium were determined. Total proteins were determined by pyrogalol colorimetric method. Amylase levels were determined by continued colorimetric method. Salivary sodium, potassium and chloride were determined by indirect potentiometry whereas salivary copper and magnesium were determined by atomic absorption spectrophotometry whereas phosphates were determined by colorimetric method with use of molybdate. Statistical analysis was performed by use of χ2 test, Mann Whitney U test analysis of covariance and Spearman´s correlation. Results: Significantly higher concentration of salivary chloride was detected in OLP patients in comparison to the controls (p=0.025). Furthermore, when the obtained results for salivary analytes were adjusted with respect to the salivary flow rate, increased levels of salivary potassium, sodium, chloride and total proteins were found in patients with OLP when compared to the controls (p=0.622; p=0.504; p=0.600; p=0.586). Concentrations of salivary analytes were not affected by smoking habit. Conclusions: Increased levels of salivary sodium, potassium and chloride are probably a result of significant differences in salivary flow rate between patients with OLP and controls and do not indicate increased salivary antimicrobial activity

Radiation induced oral mucositis – therapeutic strategy in a case report

Cilj: Oralni mukozitis je akutna komplikacija zračenja u području glave i vrata, praćena bolom, otežanim žvakanjem, gutanjem i govorom. Često uzrokuje i prekid zračenja, što može kompromitirati uspjeh liječenja. Budući da još uvijek ne postoji jedinstveni protokol liječenja mukozitisa, njegovo liječenje predstavlja izazov za kliničare. Cilj ovog rada je prikazati klinički slučaj oralnog mukozitisa uzrokovanog zračenjem, postupak obrade i liječenja. Prikazslučaja: Prikazujemo slučaj 65-godišnjeg pacijenta koji je zatražio pomoć zbog promjena i bolova u usnoj šupljini. Anamnezom, kliničkim pregledom i laboratorijskom obradom postavljene su dijagnoze oralni mukozitis uzrokovan zračenjem (3. stupanj po ljestvici Svjetske zdravstvene organizacije) i oralna kandidijaza. Pacijent je, uz česte kontrolne preglede, liječen oralnim antiseptikom, lokalnim antimikotikom i anestetikom, sustavnim analgetikom, preparatom za oblaganje i poticanje oporavka sluznice te biostimulativnom niskoenergetskom laserskom terapijom. Kod praćenog pacijenta oralni mukozitis je izliječen te je pacijent uspješno završio radioterapiju. Zaključak: Oralni mukozitis vrlo je neugodna komplikacija zračenja u području glave i vrata. Za uspješno liječenje od velike su važnosti rano postavljanje dijagnoze i česte kontrole. U liječenju oralnog mukozitisa važna je i dobra suradnja između onkologa, kirurga i doktora dentalne medicine / oralnog patologa.Aim: Oral mucositis is an acute complication of radiation in the head and neck region, accompanied by pain and difficulties in mastication, swallowing and speech. It often causes an interruption of radiation therapy and can compromise therapy success. Considering that there is still no unique treatment protocol for mucositis, its treatment represents a challenge to clinicians. The aim of this report is to present a clinical case of oral mucositis induced by radiation, its diagnostic process and treatment. Case report: We report a case of a 65-year-old patient who sought help due to presence of lesions and pain in the oral cavity. Diagnosis of oral mucositis caused by radiation (Grade 3 according to World Health Organization scale) and oral candidiasis were established through anamnesis, clinical examination and laboratory analysis. The patient was treated with oral antiseptic, local antifungal drug and anesthetic, systemic analgesics, agent for coating and stimulating mucosal recovery, and biostimulative low level laser therapy with frequent follow-ups. Oral mucositis was cured and radiotherapy was successfully completed. Conclusion: Oral mucositis is a very unpleasant complication of radiation in the head and neck region. Early diagnosis and frequent followups are of great importance for successful treatment. Also, a multidisciplinary approach between oncologist, surgeon and dentist/oral pathologist is essential for successful treatment of mucositis

