Oral Lichen Planus - Related Connection with HLA-System Antigens.

AIM: To determine whether there is an immunogenic connection and antigen difference between the HLA antigens in the erosive (EOLP) and reticular (ROLP) oral lichen planus. MATERIALS AND METHOD: 73 patients with ROLP and EOLP have been tested. Typing of the HLA antigens has been made for locus A and B. The typing of the HLA was conducted with the use of microlymphocyto toxic test by Terasaki. The reading of the findings has been conducted with an inverse microscope. When a reaction has 4 points it is considered to be positive. RESULTS: The most frequently typified antigens in ROLP from locus A are HLA А2 (57.57%) and А3 (33.33)%, and for locus B 21.21%. In EOLP it is А9 (8888%). In locus B a connection has been found with HLA B8 (77.77%). The statistical analysis with the ×2 test has shown that the carriers of HLA A9 display a relative risk (RR) of 3.65 and ×2=20.72. Consequently, there is high static importance for locus A p<0,001. For locus B, In EOLP for HLA B8, RR=6. 7 ×2=37.64 and p<0,001. ROLP has shown association with HLA A3, where RR=2. 31 and ×2 =9.14 and p<0.05. CONCLUSIONS: In ROLP A3 antigen and in EOLP A9 and A8 may be considered as carriers with proneness to OLP.

Orthodontic Treatment of a Periodontally - Affected Adult Patient (Case Report).

BACKGROUND: The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics. CASE PRESENTATION: The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention. CONCLUSION: Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients.

Clinical Therapeutic Effects of the Application of Doxycycline in the Treatment of Periodontal Disease.

OBJECTIVE: To compare the therapeutic effects of the application of doxycycline-full dose (100 mg) and sub-dose (20 mg) in the treatment of periodontal disease. MATERIAL AND METHODS: A total of 60 patients with periodontal disease were examined. Patients are divided into two groups: A) treated with antimicrobial dose of 100 mg doxycycline once daily for 30 days, and B) treated with 2 x 20 mg/day. doxycycline, during 75 days. Among all patients a conservative treatment was carried out and ordinated the proper dose doxycycline in total dose during treatment from 3 gr. Index of dental plaque by Löe-Sillness, index of gingival inflammation and gingival bleeding by Cowell were followed. RESULTS: Values of dental plaque in relation first examination, 10th, 20th day, 1 month and 2.5 months, showed that after 2.5 months, average value (x = 0.83) of dental plaque in second group is slightly less than the value (x = 0.93) of dental plaque in the first group. The average value (x = 0.17) of gingival inflammation in second group is significantly less than the value (x = 0.50) of gingival inflammation in the first group. The average value (x = 0.97) of gingival bleeding in patients from the first group was significantly higher than value(x = 0.37) of gingival bleeding in the second group. CONCLUSION: Patients whose therapy was helped by a sub-dose doxycycline demonstrated positive therapeutic effects on gingival inflammation and bleeding.

The Effects of NBF Gingival Gel Application in the Treatment of the Erosive Lichen Planus: Case Report.

The therapy of erosive lichen planus (ELP) has been particular problem in the treatment of oral lesions. This case of ELP in male patient 29 years old was treated with topic application of the NBF gingival gel, three times a day after meal, previously rinsed with Clorhexidine gluconate 0.12%. After 5 days of treatment, initial improvements were recorded, and after two weeks of application of the NBF gingival gel we observed significant improvement. Clinical monitoring after the fifth day showed mild epithelialization of the eroded mucosa, yet still present erythematous base of the lesion. After the second week the erythema area was significantly reduced and the eroded surfaces of the mucosa were minimal, measured less than 0.5 mm. After the third week there were no erosions to detect on the oral mucosa, yet still present vague redness, which completely pulled after the fourth week. Treatment ended after the fifth week when the topical application of the NBF gingival gel was terminated, and therapy was done, and clinically achieved effects remained stable even after the third month of the treatment. Topic application of the NBF gingival gel with ELP patients showed positive clinical effects in relatively short time period.

