Systemic Anti-Inflammatory Agents in the Prevention of Chemoradiation-Induced Mucositis: A Review of Randomised Controlled Trials.

Mucositis is a pathological condition characterised by inflammation and ulceration of the mucous membranes lining the alimentary canal, particularly in the mouth (oral mucositis) and the gastrointestinal tract. It is a common side effect of cancer treatments, including chemotherapy and radiotherapy, and it is sometimes responsible for treatment interruptions. Preventing mucositis throughout the alimentary tract is therefore crucial. However, current interventions mainly target either oral or gastrointestinal side effects. This review aimed to investigate the use of systemically administered anti-inflammatory agents to prevent mucositis in cancer patients undergoing cancer treatment. PubMed, Ovid, Scopus, Web of Science, WHO ICTRP and ClinicalTrials.gov were screened to identify eligible randomised controlled trials (RCTs). The published literature on anti-inflammatory agents provides mixed evidence regarding the degree of efficacy in preventing/reducing the severity of mucositis in most anticancer treatments; however, sample size continued to be a significant limitation, alongside others discussed. Our review yielded a list of several anti-inflammatory agents that exhibit potential mucositis-preventive effects in cancer patients undergoing cancer treatment, which can be used to inform clinical practice.

The expression of salivary EGF, VEGF, endothelin, and transferrin in waterpipe and cigarette smokers.

The aim of this study was to evaluate the effects of two forms of tobacco smoking, cigarettes and water pipe smoking (WPS), on the expression of a panel of salivary proteins in healthy adults. Three groups of age and gender-matched participants were enrolled in the study: never-smokers, cigarette smokers and WPS (N = 55 per group). Expression of epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), endothelin and transferrin in unstimulated whole saliva was estimated using enzyme-linked immunosorbent assays. Statistical analysis consisted of one-way ANOVA and Tukey's post hoc tests, in addition to bioinformatics analysis. VEGF expression was the least in WPS (51.1 ± 14.5 pg/ml) compared to both controls (150.1 ± 13.8 pg/ml) and cigarette smokers (93 ± 9.9 pg/ml), with a significant difference in WPS (p < 0.001) and cigarette smokers (p < 0.01) compared to controls. Furthermore, transferrin showed the weakest expression in the WPS group (1238 ± 261.4 pg/ml) compared to controls (2205.6 ± 298.6 pg/ml) (p = 0.05) and cigarette smokers (1805.4 ± 244 pg/ml). Neither EGF nor endothelin expression showed any statistical difference between the groups (p > 0.05). Gene-gene interaction network demonstrated that FLT1, TFRC, KDR, VEGFB and PGF genes had the highest potential for interaction with the studied proteins. Further functional annotations on the identified markers in the interaction network were performed to identify HIF-1 pathways among the most relevant pathways. In conclusion, smoking habits alter the expression of salivary VEGF and transferrin, which may correspond to early sub-clinical changes in the oral mucosa. The clinical relevance of these salivary changes requires further research.

How good is ChatGPT at answering patients' questions related to early detection of oral (mouth) cancer?

OBJECTIVES: To examine the quality, reliability, readability, and usefulness of ChatGPT in promoting oral cancer early detection. STUDY DESIGN: About 108 patient-oriented questions about oral cancer early detection were compiled from expert panels, professional societies, and web-based tools. Questions were categorized into 4 topic domains and ChatGPT 3.5 was asked each question independently. ChatGPT answers were evaluated regarding quality, readability, actionability, and usefulness using. Two experienced reviewers independently assessed each response. RESULTS: Questions related to clinical appearance constituted 36.1% (n = 39) of the total questions. ChatGPT provided "very useful" responses to the majority of questions (75%; n = 81). The mean Global Quality Score was 4.24 ± 1.3 of 5. The mean reliability score was 23.17 ± 9.87 of 25. The mean understandability score was 76.6% ± 25.9% of 100, while the mean actionability score was 47.3% ± 18.9% of 100. The mean FKS reading ease score was 38.4% ± 29.9%, while the mean SMOG index readability score was 11.65 ± 8.4. No misleading information was identified among ChatGPT responses. CONCLUSION: ChatGPT is an attractive and potentially useful resource for informing patients about early detection of oral cancer. Nevertheless, concerns do exist about readability and actionability of the offered information.

Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians - part II.

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort, and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlap in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover recurrent aphthous stomatitis, pemphigus vulgaris and mucous membrane pemphigoid, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians. Part I.

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlapping in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover pemphigus vulgaris and mucous membrane pemphigoid, recurrent aphthous stomatitis, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

The Effects of Antimicrobial Mouthwashes on Systemic Disease: What Is the Evidence?

