Topical NAVS naphthalan for the treatment of oral lichen planus and recurrent aphthous stomatitis: A double blind, randomized, parallel group study.

AIM: To evaluate the effectiveness of non-aromatic very rich in steranes (NAVS) naphthalan in the treatment of oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS). Null hypothesis was that there would be no difference between NAVS and topical steroids in the treatment of OLP and RAS. METHODS: The study consisted of two sub-trials conducted as randomized, double-blind controlled studies: first included OLP patients and second patients with RAS. Patients received either NAVS or 0.05% betamethasone dipropionate. Primary outcomes were activity score (OLP patients), No of lesions and lesion diameter (RAS patients) and pain intensity (VAS) while secondary outcome included the impact of the disease on quality of life assessed by Oral health impact profile (OHIP 14). RESULTS: No significant differences in terms of OLP clinical signs (p = 0.84, η2 = 0.001) and responses on the OHIP-14 (p = 0.81, η2 = 0.002) or on VAS (p = 0.14, η2 = 0.079) between NAVS and betamethasone groups were observed. In RAS patients, no significant differences between the groups in terms of lesion number (at days 3 and 5, p = 0.33 and p = 0.98, respectively), lesion diameter (days 3 and 5, p = 0.24 and p = 0.84, respectively) were observed. However, in NAVS group a significant reduction of lesions diameter was observed on the 3rd day, while in betamethasone group a significant reduction in lesions diameter was evident only after the 5th day. No significant differences in VAS (p > 0.05) and the OHIP-14 (p > 0.05) between groups were found. CONCLUSION: No evidence of differences between the two compared interventions was found. REGISTRATION: Retrospective registration of this trial was conducted in ClinicalTrials.gov on September 30, 2016; trial registration number: NCT02920658. https://clinicaltrials.gov/ct2/show/NCT02920658?term=NAVS&draw=2&rank=4.

Salivary Cortisol Levels and Burning Symptoms in Patients with Burning Mouth Syndrome before and after Low Level Laser Therapy: a Double Blind Controlled Randomized Clinical Trial.

OBJECTIVES: Burning mouth syndrome (BMS) is a disorder which is described as burning sensation of the oral mucosa without pathological changes. Most of the patients have some underlying stressful conditions. Stress induces an increase in secretion of different endocrine glands resulting in higher levels of glucocorticoids. One of the options for treatment of BMS includes low level laser therapy (LLLT). The aim of this research was to determine salivary cortisol levels and intensity of burning symptoms in BMS patients before and after LLLT. MATERIALS AND METHODS: Twenty-three participants were allocated by randomization in two groups: 12 patients in the study group and 11 patients in the placebo group. Cortisol levels in all patients were analyzed from the sample of saliva collected without stimulation. In both groups, the LLLT was performed once a day for ten consecutive days (excluding weekend) with Ga-Al-As light-emitting diode type of laser, with a wavelength of 685nm. In the control group, LLLT was done with inactive laser probe which was only emitting audio signal. The intensity of burning symptoms was measured by a visual analogue scale (VAS). The VAS and unstimulated saliva were measured at baseline and on the last day of the LLLT. A quantitative analysis of saliva was performed using competitive commercial ELISA-kit. RESULTS: VAS scores and salivary cortisol levels were significantly lower in both groups after LLLT. CONCLUSIONS: LLLT can be useful in patients with BMS for reducing burning symptoms and salivary cortisol level. Future studies on a larger number of patients should clarify whether the positive results are an outcome of laser effectiveness or of placebo effect.

Corrigendum to "Oral Adverse Reactions Caused by Over-the-Counter Oral Agents".

[This corrects the article DOI: 10.1155/2015/196292.].

[INFLUENCE OF NECK DISSECTION ON THE CORRESPONDING MOTOR AND SENSORY NERVES]. / UTJECAJ DISEKCIJE VRATA NA ODGOVARAJUCE MOTORICKE I OSJETNE ZIVCE.

