DENTIST AND EARLY DETECTION OF ORAL CARCINOMA

Karcinom usne šupljine spada među deset karcinoma s najnepovoljnijom prognozom. Uzrok visoke smrtnosti jest činjenica da se više od polovice slučajeva otkrije u uznapredovalom stadiju. Karcinom usne šupljine u ranim stadijima ne izaziva nikakve tegobe a simptomi počinju biti izraženi tek u uznapredovalom stadiju bolesti. Karcinom usne šupljine može se otkriti u najranijem stadiju jednostavnim pregledom oralne sluznice. Radi se o lokalizacijama koje su dostupne pregledu golim okom i vidljive tijekom uobičajenog stomatološkog pregleda. Sam pregled je neinvazivan, traje 1-1.5 minutu, ne zahtijeva nikakvu posebnu opremu i ne izaziva nelagodu pacijentu. Osim boljeg poznavanja fi zioloških i patoloških karakteristika oralne sluznice, stomatolog je u idealnoj poziciji da svakodnevno obavlja preglede za rano otkrivanje karcinoma usne šupljine, budući da po prirodi svog posla redovito gleda u usta pacijentima. U Hrvatskoj se godišnje na lokalizacijama dostupnim stomatološkom pregledu dijagnosticira između 300 i 400 novih slučajeva karcinoma. Budući da karcinom usne šupljine u ranom stadiju ne uzrokuje simptome, stomatologe valja senzibilizirati/motivirati da svim pacijentima uz zube redovito pregledaju i oralnu sluznicu, bez obzira imaju li tegobe ili nemaju.Oral cancer is one of the ten cancers with the worst prognosis. Higher mortality rate is due to the fact that the majority of cases are diagnosed at an advanced stage. Early stage of the disease causes no discomfort and symptoms start to present in later stages. Oral cancer can be detected in its earliest stage by simple examination of oral mucosa. Oral mucosa can be easily examined during routine dental examination. The examination itself is noninvasive, takes no more than one minute, does not require any special equipment, and poses no discomfort to the patient. Apart rom better knowledge about the physiological and pathological characteristics of oral mucosa, dentist is in an ideal position to perform oral mucosa examinations every day, since he/she regularly sees the patient oral cavity. In Croatia, between 300 and 400 new cases of oral carcinoma per year are diagnosed at the sites that are visible during routine dental examination. Since oral cancer in its early stage does not cause any symptoms, dentists should be sensitized/motivated to perform mucosal as well as dental examinations in all patients irrespective of the patient’s lack of complaint

Evaluation of pretreatment serum interleukin-6 and tumour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma

Background: Oral squamous cell carcinoma (OSCC) constitutes 3 percent of all cancers with predominant occurrence in middle aged and elderly males. Tumour recurrence worsens disease prognosis and decreases quality of life in patients with OSCC. Proinflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) have been suggested to play a certain role in variety of tumours. The aim of this study was to investigate the relationship of pretreatment serum IL-6 and TNF-α levels on tumour recurrence in patients with OSCC in order to identify potential biomarkers for the early detection of disease recurrence. Material and Methods: The patients with newly diagnosed OSCC were treated and followed from the first visit from November 2006 until January 2008. Serum IL-6 and TNF-α concentrations were measured. The records of the patients were re-examined in July 2012 and data were recorded about cancer characteristics and tumour recurrence. Disease free survival was analyzed by Kaplan-Meier survival curves, log rank test and Cox proportional hazards regression. Results: Serum IL-6 was shown as an independent risk factor for tumour recurrence. Conclusions: Pretreatment serum IL-6 concentration may be a useful biomarker for identification of OSCC patients with increased risk of the disease recurrence

Delayed contact sensitivity on the lips and oral mucosa due to propolis-case report

We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products

Superficial Morphea of the Lips and Gingiva

No abstract available</p

Oral burning symptoms and burning mouth syndrome-significance of different variables in 150 patients