The potential association between antimicrobial mouthwash use and systemic health has gained attention in recent years with reports highlighting how some common systemic conditions are influenced by the use of different types of mouthwashes. In this context, links between mouthwash use and cardiovascular disease, diabetes mellitus, oral cancer, Alzheimer's disease, and preeclampsia have been proposed, albeit with limited levels of evidence. Chlorhexidine mouthwash in particular has been the most widely studied agent while available data on other types of over-the-counter mouthwashes are generally scarce. Furthermore, there is currently no evidence-based recommendations on the appropriate use of mouthwashes during pregnancy. This article will present the current evidence on the association between mouthwash use and the aforementioned conditions with emphasis on the mechanisms that may underlie such an association.

Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report.

BACKGROUND: Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE: To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS: PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS: A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS: AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.

Mechanisms underlying sex bias in oral immune-mediated conditions, an insight.

The predilection for women in systemic autoimmune diseases is well established. However, this sex bias in oral autoimmune diseases has been classically reported from an epidemiological perspective without any elaborate attempts to unveil the underlying mechanisms. The unique nature of the oral environment is likely to impose a combination of systemic and local factors that ultimately result in the sex bias in autoimmune diseases of the oral cavity. Variations of immune responses, target organ vulnerability, endocrine and genetic factors, sex chromosomes and modes of parental inheritance are potential systemic factors, while the oral microbiome, oral tolerance, saliva, and oral epithelial stem cells may account for local contributing factors. This review will discuss the preponderance of women in oral immune-mediated diseases, the potential systemic and local mechanisms underlying this predominance and highlight the crucial need for further research in this area.

Differential Expression Profile of Salivary oncomiRNAs among Smokeless Tobacco Users.

OBJECTIVE: The aim of this study was to evaluate the expression of selected salivary oncomiRNAs among smokeless tobacco users and nonsmokers. MATERIALS AND METHODS: Twenty-five subjects with chronic smokeless tobacco habit (> 1 year) and 25 nonsmokers were selected for this study. MicroRNA was extracted from saliva samples using the miRNeasy Kit (Qiagen, Hilden, Germany). The forward primers used in the reactions include hsa-miR-21-5p, hsa-miR-146a-3p, hsa-miR-155-3p, and hsa-miR-199a-3p. Relative expression of miRNAs was calculated using the 2-ΔΔCt method. Fold change is calculated by raising 2 to the power of the negative ΔΔCT value. STATISTICAL ANALYSIS: Statistical analysis was carried out using GraphPad Prism 5 software. A p-value less than 0.05 was considered statistically significant. RESULTS: The four tested miRNAs were found overexpressed in saliva of subjects with smokeless tobacco habit when compared with saliva from nontobacco users. miR-21 expression was 3.74 ± 2.26 folds higher among subjects with smokeless tobacco habit compared to nontobacco users (p < 0.01). The expression for miR-146a (5.56 ± 8.3 folds; p < 0.05), miR-155 (8.06 ± 23.4 folds; p < 0.0001) and miR-199a (14.39 ± 30.3 folds; p < 0.05) was significantly higher among subjects with smokeless tobacco habit. CONCLUSION: Smokeless tobacco leads to salivary overexpression of the miRs 21, 146a, 155, and 199a. Monitoring the levels of these four oncomiRs may provide insight about the future development of oral squamous cell carcinoma, especially in patients with smokeless tobacco habits.

Prediction of Lymphovascular and Perineural Invasion of Oral Squamous Cell Carcinoma by Combined Expression of p63 and Cyclin D1.

OBJECTIVES: The aim of this study was to determine the value of immune expression of p63 and cyclin D1 in the prediction of lymphovascular invasion (LVI) and perineural invasion (PNI) in oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Clinical and histopathologic features of 65 subjects with histologically confirmed OSCC were collected. Tissue microarray blocks representing all subjects were prepared for the immunohistochemical quantification of the nuclear expression of p63 and cyclin D1 using immune ratio plugin of image J software. Image analysis was performed by two independent pathologists. Independent samples t-test, analysis of variance, and receiver operating characteristic curve tests were used for statistical analysis. The level of significance was set at p≤ 0.05. RESULTS: The optimum cutoff value for the prediction of LVI for p63 and cyclin D1 was found to be 100 and 93.2, respectively, while the optimum cutoff value for the prediction of PNI for p63 and cyclin D1 was found to be 95.9 and 94, respectively. p63 and cyclin D1 expression correlated with several clinicopathologic features of the studied population. p63 expression was a significant predictor of moderate/poorly differentiated OSCC compared with well-differentiated OSCC. A parallel combination of positive p63 and cyclin D1 increased the specificity of predicting LVI from 89.1% and 67.4% for either p63 or cyclin D1, respectively, to 93.5% with a positive predictive value of 92.5%. Similarly, the parallel combination of the two markers raised the specificity of predicting PNI from 70% and 77.5% for either p63 or cyclin D1, respectively, to 90% with a positive predictive value of 86.3%. CONCLUSION: Combined overexpression of nuclear markers p63 and cyclin D1 can be considered as a valuable independent predictor of LVI and PNI, and hence tumor progression, in OSCC.

