Abstract
The anti-fungal effect of miconazole and miconazole-loaded chitosan nanoparticles gels in diabetic patients with Oral candidiasis – randomized control clinical trial and microbiological analysis
Gamil Y, Hamed MG, Elsayed M, et al. BMC Oral Health. 2024;24(1):196. doi: 10.1186/s12903-024-03952-0
ABSTRACT
Background
Oral thrush is the most common occurring fungal infection in the oral cavity in uncontrolled diabetic patients, it is treated by various antifungal drugs according to each case. This study aimed to evaluate the therapeutic effects of topical application of miconazole and miconazole-loaded chitosan nanoparticles in treatment of diabetic patients with oral candidiasis.
Methods
In this randomized controlled clinical trial. A total of 80 diabetic patients presenting with symptomatic oral candidiasis were randomly assigned into two treatment groups: miconazole and miconazole-loaded chitosan nanoparticles. The patients were treated for 28 days, and clinical assessments were conducted at baseline, 7, 14, 21 and 28 days. Clinical parameters, including signs and symptoms of oral candidiasis were evaluated and microbiological analysis was performed to determine the Candida species and assess their susceptibility to the antifungal agents. Statistical analysis was done to the categorical and numerical data using chi-square test and Kruskal Wallis test.
Results
The antifungal efficacy between the miconazole and miconazole-loaded chitosan nanoparticles (CS-MCZ) groups insignificant difference (P > 0.05) was observed. Both treatment modalities exhibited comparable effectiveness in controlling oral candidiasis symptoms and reducing Candida colonization as miconazole-loaded chitosan nanoparticles group showed a significant difference in the clinical improvement in respect of both signs and symptoms from baseline (70%) until the end of study at 28 days (5%) (P < 0.05) Moreover, miconazole-loaded chitosan nanoparticles, there was a significant reduction in the number of colonies forming units of Candida albicans from baseline until the end of the study at 28-day with P value < 0.000.
Conclusions
This randomized controlled clinical trial and microbiological analysis demonstrate that both miconazole and miconazole-loaded chitosan nanoparticles are effective in the treatment of oral candidiasis in diabetic patients with no adverse reactions.
Copyright © 2024 The Authors. Springer Nature. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
Oral lichen planus and lichenoid lesions – challenges and pitfalls for the general dental practitioner
Binnie R, Dobson ML, Chrystal A, et al. Br Dent J. 2024;236(4):285-292. doi: 10.1038/s41415-024-7063-y
ABSTRACT
Background
Lichen planus is a chronic, mucocutaneous inflammatory condition which, due to its prevalence, will be familiar to the dental profession. However, diverse forms of presentation, important differential diagnosis, potential malignant change and monitoring requirements often result in challenges for those in primary care. This paper looks to examine these challenges and provide information to support those who are involved in recognition and management of patients with lichen planus.
Key points
• Refer any suspected oral lichen planus or lichenoid lesion to specialist services unless competent to manage in practice and if appropriate.
• Treat symptomatic patients with first line topical corticosteroid preparations for short-term management and as directed by specialist services for long-term management. For lichenoid contact reactions, engage with specialist requests to replace amalgam restorations.
• General dental practitioners should have awareness of the risk of malignant transformation associated with oral lichen planus, monitor patients and alert specialist services to any clinically significant changes.
Copyright © 2024 The Authors. Springer Nature. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
Oral lichen planus: a narrative review navigating etiologies, clinical manifestations, diagnostics, and therapeutic approaches
Nukaly HY, Halawani IR, Alghamdi SMS, et al. J Clin Med. 2024;13(17):5280. doi: 10.3390/jcm13175280
ABSTRACT
Background/Objectives
Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP’s pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research.
Methods
A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP.
Results
OLP’s pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed.
Conclusions
Regular screenings and biopsies are essential due to OLP’s likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.