Role of humoral mechanisms in etiology of lichen planus.

AIM: To examine the role of IgA, CIC and component C3 as indicators of humoral immune response in the etiopathogenesis of oral erosive lichen planus (OELP). MATERIAL AND METHOD: The study comprised 19 patients with OELP whose samples of blood, saliva and tissue were obtained after carefully taken medical history and clinical examination. Samples of oral mucosa were taken from the site of lesion, i.e. exclusively from buccal mucosa (1 cm in width and length), and from the deep epithelium as well as a segment from the lamina propria. Determination of immunoglobulins in serum and saliva, and determination of component C3, was done using the micro-elisa technique by Rook&Cameron, Engvall and Ulman. Determination of CIC in serum and mixed saliva was done with the PEG (polyethylene glycol) method. Determination of immunoglobulin A and component C3 in biopsy material was done with direct immunofluorescence. RESULTS: Levels of immunoglobulin A in serum in OELP during exacerbation were decreased (1.04±0.49 gr/l) and during remission increased (5.92±0.62) in comparison with the control group (p<0.001). Levels of CIC during exacerbation and remission were increased (p<0.001), and component C3 levels were increased in both examined phases in the examined group compared with the control group (p<0.05). Deposits of IgA were registered in one (5.88%) patient with OELP and component C3 was registered in 3 (17.64%) patients. CONCLUSION: Changes in IgA values, as well as CIC and component C3, may correlate with changes in oral mucosa emphasizing the role of humoral immune response in the pathogenesis of oral lichen planus.

Therapeutic effect of proaftol in treatment of recurrent aphthous stomatitis.

UNLABELLED: Recurrent aphthous stomatitis (RAS) is a quite frequent, painful, ulcerative disease that affects the lining of the oral cavity and has an unknown etiology. The aim of this article is to examine the impact of the medication proaftol on epithelization speed and severity of pain in patients with RAS. In this randomized, double-blind, placebo-controlled study respondents were divided into two groups where one group was treated with proaftol spray and the other with a placebo. Aphthae considered for treatment had a diameter of 5-6 mm. The participants were given instruction on the use of the spray, two sprayings on the place of the aphtae 3-4 times a day. We examined two parameters in the symptomatology of RAS-lesion size (mm) and pain intensity (noted on four subjective levels: 0-no pain, 1-discomfort, 2-moderate pain, 3-severe pain). These parameters were noted on the baseline, the third, the fifth and the eighth days of examination. RESULTS: A significant faster reduction of the dimension of aphthous ulcers in patients treated with proaftol 3rd day p<0.001, 5th day p<0.0006, 8th day full epithelization in the control group. The magnitude of pain in the experimental compared with the control group on 3rd, 5th and 8th day was also significantly reduced: p<0.0001, p<0.007, p<0.007 respectively. CONCLUSION: The use of proaftol positively influences the rate of epithelization and reduction of subjective feeling of pain in patients with RAS. The action of propolis should be the goal of studies with a larger number of subjects.

Perceived stress in dental practice.

Stress is a normal physiological response to events that make us feel threatened, or upset our balance in some way. In medicine, it is known that stress, as an emotional state, can be a trigger for many psychosomatic disorders. Work stress and burnout are considered to be serious professional risks in dentistry. The dentist should be aware of these stressors and attempt to manage them in order to avoid becoming occupationally dissatisfied. On the other hand, the other common characteristic of modern life is a growing burden of different chronic diseases. Periodontal disease is one of the two most important oral diseases contributing to the global burden of chronic disease. The aim of this study was to assess the perceived stress in patients with periodontal pathologies, and to compare it with the stress in doctors-dentists and students of dentistry as future professionals. Our study confirmed the presence of significant stress in all three groups of examinees (patients, doctors, and students). Surprisingly, the obtained PSQ scores are similar in the examined groups. In addition, no differences between perceived stress in males and females have been found. There is a minimal positive correlation between age and obtained scores. However, stress must be evaluated as a risk factor both for professionals or for chronic dental patients and some response measures must be undertaken.

