Diagnostic et traitement des lésions lichénoïdes de la muqueuse buccale provoquées par des allergènes: Présentation d’un cas clinique

Les lésions lichénoïdes de la muqueuse buccale provoquées par des allergènes peuvent se manifester aussi bien lors d’un lichen plan buccal (LPB) que lors d’une lésion lichénoïde buccale (LLB). Cliniquement et histologiquement, le LPB est difficile à différencier de la LLB. Cependant, le diagnostic de LPB peut être confirmé par un examen histologique. Le LPB est considéré comme une lésion potentiellement maligne. Selon les données actuelles de la littérature, les LLB semblent présenter un risque accru de transformation maligne. Sur la base d’un cas clinique, il est montré dans ce travail qu’une approche interdisciplinaire dans l’investigation diagnostique des lésions muqueuses, comprenant des tests allergologiques, a permis d’établir une relation entre une allergie de contact à l’amalgame et des altérations lichénoïdes de la muqueuse buccale. Le traitement subséquent réalisé dans ce cas illustre de façon exemplaire les étapes des différentes options de soins médico-dentaires lors d’allergies de contact multiples à des matériaux dentaires

Allergen-triggered lichenoid oral mucosa lesions

Allergen-getriggerte lichenoide Mundschleimhautläsionen können sowohl beim oralen Lichen planus (OLP) als auch bei der oralen lichenoiden Läsion (OLL) auftreten. Klinisch und histologisch sind OLP und OLL nur schwer voneinander abzugrenzen. Ein OLP kann durch eine histologische Untersuchung gesichert werden. Dabei gilt der OLP als eine potenziell maligne Veränderung. Basierend auf aktuellen Daten der Literatur steht die OLL im Verdacht, ein erhöhtes Risiko einer malignen Transformation zu haben. Anhand eines klinischen Falles wird gezeigt, dass über eine interdisziplinäre Vorgehensweise in der Allergie- und Schleimhautdiagnostik ein Zusammenhang zwischen einer Kontaktallergie auf Amalgam und den lichenoiden Schleimhautveränderungen bestand. Die anschliessende Therapie zeigt exemplarisch die Schritte der zahnärztlichen Versorgungsmöglichkeiten bei multiplen Kontaktallergien auf Dentalmaterialien.Allergen-triggered lichenoid oral mucosa lesions may occur both in oral lichen planus (OLP) and oral lichenoid lesions (OLL). Clinically, OLP and OLL are difficult to distinguish from each other. An OLP should be checked by histological examination. Therefore all patients with OLP should be included into a close control interval due to the the potential malignant trans- formation, whereas in the literature a higher risk of malignancy is attributed to OLL in comparison with OLP. Based on a clinical case, it is demonstrated that an interdisciplinary approach in allergy and mucous diagnosis is necessary to verify the correaltion between a contact allergy to amalgam and the lichenoid mucosal lesions. The subsequent treatment exemplifies the steps of dental therapies with multiple contact allergies to dental materials

Contact allergies to dental materials

There is a lack of epidemiological data on allergies to dental materials. For example, in the recently published fifth German Oral Health Study (DMS V), no information was given on any common allergies or allergies to dental materials. The aim of the present observational study was therefore to determine the frequencies and symptoms of allergies to dental materials. A public consultation hour for allergies of the oral mucosa and material incompatibilities has been integrated in the Department of Dental Prosthodontics and Materials Science in Leipzig, where clinical patient data have systematically been collected since 2012. The objective mucosal findings and the patients’ complaints are documented in detail in a specifically designed data sheet. This study included 86 subjects (83.7% women and 16.3% men) with oral symptoms of a contact allergy. The average age was 63 years (24–86). The most common allergies were to metals, of which nickel and cobalt were the most common allergens. Furthermore, many allergies were indicated to ingredients of cosmetics and composites. Allergies to components in methacrylate-containing denture resins came in at rank 5. 52.4% of the patients showed mucosal changes. Contact stomatitis (54.5%) and an oral lichenoid lesion (20.5%) were most frequently diagnosed. 86% of the patients reported subjective complaints. Pain and burning sensations in the mouth were mostly reported. Appropriate dental allergy history, clinical examination of the oral cavity for changes in the oral mucosa, analysis of specific dentures, and screening for psychogenic disorders are necessary to clarify the origin of these symptoms

Evaluation of Static DNA Ploidy Analysis Using Conventional Brush Biopsy-Based Cytology Samples as an Adjuvant Diagnostic Tool for the Detection of a Malignant Transformation in Potentially Oral Malignant Diseases: A Prospective Study