Objectives: Despite the extensive amount of published literature upon burning symptoms in patients with clinically healthy appearance of the oral mucosa, as well as burning mouth syndrome (BMS) itself, they both remain still challenging topics. The aim of this study was to determine the real prevalence of ?true? BMS in comparison to other patients with burning symptoms with clinically healthy appearance of the oral mucosa and then to compare ?true? BMS patients with healthy controls regarding gastritis and intake of anxiolytics and angiotensin converting enzyme inhibitors. Study design: In 150 patients with burning symptoms of clinically healthy oral mucosa, local and systemic investigations were performed and they included detection of candidal infection, salivary flow rate, presence of oral galvanism and parafunctional habits as well as complete blood count, serum ferritin, serum glucose levels, serum antibodies to Helicobacter pylori together with detailed medical history with special regard to medication intake. After ?true? BMS patients were identified they have been compared to the controls with regard to the presence of gastritis and the intake of anxiolytics and angiotensin converting enzyme inhibitors. Results: Our results show that gastritis were significantly more present among ?true? BMS patients and that they also significantly more intake anxiolitics, when compared to the control group. Conclusions: Our findings might lead to the conclusion that every ?true? BMS patient should be referred to the gastroenterologist and psychiatrist

Superficial Morphea of the Lips and Gingiva

No abstract available</p

Oralne komplikacije zračenja glave i vrata

Almost all patients (90-100%) who have undergone radiation treatment (RT) of head and neck region develop at least one oral complication. Oral complications of head and neck RT can be acute and chronic. Acute complications occur during RT and include oral mucositis, dry mouth and taste sensation disorder. Chronic complications occur several weeks, months or years after RT cessation, and include radiation caries, osteoradionecrosis and trismus.Gotovo svi pacijenti (90-100%) koji su podvrgnuti terapijskom zračenju u području glave i vrata razviju neku od komplikacija u usnoj šupljini. Oralne komplikacije terapijskog zračenja glave i vrata mogu biti akutne i kronične. Akutne komplikacije nastaju tijekom zračenja i u njih ubrajamo oralni mukozitis, suhoću usta i poremećaj okusne osjetljivosti. Kronične komplikacije nastaju nekoliko tjedana, mjeseci ili godina po završetku zračenja, i podrazumijevaju radijacijski karijes, osteoradionekrozu i trizmus

Gingival Necrosis Caused by an Ill-Fitting Denture

U ovom prikazu opisali smo slučaj 80-godišnjeg pacijenta koji je bio upućen u Zavod za oralnu medicinu Stomatološkog fakulteta u Zagrebu zbog gingivalnog ulkusa prisutnog osam dana. Na kliničkom pregledu uočena je eksponirana kost na bezubom alveolarnom grebenu u području molara s desne strane mandibule veličine 0,8 cm u promjeru. Inače, pacijent je svakodnevno uzimao doksazosin jer je imao teškoća s urinarnim traktom te ipatropij-bromid zbog respiratornih tegoba. Donju djelomičnu protezu nije promijenio već šest godina. Na početku je, točnije prva tri dana, bio liječen parodontnim zavojem (Resopack, HagenWerken, Njemačka) uz preporuku da ne nosi protezu, no nakon tri dana klinički pregled nije pokazao poboljšanje stanja. Zato smo se odlučili na liječenje topikalnim kortikosteroidom (betametazon) i oralnim antiseptikom (klorheksidin-diglukonat) tri puta na dan. Nakon tri tjedna lezija je zacijelila. Naveden je popis mogućih čimbenika koji mogu rezultirati nastankom ulkusa gingive.We present a case of an 80-year-old male who was referred to the Department of Oral Medicine, School of Dental Medicine University of Zagreb, Croatia due to gingival ulcer which was present for eight days. Clinical examination has revealed exposed bone on the toothless alveolar ridge in the lower molar region on the right side of 0.8 cm in diameter. Otherwise, the patient was taking doxazosin due to urinary problems and ipatropium bromide due to respiratory problems. The patient wore a 6-year-old partial lower denture. He was initially treated with periodontal bandage (Resopack, HagenWerken, Germany) for the first three days and was instructed not to wear the denture; however, no benefit could be seen. Therefore, we added a local corticosteroid (betamethasone) and an oral antiseptic (chlorhexidine digluconate) applied three times a day. After 3 weeks the lesion healed. A list of possible causative factors regarding gingival ulcers is included

Oral lichen planus - retrospective study of 563 Croatian patients

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study D esign: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, his - tology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asympto - matic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly af - fected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transfor - mation all patients should be regularly monitored

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