OBJECTIVE: Radical neck dissection (RND), utilized for treatment of lymph node metastases in patients with head and neck cancers, can result in clinically significant functional disturbance secondary to the corresponding nerve damage. However, there is only limited data relative to post-operative analysis of impact of RND on the cranial and cervical nerves after neck dissection especially regarding the technique used such as electroknife or scalpel. STUDY DESIGN: 48 patients (42 men and 6 women) with intraoral cancer were enrolled. A total of 55 dissections were performed, including 7 patients who received bilateral dissections. Analysis of motor and sensory nerves was conducted seven days and three months later with regard whether electroknife or scalpel was used. RESULTS: The most frequent post-operative loss of motor function was seen in accessory and hypoglossal nerves; within sensory nerves the lingual nerve was most frequently dysfunctional. Permanent diaphragm dysfunction was seen in 15% of investigated patients. CONCLUSION: We might conclude that routine evaluation of sensoneural and motor nerve function of all potentially damaged nerves should be performed after RND, especially regarding diaphragm paralysis. There were no differences in postoperative nerve function of the examined nerves with regard to the technique used (electroknife/scalpel).

ORAL LICHEN PLANUS AND ORAL LICHENOID REACTION--AN UPDATE.

Oral lichen planus (OLP) and oral lichenoid reaction (OLR) are clinically and histopathologically similar diseases. Whereas OLP is a consequence of T cell mediated autoinflammatory process to a still unknown antigen, OLR might be caused by drugs, dental restorative materials and dental plaque. Pubmed was searched and 24 publications published over the last three years regarding etiology, diagnosis and malignant alteration were included in this study. Patients with OLR who have amalgam fillings near lesions should have them replaced, i.e. when possible they should be referred to patch test, as well as when drug-induced OLR are suspected. OLR lesions induced by drugs should disappear when the offending drug has been discontinued. Histology finding in OLR consists of more eosinophils, plasma cells and granulocytes in comparison to OLP lesions. Furthermore, OLP lesions showed more p53, bcl-2 and COX-2 positivity when compared to OLR. OLP is characterized by infiltration, atrophic epithelium, rete pegs and Max Joseph spaces, while deep infiltration into connective tissue and hyperkeratosis were the criteria for making the diagnosis of OLR. The number of degranulated mastocytes in the reticular layer, as well as the number of capillaries was higher in OLR in comparison to OLP. It seems that OLR are more prone to malignant alteration in comparison to OLP.

Mapping Electrical Impedance Spectra of the Healthy Oral Mucosa: a Pilot Study.

OBJECTIVE: Electrical impedance is the resistance to the electric current flow through a tissue and depends on the tissue's structure and chemical composition. The aim of this study was to map electrical impedance spectra for each region of the healthy oral mucosa. MATERIALS AND METHODS: Electrical impedance was measured in 30 participants with healthy oral mucosa. Measurements were performed in 14 points on the right and the left side of the oral cavity, and repeated after 7 and 14 days respectively. RESULTS: The lowest values were measured on the tongue dorsum and the highest values were measured on the hard palate. No significant differences were found between the right and the left side. Significantly higher values were found in females on the upper labial mucosa, tongue dorsum and the ventral tongue. Significant difference between smokers and non-smokers on the lower labial mucosa and floor of the mouth was found. Electrical impedance was negatively correlated with salivary flow on the upper labial mucosa, hard palate, tongue dorsum and sublingual mucosa. Higher variability of measurements was found at low frequencies. CONCLUSIONS: Electrical impedance mostly depends on the degree of mucosal keratinization. Demographic and clinical factors probably affect its values. Further studies with bigger number of participants are required.

CATASTROPHIZING IN PATIENTS WITH BURNING MOUTH SYNDROME.