Background: The accuracy of DNA image cytometry as an investigation method for potentially malignant disorders of the oral cavity is currently still a subject of controversy, due to inconsistently applied definitions of DNA aneuploidy, small cohorts and different application techniques of the method. The aim of this study was to examine the accuracy of the method as a supplementary diagnostic tool in addition to the cytological examination using internationally consented definitions for DNA aneuploidy. Methods: A total of 602 samples from 467 patients with various oral lesions were included in this prospective study. Brush biopsies from each patient were first cytologically examined and categorized by a pathologist, second evaluated using DNA image cytometry, and finally compared to either histological biopsy result or clinical outcome. Results: Using the standard definition of DNA aneuploidy, we achieved a sensitivity of 93.5%, a positive predictive value for the detection of malignant cells of 98.0%, and an area under the curve of 0.96 of DNA ploidy analysis for the detection of severe oral epithelial dysplasia, carcinoma in situ or oral squamous cell carcinoma. Importantly, using logistic regression and a two-step model, we were able to describe the increased association between DNA-ICM and the detection of malignant cells (OR = 201.6) as a secondary predictor in addition to cytology (OR = 11.90). Conclusion: In summary, this study has shown that DNA ploidy analysis based on conventional specimens of oral brush biopsies is a highly sensitive, non-invasive, patient-friendly method that should be considered as an additional diagnostic tool for detecting malignant changes in the oral cavity

Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma

This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from an identical number of oral lesions, then cytological diagnoses were made using liquid-based cytology. The final diagnoses in the study were 105 histologically proven squamous cell carcinomas (SCCs), 744 potentially malignant lesions and 503 cases of traumatic, inflammatory or benign hyperplastic oral lesions. The sensitivity and specificity of the liquid-based brush biopsy were 95.6% (95% CI 94.5–96.7%) and 84.9% (95% CI 83.0–86.8%), respectively. This led to the conclusion that brush biopsy is potentially a highly sensitive and reliable method to make cytological diagnoses of oral neoplasia. The main advantage of a brush biopsy over a scalpel biopsy is that it is less invasive and is more tolerated by the patients. Therefore, more lesions can be screened and more cancers can be detected at an early stage

Earliest Detection of Oral Cancer Using Non-Invasive Brush Biopsy Including DNA-Image-Cytometry: Report on Four Cases

Objective: We describe four patients presenting early oral cancers, detected cytologically on non‐invasive brush biopsies including DNA‐image cytometry as an adjunctive method before histology on scalpel biopsies confirmed the evidence of malignancy. Methods: Brush biopsies were performed and smears thereof investigated cytologically. After Feulgen restaining, DNA‐measurements were performed using a DNA‐Image‐Cytometer. Case reports: Oral squamous cell carcinomas were diagnosed cytologically in macroscopically suspicious lesions and malignancy confirmed by DNA‐cytometry. The initially performed scalpel biopsies did neither supply evidence of oral cancer nor of severe dysplasia. After at least one to 15 months the occurrence of cancer was finally proven histologically on a second scalpel biopsy each (three microinvasive and one in situ carcinoma). Conclusion: Non‐invasive brush biopsies are a suitable instrument for early cytologic detection of cancer of the mouth. DNA‐image‐cytometry, as an adjunctive method, can be used to confirm the cytologic diagnosis or suspicion of cancer in patients with doubtful lesions (dysplasias). DNA‐aneuploidy is a marker for (prospective) malignancy in smears of the oral cavity, which may detect malignancy months prior to histology. In future this method could be used as a mass screening tool in dentists practise. Colour figures can be viewed on http://www.esacp.org/acp/2003/25‐4/remmerbach.htm

Comparison between two cell collecting methods for liquid-based brush biopsies: a consecutive and retrospective study

