ABSTRACT
BACKGROUND: Oral candidiasis occasionally occurs in patients with oral lichen planus (OLP) or lichenoid reaction (OLR). However, not all patients undergoing corticosteroid therapy develop Candida superinfection. Thus, the identification of prognostic risk factors may help to identify patients at risk of Candida superinfection. METHODS: A retrospective cohort study was conducted to review patients with OLP/OLR who received steroid therapy at a single dental hospital between January 2016 and December 2021. The prevalence of Candida superinfection and prognostic factors were assessed. RESULTS: Eighty-two eligible patients with OLP/OLR were retrospectively reviewed. The overall prevalence of Candida superinfection during the study period was 35.37%; the median time-to-event between initiation of corticosteroid therapy and diagnosis of superinfection was 60 days (interquartile range; 34-296). The ulcerative type of OLP/OLR, number of topical steroid applications, poor oral hygiene, and oral dryness were significantly associated with superinfection (p < 0.05; Fisher's Exact test) and were identified as prognostic factors in univariable risk ratio regression. Multivariable risk ratio regression revealed the ulcerative type of OLP/OLR and number of topical steroid applications were significant prognostic factors for Candida superinfection in patients with OLP/OLR. CONCLUSION: Candida superinfection occurs in approximately one-third of patients with OLP/OLR undergoing corticosteroid therapy. Patients with OLP/OLR should be closely monitored in the first 2 months (60 days; median time to infection) after steroid prescription. The ulcerative type of OLP/OLR and a higher number of topical steroid applications per day may represent prognostic factors to identify patients at risk of Candida superinfection.
Subject(s)
Lichen Planus, Oral , Lichenoid Eruptions , Superinfection , Humans , Lichen Planus, Oral/complications , Lichen Planus, Oral/drug therapy , Lichen Planus, Oral/epidemiology , Retrospective Studies , Candida , Prevalence , Prognosis , Superinfection/epidemiology , Steroids/adverse effects , Adrenal Cortex Hormones/adverse effectsABSTRACT
OBJECTIVES: To determine the factors associated with public hospital dentists' awareness of HLA-B*15:02 screening in trigeminal neuralgia (TN) and the national gene screening policy in Thailand. METHODS: Cross-sectional study. A validated questionnaire was distributed to public hospital dentists with at least 1 year of practice in Southern Thailand (n = 760) to assess their knowledge of TN, carbamazepine (CBZ) use, awareness of HLA-B*15:02 screening, and the gene screening policy. RESULTS: A total of 385 dentists participated (50.7% response rate); 81.3% of respondents were aware of HLA-B*15:02 screening. However, 18.7% of dentists were not aware of the importance of gene testing. Furthermore, dentists who were aware of gene screening had significantly better knowledge of TN diagnosis and CBZ use than "unaware" dentists. Awareness of HLA-B*15:02 screening was also significantly associated with dental specialty. Moreover, 80.5% of respondents were not aware of the gene screening policy. The primary problems related to the policy were its inefficient publication, poor implementation, and lack of clinical practice guidelines (CPGs) to encourage dentists to follow the policy and prescribe gene tests. CONCLUSION: While most hospital dentists were aware of the necessity of HLA-B*15:02 screening prior to prescribing CBZ in TN, the majority were unaware of the national gene screening policy. Dental specialty and knowledge were associated with awareness of HLA-B*15:02 screening.