Radiation induced oral mucositis – therapeutic strategy in a case report

Cilj: Oralni mukozitis je akutna komplikacija zračenja u području glave i vrata, praćena bolom, otežanim žvakanjem, gutanjem i govorom. Često uzrokuje i prekid zračenja, što može kompromitirati uspjeh liječenja. Budući da još uvijek ne postoji jedinstveni protokol liječenja mukozitisa, njegovo liječenje predstavlja izazov za kliničare. Cilj ovog rada je prikazati klinički slučaj oralnog mukozitisa uzrokovanog zračenjem, postupak obrade i liječenja. Prikazslučaja: Prikazujemo slučaj 65-godišnjeg pacijenta koji je zatražio pomoć zbog promjena i bolova u usnoj šupljini. Anamnezom, kliničkim pregledom i laboratorijskom obradom postavljene su dijagnoze oralni mukozitis uzrokovan zračenjem (3. stupanj po ljestvici Svjetske zdravstvene organizacije) i oralna kandidijaza. Pacijent je, uz česte kontrolne preglede, liječen oralnim antiseptikom, lokalnim antimikotikom i anestetikom, sustavnim analgetikom, preparatom za oblaganje i poticanje oporavka sluznice te biostimulativnom niskoenergetskom laserskom terapijom. Kod praćenog pacijenta oralni mukozitis je izliječen te je pacijent uspješno završio radioterapiju. Zaključak: Oralni mukozitis vrlo je neugodna komplikacija zračenja u području glave i vrata. Za uspješno liječenje od velike su važnosti rano postavljanje dijagnoze i česte kontrole. U liječenju oralnog mukozitisa važna je i dobra suradnja između onkologa, kirurga i doktora dentalne medicine / oralnog patologa.Aim: Oral mucositis is an acute complication of radiation in the head and neck region, accompanied by pain and difficulties in mastication, swallowing and speech. It often causes an interruption of radiation therapy and can compromise therapy success. Considering that there is still no unique treatment protocol for mucositis, its treatment represents a challenge to clinicians. The aim of this report is to present a clinical case of oral mucositis induced by radiation, its diagnostic process and treatment. Case report: We report a case of a 65-year-old patient who sought help due to presence of lesions and pain in the oral cavity. Diagnosis of oral mucositis caused by radiation (Grade 3 according to World Health Organization scale) and oral candidiasis were established through anamnesis, clinical examination and laboratory analysis. The patient was treated with oral antiseptic, local antifungal drug and anesthetic, systemic analgesics, agent for coating and stimulating mucosal recovery, and biostimulative low level laser therapy with frequent follow-ups. Oral mucositis was cured and radiotherapy was successfully completed. Conclusion: Oral mucositis is a very unpleasant complication of radiation in the head and neck region. Early diagnosis and frequent followups are of great importance for successful treatment. Also, a multidisciplinary approach between oncologist, surgeon and dentist/oral pathologist is essential for successful treatment of mucositis

Radiation induced oral mucositis – therapeutic strategy in a case report

Cilj: Oralni mukozitis je akutna komplikacija zračenja u području glave i vrata, praćena bolom, otežanim žvakanjem, gutanjem i govorom. Često uzrokuje i prekid zračenja, što može kompromitirati uspjeh liječenja. Budući da još uvijek ne postoji jedinstveni protokol liječenja mukozitisa, njegovo liječenje predstavlja izazov za kliničare. Cilj ovog rada je prikazati klinički slučaj oralnog mukozitisa uzrokovanog zračenjem, postupak obrade i liječenja. Prikazslučaja: Prikazujemo slučaj 65-godišnjeg pacijenta koji je zatražio pomoć zbog promjena i bolova u usnoj šupljini. Anamnezom, kliničkim pregledom i laboratorijskom obradom postavljene su dijagnoze oralni mukozitis uzrokovan zračenjem (3. stupanj po ljestvici Svjetske zdravstvene organizacije) i oralna kandidijaza. Pacijent je, uz česte kontrolne preglede, liječen oralnim antiseptikom, lokalnim antimikotikom i anestetikom, sustavnim analgetikom, preparatom za oblaganje i poticanje oporavka sluznice te biostimulativnom niskoenergetskom laserskom terapijom. Kod praćenog pacijenta oralni mukozitis je izliječen te je pacijent uspješno završio radioterapiju. Zaključak: Oralni mukozitis vrlo je neugodna komplikacija zračenja u području glave i vrata. Za uspješno liječenje od velike su važnosti rano postavljanje dijagnoze i česte kontrole. U liječenju oralnog mukozitisa važna je i dobra suradnja između onkologa, kirurga i doktora dentalne medicine / oralnog patologa.Aim: Oral mucositis is an acute complication of radiation in the head and neck region, accompanied by pain and difficulties in mastication, swallowing and speech. It often causes an interruption of radiation therapy and can compromise therapy success. Considering that there is still no unique treatment protocol for mucositis, its treatment represents a challenge to clinicians. The aim of this report is to present a clinical case of oral mucositis induced by radiation, its diagnostic process and treatment. Case report: We report a case of a 65-year-old patient who sought help due to presence of lesions and pain in the oral cavity. Diagnosis of oral mucositis caused by radiation (Grade 3 according to World Health Organization scale) and oral candidiasis were established through anamnesis, clinical examination and laboratory analysis. The patient was treated with oral antiseptic, local antifungal drug and anesthetic, systemic analgesics, agent for coating and stimulating mucosal recovery, and biostimulative low level laser therapy with frequent follow-ups. Oral mucositis was cured and radiotherapy was successfully completed. Conclusion: Oral mucositis is a very unpleasant complication of radiation in the head and neck region. Early diagnosis and frequent followups are of great importance for successful treatment. Also, a multidisciplinary approach between oncologist, surgeon and dentist/oral pathologist is essential for successful treatment of mucositis