Brain Meningiomas Manifesting as Intracranial Hemorrhage: Comprehensive Systematic Review and Report of the First Case of Hemorrhagic Meningiomatosis.

OBJECTIVE: To characterize the salient features of hemorrhagic manifestation of meningiomas and to report on the first case of hemorrhagic meningiomatosis. METHODS: A comprehensive systematic review of the English-language literature was performed using MEDLINE, PubMed, and Google Scholar databases to identify case reports and series of brain meningiomas manifesting as intracranial hemorrhage. RESULTS: A total of 65 patients were evaluated. Most patients were female (64.6%). The average age at presentation was 58.1 ± 14.3 years. The most common presenting symptom was focal neurologic deficits (n = 47; 71.2%). Identification of tumor was missed/not possible in 24.6% of patients. The most common reported comorbidity was hypertension. Most tumors were located in convexity (n = 36; 55.3%). Subdural hematoma (± other hemorrhages) was the most common type of intracranial hemorrhage (n = 46; 70.7%). Computed tomography hyperintensity (25.7%) and magnetic resonance imaging T2 hypointensity (22%) were the most prevalent radiologic findings. The predominant histopathology subtype was meningothelial (syncytial) (n = 24; 36.4%). The estimated mortality was 13.8%. Among those who survived, 39.9% had residual deficits at a median follow-up of 8.1 ± 5.8 months. CONCLUSIONS: Intracranial hemorrhage induced by meningiomas is associated with significant mortality and morbidity. Identifying unexpected meningioma in the setting of intracranial bleed can help optimize preoperative planning (e.g., surgical approach) and facilitate total resection of the underlying tumor. Therefore, clinicians should have a high index of suspicion with a low threshold for investigation of meningiomas in the setting of intracranial hemorrhage.

Management of mucous membrane pemphigoid: a literature review and update

Mucous membrane pemphigoid (MMP) is a rare group of heterogeneous chronic autoimmune diseases that predominantly manifest as blistering of the mucous membranes. MMP lesions often heal with scarring, which may result in impaired organ function and significant morbidity. The exact pathogenic mechanisms of MMP are still largely unknown while the diagnosis is based on a combination of clinical, histological and immuno-pathological findings. Several treatment modalities of MMP are available and are reported in the literature, however, such treatment options are principally guided by expert opinions and descriptive reports. Non-specific immunosuppression, especially corticosteroids, remains the mainstay of treatment, which often leads to severe adverse effects. Therefore, safer and more effective therapeutic modalities are required. This comprehensive literature review outlines the current knowledge and recent advances in the field of MMP management, with particular emphasis on the oral variant of MMP.

Cranioplasty for Skull Defects With Polypropylene Abdominal Wall Mesh.

OBJECTIVE: Cranioplasty is a well-established common surgery in the practice of neurosurgery and craniofacial surgery. In young patients, complete skull defect closure by bone splitting may be troublesome due to the difficulty to obtain enough bone area. In such cases, sometimes the authors need to use allografts, which may not be widely available in rural practice. In this study, the authors present the series of cranioplasty with polypropylene mesh, which is widely used in abdominal wall closure. PATIENTS AND METHODS: Nine patients with depressed compound skull fracture were treated by performing this technique. Selection criteria were: compound depressed skull fractures in which bones were fragmented in a way not able to be reconstructed with and leaving a skull defect, small-sized or relatively medium-sized skull defects, and skull defects not located on the sharp curvatures of the skull which needs firm bended meshes. All patients were male and their ages ranged between 8 months and 36 years.The skull bone defect was reconstructed with polypropylene abdominal wall mesh, which was sutured circumferentially with the galeal tissue. RESULTS: Skull defects were successfully treated in all patients. The follow-up period ranged from 4 to 13 months. One patient with a history of alcoholism and neglectance developed a wound infection after 3 weeks of surgery. This patient was treated successfully with intravenous antibiotics without the need to remove the mesh. There were no complications in the remaining 8 patients. CONCLUSIONS: Polypropylene mesh is a cheap and effective material for the reconstruction of small-sized or medium-sized skull defects. It can be a good alternative in rural practice and/or low economic communities, when other cranioplasty materials are not available.

Psychosocial profiles and their correlation with physical diagnosis in temporomandibular disorders, a preliminary report.