Background!#!This study compares two different cell collectors, the Orcellex Brush (rigid brush) and the Cytobrush GT (nylon brush), using liquid-based cytology. A comparison of their obtainment procedures was also considered. The aim was to determine the diagnostic accuracy for detection of malignancy in oral brush biopsies. PICO-Statement: In this consecutive and retrospective study we had as population of interests, patients with oral lesions, the intervention was the brush biopsy with two different cell collectors and the control was healthy oral mucosa. The outcome of the study was to compare both cell collectors.!##!Methods!#!From 2009 to 2018, 2018 patients with oral lesions were studied using the nylon brush (666 cases) and rigid brush (1352 cases). In the first cohort five smears per patient were taken with the nylon brush, while each patient received one smear with the rigid brush in the second cohort. These were further processed in a liquid-based procedure. Cytological evaluations were categorised into 'negative', which were considered as negative, whereas 'doubtful', 'suspicious' and 'positive' cytological results were overall considered as positive for malignancy in comparison to the final histological diagnoses. Additionally, the clinical expenditure for each collector was estimated.!##!Results!#!2018 clinically and histologically proven diagnoses were established, including 181 cases of squamous cell carcinomas, 524 lichen, 454 leukoplakias, 34 erythroplakias and 825 other benign lesions. The sensitivity and specificity of the nylon brush was 93.8% (95% CI 91.6-95.5%) and 94.2% (95% CI 91.8-95.5%) respectively, whereas it was 95.6% (95% CI 94.4-96.6%) and 84.9% (95% CI 83.8-87.5%) for the rigid brush. The temporal advantage using the plastic brushes was 4×  higher in comparison to the nylon brush. The risk suffering from a malignant oral lesion when the result of the brushes was positive, suspicious, or doubtful was significantly high for both tests (nylon brush OR: 246.3; rigid brush OR: 121.5).!##!Conclusions!#!Both systems have a similar sensitivity, although only the rigid brush achieved a satisfactory specificity. Additional methods, such as DNA image cytometry, should also be considered to improve the specificity. Furthermore, the rigid brush proved to be more effective at taking a sufficient number of cells, whilst also being quicker and presenting less stress for the patient

Bacterial Colonization and Tissue Compatibility of Denture Base Resins

Currently, there is minimal clinical data regarding biofilm composition on the surface of denture bases and the clinical tissue compatibility. Therefore, the aim of this experimental study was to compare the bacterial colonization and the tissue compatibility of a hypoallergenic polyamide with a frequently used PMMA resin tested intraorally in a randomized split-mouth design. Test specimens made of polyamide (n = 10) and PMMA (n = 10) were attached over a molar band appliance in oral cavity of 10 subjects. A cytological smear test was done from palatal mucosa at baseline and after four weeks. The monolayers were inspected for micronuclei. After four weeks in situ, the appliance was removed. The test specimens were immediately cultivated on non-selective and selective nutrient media. All growing colonies were identified using VITEK-MS. The anonymized results were analyzed descriptively. A total of 110 different bacterial species could be isolated, including putative pathogens. An average of 17.8 different bacterial species grew on the PMMA specimens, and 17.3 on the polyamide specimens. The highest number of different bacterial species was n = 24, found on a PMMA specimen. On the two specimens, a similar bacterial distribution was observed. Micronuclei, as a marker for genotoxic potential of dental materials, were not detected. This study indicates that the composition of bacterial biofilm developed on these resins after four weeks is not influenced by the type of resin itself. The two materials showed no cytological differences. This investigation suggests that polyamide and PMMA are suitable for clinical use as denture base material

Clinical comparison of liquid-based and conventional cytology of oral brush biopsies: a randomized controlled trial

Abstract Background Exfoliative cytology performed on oral brush samples can help dentists to decide, whether a given oral lesion is (pre-) malignant. The use of non-invasive brush biopsies as an auxiliary tool in the diagnosis of oral mucosal lesions has gained renewed interest since improvements in cytological techniques such as the development of adjuvant diagnostic tools and liquid-based cell preparation techniques. Methods The aim of this study was to compare the quality of two different preparation techniques (cell collectors): the conventional transfer procedure to glass slides and the so-called liquid-based cytology preparation method. Cell smears were collected from 10 orally healthy individuals (mean age: 24 years) from the palatine mucosa at two different times (baseline and 4 weeks later). Slides of both techniques were stained by Giemsa (n = 40) and May-Gruenwald Giemsa (n = 40). The statistical analysis was performed with Excel. Results On specimen analysis, the liquid-based cytology showed statistically significant improvement compared to conventional glass sides (p < 0.001). Thin layers, which were performed by liquid-based cytology showed significantly better results in the parameters (p < 0.001): uniform distribution, cellular overlapping, cellular disformation, mucus, microbial colonies and debris. The conventional glass slides approach showed more cell overlapping and contamination with extraneous material than thin layers, which were performed by Orcellex® Brush cell collectors. Conclusions Both techniques are diagnostically reliable. The liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility. Liquid-based cytology simplifies cell collection due to easier handling and less transfer errors by dentists