Copyright © 2024 The Authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
The oral microbial ecosystem in age-related xerostomia: a critical review
Pei XM, Zhou LX, Tsang MW, et al. Int J Mol Sci. 2024;25(23):12815. doi: 10.3390/ijms252312815
ABSTRACT
Xerostomia is a widespread condition among the elderly, impacting as many as 50% of individuals within this demographic. This review aims to analyze the association between age-related xerostomia and the oral microbial ecosystem. Xerostomia not only induces discomfort but also heightens the susceptibility to oral diseases, including dental caries and infections. The oral microbial ecosystem, characterized by a dynamic equilibrium of microorganisms, is integral to the maintenance of oral health. Dysbiosis, defined as a microbial imbalance, can further aggravate oral health complications in those suffering from xerostomia. This review investigates the composition, diversity, and functionality of the oral microbiota in elderly individuals experiencing xerostomia, emphasizing the mechanisms underlying dysbiosis and its ramifications for both oral and systemic health. A comprehensive understanding of these interactions is vital for the formulation of effective management and prevention strategies aimed at enhancing the quality of life for older adults.
Copyright © 2024 The Authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a systematic review and meta-analysis
Dodds MWJ, Haddou MB, Day JEL. BMC Oral Health. 2023;23(1):406. doi: 10.1186/s12903-023-03084-x
ABSTRACT
Background
Xerostomia negatively affects quality of life. Symptoms include oral dryness; thirst; difficulty speaking, chewing, and swallowing food; oral discomfort; mouth soft tissue soreness and infections; and rampant tooth decay. The objective of this systematic review and meta-analysis was to investigate if gum chewing is an intervention that results in objective improvements in salivary flow rates and subjective relief from xerostomia.
Method
We searched electronic databases including Medline, Scopus, Web of Science, Embase, Cochrane Library (CDSR and Central), Google Scholar and the citations of review papers (last searched 31/03/23). The study populations included: 1) elderly people with xerostomia (> 60 years old, any gender, and severity of xerostomia), and 2) medically compromised people with xerostomia. The intervention of interest was gum chewing. Comparisons included gum chewing vs. no gum chewing. The outcomes included salivary flow rate, self-reported xerostomia, and thirst. All settings and study designs were included. We conducted a meta-analysis on studies where measurements of unstimulated whole salivary flow rate for both a gum chewing, and no gum chewing intervention (daily chewing of gum for two weeks or longer) were reported. We assessed risk of bias using Cochrane’s RoB 2 and ROBINS-I tools.
Results
Nine thousand six hundred and two studies were screened and 0.26% (n = 25) met the inclusion criteria for the systematic review. Two of the 25 papers had a high overall risk of bias. Of the 25 papers selected for the systematic review, six met the criteria to be included in the meta-analysis which confirmed a significant overall effect of gum on saliva flow outcomes compared to control (SMD = 0.44, 95% CI: 0.22—0.66; p = 0.00008; I2 = 46.53%).
Conclusions
Chewing gum can increase unstimulated salivary flow rate in elderly and medically compromised people with xerostomia. Increasing the number of days over which gum is chewed increases the improvement in the rate of salivation. Gum chewing is linked with improvements in self-reported levels of xerostomia (although it is noted that no significant effects were detected in five of the studies reviewed). Future studies should eliminate sources of bias, standardise methods to measure salivary flow rate, and use a common instrument to measure subjective relief from xerostomia.
Copyright © 2023 The Authors. Springer Nature. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
The experience of dry mouth and screening for Sjögren’s Syndrome by the dentist: patient – reported experiences
Rihab B, Lina EH, Noémie ST, et al. BMC Oral Health. 2023;23(1):1010. doi: 10.1186/s12903-023-03727-z
ABSTRACT
Background
One of the main clinical features of Sjögren’s Syndrome is oral dryness, which is associated with an increased risk of oral diseases and a lower oral life quality. Dentists have a key role to play in the Sjögren’s Syndrome diagnosis and specific management. In parallel, many patients rely on patient associations, which offer opportunities for members to seek information about their disease and share their experiences. We aimed to evaluate patients experience with dry mouth and the importance of dentists in Sjögren’s Syndrome diagnosis and its management.