Electric potential difference in oral cavity in patient with burning mouth syndrome

Cilj: Sindrom pekućih usta (SPU) je kronično, idiopatsko, multifaktorijalno bolno stanjekoje karakteriziraju pekuće bolne senzacije u području usne šupljine koje mogu varirati tijekomdana. Simptomi SPU-a mogu potrajati godinama. Bol je najčešće lokaliziran bilateralnou području lateralne i prednje dvije trećine jezika, tvrdog nepca i donje usne. Najčešće se pojavljujeu populaciji žena srednje i starije dobi. Iako je etiopatogeneza ove bolesti i dalje nepoznata,u dijagnostici se koristi metoda isključenja svih mogućih uzročnih čimbenika. Kao jedanod mogućih lokalnih čimbenika u nastanku SPU-a spominje se i galvanizam koji se uusnoj šupljini može javiti kada pacijent ima dvije ili više legura koje međusobno interferiraju,stoga je bitno dobro poznavati svojstva dentalnih materijala koja mogu pridonijeti nastankurazlike električnog potencijala. Svrha rada bila je ispitati pojavnost električnog potencijalakod osoba s dijagnosticiranim primarnim ili sekundarnim sindromom pekućih usta koje imajunajmanje dva metala različite plemenitosti u usnoj šupljini. Ispitanici i postupci: U istraživanjusu sudjelovala 34 pacijenta u SPU-ovoj skupini i 38 pacijenata u kontrolnoj skupini. Rezultati:Statističkom obradom podataka nije otkrivena značajna razlika električnog potencijalameđu ispitanim skupinama (p = 0,925). Zaključak: Iako je razlika električnog potencijala u literaturispomenuta kao potencijalni lokalni čimbenik u nastanku SPU-a, ovim istraživanjemnismo dokazali njihovu povezanost.Aim: Burning mouth syndrome is a chronic, idiopathic, multifactorial painfulcondition which is characterized by a burning sensation in the mouth and can vary during theday. Once BMS symptoms occur, they can last for a few years. The pain is mostly localisedbilaterally in the lateral and anterior two-thirds of tongue, hard palate, and lower lip. BMS ismostly present in middle age and old female population. Even though etiopathogenesis ofthe disease remains unknown, its diagnostic methods are based on exclusion of all possiblecausal factors. Oral electrogalvanism, known as one of the potential factors responsible forBMS can occur when the patient has two or more alloys that can interfere. Therefore it isessential to know all the characteristics of dental materials that may contribute to galvanism.The purpose of this study was to examine the occurence of electrical potential diffrence inpatients with primary or secondary burning mouth syndrome having at least two metals ofdifferent nobility in their oral cavity. Methods: This study included 34 patients in BMS and 38patients in the control group. Results: Statistical analysis of the data revealed no significantdifference in the electrogalvanic potential between the examined gruops (p = 0.925).Conclusion: Although oral electrogalvanism is mentioned in the literature to be potentiallocal factor in BMS development, in this study we did not prove their connection