Hematological biomarkers of systemic inflammation in genuine (physiologic and pathologic) halitosis.

Halitosis is an unpleasant odor discharged through the oral cavity with a prevalence as high as 30%-50% of the general population. Conventional diagnostic methods have been focused on mouth air analysis measuring the amount of sulfur compounds which does not directly reflect the cause of halitosis. Also, the possible role of halitosis as an indicator of general health status has been steadily suggested and inflammation has been constantly associated with aversive body odor. Therefore, this study aimed to search for inter-relationships between hematologic indicators, clinical characteristics, and halitosis measurement that can predict the presence of pathologic halitosis and its intensity. Furthermore, the tentative relationship between halitosis and the presence of systemic inflammation was investigated. A total of 125 patients were divided into 103 patients in the genuine halitosis group (value ⩾80 ppb) and 22 patients in the pseudo halitosis group (value <80 ppb) based on portable sulfide monitor measurements. Clinical examination and hematological indices including inflammatory prognostic factors and halitosis measurements including organoleptic testing, portable sulfide monitor, and gas chromatography were evaluated. The genuine halitosis group showed a significantly higher white blood cell (WBC) count (p< 0.01) compared to the pseudo halitosis group. Erythrocyte sedimentation rate (ESR,ß= 0.341,p< 0.05) values and duration of halitosis (ß= 0.353,p< 0.05) showed a significant association with halitosis intensity and neutrophil to lymphocyte ratio (NLR) values (ß= 3.859,p< 0.05) were significantly related to genuine halitosis diagnosis. A new WBC cut-off value of 5575µl-1showed near to fair discriminative power in predicting genuine halitosis (area under the curve 0.661,p< 0.05). The results of this study showing an increased WBC count in genuine halitosis and its strong association with hematologic indices of subclinical inflammation including ESR and NLR suggest inflammatory hematologic markers as potential diagnostic tools in the diagnosis of genuine halitosis.

Is thyroid autoimmunity a predisposing factor for fibromyalgia? A systematic review and meta-analysis.

OBJECTIVES: Studies report that autoimmune thyroid disease and elevated levels of thyroid autoantibodies are associated with fibromyalgia and widespread chronic pain. The aim of this meta-analysis was to investigate the relationship between fibromyalgia and thyroid autoimmunity. Clinical symptoms and depression associated with fibromyalgia were also investigated in relation to the presence of thyroid autoantibodies. METHODS: A literature search was conducted on PubMed and Embase for studies published between January, 1980 and February, 2020 on thyroid autoimmunity in fibromyalgia patients. Two reviewers independently screened and assessed the quality of the articles. Meta-analysis was performed to analyse the difference in frequency of thyroid autoantibody positivity between fibromyalgia patients and healthy controls. Clinical symptoms and depression were also analysed according to the presence of thyroid autoantibodies. RESULTS: Data from 10 original studies were included in the systematic review, and 5 case-control studies that satisfied the selection criteria were subjected to meta-analysis. Thyroid autoantibody positivity was more common in fibromyalgia patients compared to healthy controls (thyroid peroxidase antibody: OR 3.41, 95% CI 1.97-5.90; thyroglobulin antibody: OR 2.23, 95% CI 1.23-4.01). The frequency of postmenopausal status was significantly higher in fibromyalgia patients with thyroid autoantibodies (OR 1.95, 95% CI 1.23-3.08). However, the severity of disease (pain and fatigue level, fibromyalgia impact questionnaire score, and disease duration) and prevalence of depression did not show a statistically significant difference according to thyroid autoantibody positivity. CONCLUSIONS: Thyroid autoimmunity should be considered in fibromyalgia patients. The percentage of women in menopause was higher in thyroid autoantibody positive fibromyalgia patients.

Limited implication of initial bone scintigraphy on long-term condylar bone change in temporomandibular disorders-Comparison with cone beam computed tomography at 1 year.

BACKGROUND: The current diagnostic criteria for temporomandibular disorders (TMD) do not require imaging for the diagnosis of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) condyle, and there is a lack of data investigating the effectiveness of imaging modalities in predicting long-term TMJ DJD prognosis. OBJECTIVES: To verify the association between initial bone scintigraphy results and long-term DJD bone changes occurring in the TMJ condyle on cone beam computed tomography (CBCT). METHODS: Initial bone scintigraphy, panoramic radiography and CBCT results were analysed in relation to long-term (12 months) TMJ DJD bone change on CBCTs in 55 TMD patients (110 joints). Clinical and radiographic indices were statistically analysed among three groups (improved, no change, and worsened) based on long-term TMJ DJD prognosis calculated by destructive change index (DCI). RESULTS: Neither the uptake ratio nor visual assessment results from initial bone scintigraphy showed a significant difference according to long-term condylar bone change groups. The cut-off value of bone scintigraphy uptake ratio was 2.53 for long-term worsening of TMJ DJD. Worsening of TMJ DJD was significantly associated with the diagnosis based on panoramic radiography (p = .011) and CBCT (p < .001). Initial DCI (ß = -.291, p = .046) had a significant association with long-term worsening of TMJ DJD. CONCLUSION: Initial bone scintigraphy results did not show sufficiently close associations with long-term TMJ DJD prognosis. This should be considered in the selection process of imaging modalities for TMJ DJD patients. Future studies are needed to develop prognostic indices that comprise both clinical and imaging contents for improved predictive ability.

Various diagnostic possibilities for zygomatic arch pain: Seven case reports and review of literature.

BACKGROUND: Pain of the zygomatic arch region is common among patients with orofacial pain, especially in those with temporomandibular disorder-related pain of a myogenic origin. Since zygomatic arch pain may occur due to various causes other than muscle pain, appropriate diagnosis and treatment planning is essential to ensure its successful management. Unfortunately, zygomatic arch pain has not been handled as an independent clinical feature until now, and studies have mainly focused on pain resulting from trauma and surgical procedures. CASE SUMMARY: We describe 7 independent cases, all of which presented with the identical chief complaint of pain in the zygomatic arch region. However, the underlying causes were different for each, being myofascial pain, myositis, tooth crack, dental caries, sinusitis, neuropathic pain, and salivary gland tumor respectively. In this case report, the clinical features of each case are investigated and diseases to be considered in the diagnostic process are suggested, along with the diagnostic modalities (including computed tomography and magnetic resonance imaging) that can lead to the appropriate final diagnosis. CONCLUSION: Zygomatic arch pain is a common complaint encountered in the orofacial pain clinic but may lead to misdiagnosis. Clinicians must have in-depth knowledge of the possible differential diagnoses and evaluation tools.