Methods
We carried out a cross-sectional survey in 2020 based on a questionnaire drafted in collaboration with clinicians specializing in Sjögren’s Syndrome and patient members of a patient association. The survey consisted of 27 questions divided into the six sections: the patient’s profile, their experience with dry mouth and treatments used to manage, characteristics of experienced oral-health problems, effects of dry mouth and its consequences on the quality of life, evaluation of the dentist role in the screening of Sjögren’s Syndrome, and its management by the dentist. Recruitment was carried out via the patient association’s newsletter, website, and social networks. Sjögren’s diagnosis was self-reported.
Results
One thousand four hundred fifty-eight patients fully responded to the survey. Most respondents were women over 50 and were mainly concerned with primary Sjögren’s Syndrome. Overall, 86.97% of respondents reported experiencing frequent or constant dry mouth and 69.01% declared having had oral problems (candidiasis, oral pain, loss or alteration of taste, bad breath, gastro-esophageal reflux). We found a positive correlation between the frequency of dry mouth and each of these disorders and between the frequency of dry mouth and alterations in life quality dimensions. Finally, 74.9% of patients did not report having dry mouth to their dentist prior to being diagnosed with Sjögren’s Syndrome and 58% had not been informed about the oral risks associated with it by their dentist and sought information themselves or from their physician.
Conclusions
We confirm the significant consequences of dry mouth on oral quality of life, as well as its association with oral health problems. Sjögren’s Syndrome screening by dentists should be increased, as well as prevention of the associated oral health risks.
Copyright © 2023 The Authors. Springer Nature. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
Trigeminal neuralgia: a practical guide
Lambru G, Zakrzewska J, Matharu M. Pract Neurol. 2021;21(5):392-402. doi: 10.1136/practneurol-2020-002782
ABSTRACT
Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.
Copyright © 2021 The Authors. BMJ Group. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
The challenges in clinical diagnosis of trigeminal neuralgia: a review
Pergolizzi JV, LeQuang JAK, El-Tallawy SN, et al. Cureus. 2024;16(6):e61898. doi: 10.7759/cureus.61898
ABSTRACT
The lack of established laboratory tests or biomarkers for trigeminal neuralgia (TN) makes diagnosing this relatively rare condition extremely challenging. Trigeminal nerve compression observable on magnetic resonance imaging may indicate TN, but many patients do not have visible lesions or compression. In particular, TN may be confused with migraine, cluster headache, temporomandibular disorder, and other types of headache. An accurate diagnosis is imperative for proper treatment since these conditions do not respond to the same treatment. Many symptoms of these headaches can be vague or overlap, and clinicians depend in large measure on the subjective reports of their patients. Nevertheless, it is imperative to diagnose TN better, which can cause excruciating pain, reduce the quality of life, and even result in disability. It is possible that TN is underestimated.
Copyright © 2024 The Authors. Springer Nature. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). creativecommons.org/licenses/by/4.0
Botulinum toxin type A for trigeminal neuralgia: a comprehensive literature review
Tereshko Y, Dal Bello S, Lettieri C, et al. Toxins (Basel). 2024;16(11):500. doi: 10.3390/toxins16110500
ABSTRACT
Trigeminal neuralgia is a neuropathic pain syndrome responsive to botulinum toxin type A therapy. This review had the goal of analyzing the different studies published from 2002 to January 2024 to better define the techniques and the types of botulinum toxin type A used, the doses, the injection routes, and the different populations of trigeminal neuralgia patients treated. We considered only articles in which the therapy was administered to humans to treat trigeminal neuralgia. Case reports, case series, open-label, retrospective, and RCT studies were considered. The research was conducted on MEDLINE and the keywords included (trigeminal neuralgia) and (botulinum). Thirty-five articles were considered suitable for this review. Botulinum toxin type A was shown to be an effective therapy for TN pain in all the articles analyzed, albeit there is a lack of standardization in methods and outcomes. The techniques, the doses, and the injection approaches were very heterogeneous among the studies. Only two botulinum toxin type A formulations have been used in this setting: onabotulinumtoxinA and lanbotulinumtoxinA. There were 300 patients treated with onabotulinumtoxinA and 760 treated with lanbotulinumtoxinA overall (in 42 patients, the formulation was not specified). The distinction between etiological and clinical types of TN has been made by only a small portion of the studies. The main adverse event was transient facial asymmetry. Botulinum toxin type A is indeed a promising therapy that is clearly effective for trigeminal neuralgia. OnabotulinumtoxinA is the most common formulation used in Western countries; however, the meager sample of TN patients treated, and the lack of standardization are not sufficient for this therapy to be approved by the FDA or EMA. Indeed, more studies with standardized methods and larger samples are needed for this purpose.