BACKGROUND: Burning mouth syndrome (BMS) is an idiopathic painful condition which manifests with burning sensations in the oral cavity in patients with clinically normal oral mucosa and without any local and/or systemic causative factor. Catastrophizing is defined as an exaggerated negative orientation toward pain stimuli and pain experience. The aim of this study was to examine the association between catastrophizing and clinical parameters of BMS, and to examine the association between catastrophizing and the quality of life in patients with BMS. MATERIALS AND METHODS: Anonymous questionnaire consisting of 3 parts (demographic and clinical data with 100 mm visual analogue scale (VAS), Croatian version of the Oral Health Impact Profile (OHIP-14) scale and Croatian version of the Pain Catastrophizing scale (PC), was distributed to 30 patients diagnosed with BMS. RESULTS: A higher level of catastrophizing was clinically significant in 30% of the patients. Total catastrophizing score and all three subcomponents of catastrophizing significantly correlated with the intensity of symptoms, but did not correlate with the duration of symptoms. Gender and previous treatment did not affect the catastrophizing. CONCLUSION: Obtaining the information about catastrophizing could help a clinician to identify patients with negative behavioural patterns. Additional psychological intervention in these individuals could reduce/eliminate negative cognitive factors and improve coping with chronic painful condition such as BMS.

[Analysis of oral mucosal lesions in patients referred to oral medicine specialists]. / Analiza oralnih lezija u pacijenata upucenih u specijalisticku praksu oralne medicine.

The need for studies on prevalence of lesions in the field of oral medicine increases as more patients suffer from oral mucosal diseases. Data on prevalence of oral mucosal diseases throughout the world are scarce. Therefore, we have made a retrospective study of patients referred to the Department of Oral Medicine, University of Zagreb, during a period of one year, i.e. 2010. Data on patient age, gender and diagnosis were recorded. Out of 1118 analyzed clinical records of the patients, 756 (67.6%) were women and 362 (32.4%) were men. The age range of female patients was 54 +/- 19 years (mean age 62.17 years) and the male age range was 49+/-21 (mean age 64.17 years). The most common diagnosis was burning mouth syndrome (23.4%), followed by xerostomia (10.6%), traumatic ulceration (8.7%), geographic tongue (6.6%) and denture stomatitis (5.7%). Other diagnoses were found in a smaller percentage. Our results point out an increased need for oral medicine services.

Psychological status and recurrent aphthous ulceration.

Recurrent aphthous ulceration (RAU) are a disease of an unknown etiology and mediated through T-cell lymphocytes. Evidence suggests that RAU is connected with chronic bowel disease, haematinic deficiencies, AIDS, food hypersensitivity and severe stress. The aim of this study was to determine whether differences in anxiety and depression could be seen in patients with RAU during acute phase and remision period and in comparison to the healthy controls. There were 30 patients with RAU (age range 36.27 +/- 15.308) and 30 controls aged 29.83 +/- 9.082. Every participant with RAU fullfilled STAI and Beck Depression Inventory II test during acute phase and during remission period as well as controls. Statistical analysis was performed by use of descriptive statistics and t-test. There are no differences in the level of depression and stress between the two phases of the RAU (acute versus remission period) as well as in comparison to the controls. Patients with acute RAU are more anxious than patients with RAU during remission period. We might conclude that psychological disturbances do not preceed the development of RAU and that the patients with acute RAU are more anxious when compared to the condition when they do not have RAU due to the discomfort they experience.

Orofacial granulomatosis treated with intralesional triamcinolone.

Orofacial granulomatosis (OFG) is an uncommon disease, usually presenting as recurrent or persistent swelling of the soft tissues in the orofacial region, predominantly lips (cheilitis granulomatosa). The cause of this illness is unknown. OFG may also be part of the triad of Melkersson-Rosenthal syndrome (MRS) and some consider it a monosymptomatic form of MRS. We describe a case of a Croatian male patient with recurrent swelling limited to the upper lip for the past 6 years. After establishing the diagnosis, we performed intralesional triamcinolone injections (16 mg, twice on a weekly schedule), resulting in complete remission. OFG differential diagnosis and treatment modalities are discussed.