Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry.

PURPOSE OF REVIEW: It is recognized that patients undergoing cancer treatment experience different adverse effects depending on the type of therapy they received. The objective of this work is to provide a scientific evidence-based protocol for oral care in cancer patients. Cancer resection surgery, chemotherapy, and radiotherapy can cause important complications that impact patients' quality of life. RECENT FINDINGS: Cancer patients, from the moment of diagnosis to the end of treatment and subsequent follow-up, have diverse care needs, both from a systemic and local point of view. The implementation of oral care protocols before, during, and after cancer therapy is essential because it helps to identify risk factors for the development of predictable oral complications. It is essential to establish that all cancer patients, before starting treatment, undergo a systematic dental check-up to avoid limitations during treatment and also alter their quality of life. Regular professional oral care maintenance and follow-up programs are essential to maintaining a patient's long-term oral health.

Experiences, perceptions, and decision-making capacity towards oral biopsy among dental students and dentists.

The dentist plays a crucial role in identifying oral lesions as it is their responsibility to conduct the clinical examination for diagnosing diseases in this anatomical region. Dentists should be able to perform simple oral biopsies when this procedure is necessary. However, several studies point out that dentists lack experience and perceive themselves incapable of performing biopsies. This analytical cross-sectional study aimed to assess participants' experiences and perceptions regarding a continuing education activity focused on the biopsy procedure. The secondary aim was to evaluate their ability to determine when a biopsy is indicated. The sample consisted of 228 individuals: 143 dentists and 85 undergraduate dental students who completed questionnaires related to a lecture held in May/2021, as part of the continuing educational activities of the "Red May" Project. Participants completed two questionnaires: the first assessed their experience and self-confidence in performing oral biopsies, whereas the second evaluated their capacity to define when the biopsy is indicated by means the evaluation of 10 clinical cases. The results reveal no significant difference in the percentage of correct answers between dental students and dentists. Regarding the frequency of performing the biopsy procedure, most respondents (69.7%) reported doing so rarely or never. Furthermore, while 31.6% of the participants stated that they perform biopsies depending on the case, 68.4% prefer to refer patients to specialists, such as professionals in Stomatology/Oral Medicine. These findings highlight limitations in the educational preparation of the study population concerning biopsy procedures, oral lesions, and their management. They also indicate a concerning tendency to overestimate knowledge in this area. Thus, this study emphasizes the importance of continuing education and underscores the need to revise academic curricula and provide complementary education for all dental professionals.

Is Burning Mouth Syndrome a Neuropathic Pain Disorder? A Systematic Review.

AIMS: To conduct a systematic review compiling an update on the pathophysiology of burning mouth syndrome (BMS) by reviewing the theories and studies published in the last 5 years that consider BMS a neuropathic disease. METHODS: A literature review was carried out in April 2020 on the PubMed database by using the following MeSH terms: "(burning mouth OR burning mouth syndrome OR burning mouth pain OR sore mouth OR burning tongue OR oral neuropathic pain OR glossodynia OR stomatopyrosis) AND (etiopathogenesis OR etiopathological factors OR etiology)." RESULTS: The research carried out according to the methodology found 19 case-control studies (1 of which was in vivo) and 1 RCT. Of the 19 included studies, 8 showed an evidence score of 2-; 8 showed 2+; another 2 showed 2++; and 1 showed 1+. Quality studies on this topic are insufficient and heterogenous. CONCLUSION: In the pathogenesis of BMS, both peripheral and central neuropathies appear to play a pivotal role. Nevertheless, the balance between them varies from case to case and tends to overlap. BMS does not seem to be a result of direct damage to the somatosensory nervous system, but a dysfunction in it and in the brain network.

Cutaneous, genital and oral lichen planus: A descriptive study of 274 patients

Background: Lichen planus (LP) is a chronic autoimmune disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. Objective: To evaluate the correlation between oral, genital and cutaneous lichen planus, in a sample of LP patients. Material and Methods: This descriptive study reviewed 274 clinical histories of patients, who all presented histological confirmation of lichen planus verified by a pathologist, attending research centers in Barcelona. Results: A total of 40 LP patients (14.59%) presented genital lesions. Of 131 patients with cutaneous LP (47.8%), the most commonly affected zones were the body’s flexor surfaces, representing 60.1% of cases. 24% of patients (n=55) related the start of the lesions with previous stress events. Of the 131 subjects with cutaneous lesions, 19% (n=25) also presented oral lichen planus (OLP). Of the total sample, 53.6% (n=147) of patients presented oral lesions. The systemic diseases most commonly associated with this patient sample were psychological problems such as stress, anxiety and depression (48%), hypertension (27%), gastric problems (12%), and diabetes (9.7%). A family history of lichen planus was found in only 2 cases (0,72%) out of the total of 274. Conclusions: Any patient with OLP should undergo a thorough history and examination to investigate potential extraoral manifestations. The fact that 37 patients with OLP in this series were identified with simultaneous involvement at more than one site highlights the need for exhaustive evaluation and multidisciplinary approaches to this disease

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Oral lichen planus and its relationship with systemic diseases. A review of evidence.

BACKGROUND: Oral lichen planus (OLP) is one of the most common dermatological diseases which are present in the oral cavity. It is a chronic autoimmune, mucocutaneous disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. OBJECTIVE: Review the relevant information to OLP and its relationship with systemic diseases. MATERIAL AND METHODS: Searches were carried out in the Medline/PubMed, Lilacs, Bireme, BVS, and SciELO databases by using key-words. After an initial search that provided us with 243 papers, this number was reduced to 78 from the last seven years. One of the first criteria adopted was a selective reading of the abstracts of articles for the elimination of publications that presented less information regarding the subject proposed for this work. All the selected articles were read in their entirety by all of the authors, who came to a consensus about their level of evidence. The Scottish Intercollegiate Guidelines Network (SIGN) criteria were used as the criteria of methodological validation. RESULTS: Only 9 articles showed an evidence level of 1+, 2+, 3 or 4, as well as a recommendation level of A, B, C or D. Three of them were non-systematic reviews, one was a cohort study and only one was a controlled clinical trial. Three of the studies were case series, with respective sample sizes of 45, 171 and 633 patients. CONCLUSIONS: Several factors have been associated with OLP. Patients with OLP are carriers of a disease with systemic implications and may need the care of a multidisciplinary team. The correct diagnosis of any pathology is critical to making effective treatment and minimizes iatrogenic harm. For OLP is no different, taking into account its association with numerous systemic diseases that require special attention from health professionals. Periodic follow-up of all patients with OLP is recommended. Key words:Oral lichen planus, etiopathogenesis, systemic diseases.