Copyright © 2024 The Authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
Chronic facial pain: trigeminal neuralgia, persistent idiopathic facial pain, and myofascial pain syndrome-an evidence-based narrative review and etiological hypothesis
Gerwin R. Int J Environ Res Public Health. 2020;17(19):7012. doi: 10.3390/ijerph17197012
ABSTRACT
Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed.
Methods
Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included.
Discussion
The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP.
Conclusion
PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.
Copyright © 2020 The Authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
A systematic review of treatment for patients with burning mouth syndrome
Tan HL, Smith JG, Hoffmann J, et al. Cephalalgia. 2022;42(2):128-161. doi: 10.1177/03331024211036152
ABSTRACT
Background
Burning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments.
Aim
This review aimed to study the short- (⩽3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects.
Materials and methods
Randomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020).
Results
Twenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment.
Conclusion
A more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.
Copyright © 2022 The Authors. Sage. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
Oral chronic graft-versus-host disease: pathogenesis, diagnosis, current treatment, and emerging therapies
Nguyen JT, Jessri M, Costa-da-Silva AC, et al. Int J Mol Sci. 2024;25(19):10411. doi: 10.3390/ijms251910411
ABSTRACT
Chronic graft-versus-host disease (cGvHD) is a multisystem disorder that occurs in recipients of allogeneic hematopoietic (alloHCT) stem cell transplants and is characterized by both inflammatory and fibrotic manifestations. It begins with the recognition of host tissues by the non-self (allogeneic) graft and progresses to tissue inflammation, organ dysfunction and fibrosis throughout the body. Oral cavity manifestations of cGVHD include mucosal features, salivary gland dysfunction and fibrosis. This review synthesizes current knowledge on the pathogenesis, diagnosis and management of oral cGVHD, with a focus on emerging trends and novel therapeutics. Data from various clinical studies and expert consensus are integrated to provide a comprehensive overview.
Copyright © 2024 The Authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0
Oral chronic graft-versus-host disease
Dean D, Sroussi H. Front Oral Health. 2022:3:903154. doi: 10.3389/froh.2022.903154
ABSTRACT
Chronic oral graft-versus-host disease (cGVHD) is a complex, frequent, and highly impactful complication of allogeneic hematopoietic cell transplantation (alloHCT). It represents the leading cause of morbidity and mortality in long-term alloHCT survivors. cGVHD can affect almost any visceral organ system and commonly affects the skin, eyes and mouth, manifesting with signs and symptoms similar to other known immune-mediated and autoimmune diseases. Oral manifestations of GVHD include inflammation, thinning, and ulceration of oral mucosal tissues (similar to lichen planus), lymphocyte-mediated salivary gland dysfunction (similar to Sjögren/Sicca Syndrome), and decreased oral opening (trismus) secondary to sclerosis of oral and perioral tissues (analogous to limitation in scleroderma). Potential sequelae include severe mucosal pain, compromised nutrition, weight loss, limitation in opening, and sometimes irreversible fibrosis of the salivary glands. While some cases can be managed with topical therapies, management may also require long-term targeted immunosuppressive and/or corticosteroid therapy with associated risk of local and systemic infection, hyperglycemia, kidney dysfunction, osteopenia/osteoporosis, and possibly secondary malignancies. The aim of this mini-review is to provide an up-to-date review of literature related to the diagnosis and management of oral cGVHD to aid dental and medical clinicians in optimizing oral cGVHD therapy while minimizing potential adverse effects.
Copyright © 2022 The Authors. This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. creativecommons.org/licenses/by/4.0