T-cell subpopulations in lesions of oral lichen planus.

AIM OF THE STUDY: To determine the distribution and frequency of T(CD3) cells and cell sub-populations in tissue specimens of erosive lichen planus (EOLP). MATERIAL AND METHOD: Tissue specimens from buccal mucosa were taken from 14 healthy individuals--control group (CG)--and 17 subjects with EF-OLP. Applying monoclonal antibodies, T(CD3) cells, T cell subpopulations, The CD4, CD8 and CD4/CD8 ratios in both groups were determined. Cells in the epithelium and lamina propria were quantitatively and qualitatively determined in both groups. Data were analysed using the Student's t-test. RESULTS: There were 5.95 2.12% T(CD3) cells in the control group as against 9.80 4.04% in the examined group (p<0.001). The distribution of T(CD3) cells in the lamina propria was 25.35 12.04% in the examined group compared to the control group (p<0.001). There were 3.45 2.05% CD4 epithelial cells in the control group and 4.00 1.95% in the examined group (p<0.4). There were 2.50 1.8% CD8 cells in the control group and 5.80 3.72% in the examined group (p<0.001). The CD4/CD8 ratio was 0.51 0.12% in the examined group and it was evidently reduced in comparison with the control group. An increased distribution of CD4 cells (10.30 7.60%) and CD8 cells (15.05 5.20%) in the lamina propria compared with the epithelium was observed in the examined group (p<0.001). The CD4/CD8 ratio in the epithelium was 0.51 0.12% as against the ratio of the lamina propria, which was slightly increased (0.68 0.48%) with a low statistically significant difference (p<0.05). CONCLUSION: Differences in the distribution of T-lymphocyte subsets between the control and examined groups were found (p<0.001). An increased distribution and frequency of CD4 and CD8 cells in the lamina propria was observed. These were predominantly located in the sub-basal region of the stratum papillare and rarely seen in the intra-epithelial region.

Oral findings in end-stage renal disease.

The aim of the study was to analyse and compare the most frequent clinical oral symptoms, signs and lesions at end-stage renal disease (ESRD), before kidney transplantation (BKT) and after kidney transplantation (AKT). A total of 35 subjects with ESRD were included, 19 in group A (BKT) and 16 in group B (AKT). Oral lesions were classified according to referent clinical diagnostic criteria: Serum albumins, urea, creatinine and salivary urea, creatinine uremic acid were determined by standard biochemical spectrophotometric methods (Human, Germany). For serum albumin concentration measurement (g/L) the method of bromcresol green assay was used while serum and salivary uric acid determination (µmol/L) was performed according the uricase/PAP method. Serum creatinine concentration was measured (µmol/L) with the Jaffe kinetics method, without deproteinization. Oral signs, symptoms and lesions were higher in group A: metallic taste (O.R. = 6.61/ ± 95% CI : 1.13 < O.R. < 38.69), dry mouth (O.R. = 30/ ± 95% CI : 3.15 < O.R. < 285.71), uremic stomatitis (O.R. = 6.5/ ± 95% CI : 1.47 < O.R. < 28.80 and coated tongue (O.R. = 11.73/ ± 95% CI : 2.31 < O.R. < 59.54). On the other hand, in group B, gingival enlargement (O.R. = 59.5/ ± 95% CI : 7.41 < O.R. < 478.05) was more common. High statistically significant differences were recorded between group A and B for dry mouth and gingival enlargement (p > 0.001). Blood urea, creatinine and albumin levels, as well as salivary urea creatinine and uraemic acid values, were significantly higher in group A. Chances of the appearance of all symptoms, clinical signs and lesions, except gingival enlargement, were greater in group A as against group B. Some of our findings correspond with the stage of the disease and some with the use of medicaments in treatment.