OBJECTIVE: To assess representative psychosocial features in a group of temporomandibular disorder (TMD) patients from Jordan using Axis II of the Diagnostic Criteria for TMD (DC/TMD) protocol. METHODS: Ninety-eight TMD patients were examined according to Axis I DC/TMD protocol in addition to assessment of their pain-related disability, psychological distress, and stress reactivity. RESULTS: Just under half of the patients (49%) had high intensity of characteristic pain (self-reported TMJ-related pain) and one-third (32%) had high levels of pain-related disability. Furthermore, significant proportions of patients expressed moderate-severe degrees of distress and stress reactivity (41% and 39%, respectively). Significant correlations were identified between the Graded Chronic Pain Scale (GCPS) and each of the pain-related TMD subgroups. CONCLUSION: TMD patients are susceptible to high levels of pain-related psychosocial impairment, and clinicians should be aware of the possible correlations between the physical TMD diagnosis and specific psychosocial features during treatment planning.

Interactive Crossword Puzzles as an Adjunct Tool in Teaching Undergraduate Dental Students.

Background: In the restorative dentistry module of the undergraduate dental program, dental students encounter many new terms and concepts in a short period of time. The provision of adequate learning support to reinforce key concepts can be challenging. Aim: The purpose of this study is to determine student perceptions of how effective interactive crossword puzzles are as adjunctive tools to enhance the learning of restorative dentistry. Methods: Students completed interactive crossword puzzles created by the authors, with a reward awarded to the first group of students who completed the puzzles successfully. The interactive crossword platform was programmed using the ReactJS framework and designed using Tailwind CSS. An evaluation of the student's perception of this educational method was conducted using textual feedback and Likert-scale questionnaires. Results: Students found the crossword puzzles engaging, meaningful, and successful as indicated by their favorable Likert scores and feedback. Written comments revealed student enthusiasm for and a desire to be exposed to more of these exercises. Conclusions: This work sheds light on the potential advantages of incorporating interactive crossword puzzles into the restorative dentistry course from a student's perspective. The crossword puzzles improved students' ability to review and reinforce concepts and terminology and proved to be meaningful and enjoyable. The web-based nature of the tool ensured good student responsiveness and engaged the entire class in an interactive, competitive setting. Application of the hint option, which offered a text of relevant reading material, helped students understand, retain more knowledge, and engage with course material more than they might have otherwise.

Knowledge about oral manifestations of systemic diseases among medical and dental students from Jordan: An interdisciplinary educational gap.

OBJECTIVE: To assess the ability of medical students to recognize oral manifestation of selected systemic diseases and compare their performance with dental students. MATERIALS AND METHODS: A total of 400 senior medical and dental students were approached to participate. The study protocol involved two parts; a self-administered survey and a direct interview involving clinical photographs for oral signs of systemic diseases. RESULTS: A total of 283 (70.8%) agreed to participate and completed the two- part study. The study population was made of 110 (38.9%) [82 females and 28 males] dental students, and 173(61.1%) [98 females and 75 males] medical students. The knowledge score regarding questions about the normal mouth and oral structures was 15.7 ± 6 out of 22. Dental students had a significantly higher knowledge score about normal mouth and oral structures (20.9 ± 4; range from 17 to 22) compared to medical students (10.6 ± 7; range from 4 to 21) (p = .029). The knowledge score regarding questions about oral manifestations of systemic diseases was 26.8 ± 6 out of 40. Dental students had a significantly higher knowledge score about oral manifestations of systemic diseases (30.8 ± 7; range from 15 to 37) compared to medical students (22.9 ± 4; range from 10 to 36) (p = .031). Only 24.3% (n = 42) medical students reported having adequate training to be able to distinguish between normal mouth and diseases. Nearly all medical students (91.3%; n = 158) felt that it is important to have more formal training in oral examination and disease diagnosis. CONCLUSION: Medical students lack adequate knowledge, diagnostic ability, and confidence with regard to diagnosis of oral signs of systemic diseases. To ensure that medical students have necessary skills in assessing oral diseases, curricula revisions and modifications are required, and specific oral health-related learning outcomes should be introduced and reinforced through clinical training.

Crohn's disease initially presenting with oral manifestations and managed with ustekinumab: A case report.

Oral Crohn's disease (OCD) refers to the spectrum of oral manifestations seen in Crohn`s disease (CD) patients and could precede other signs of the disease elsewhere, which requires dental practitioners to be vigilant for oral mucosal changes that may accompany such systemic disorders. Classical treatment modalities are based on the use of corticosteroids, immune-modulators and more recently, biologics. Ustekinumab is a novel agent from this last group that has shown efficacy in a limited number of case reports. A case of a debilitating CD presenting initially with oral manifestations and ultimately managed with ustekinumab is reported.

The online attention to oral cancer research: An Altmetric analysis.

OBJECTIVES: Altmetrics, or alternative metrics, have recently emerged as a web-based metrics measuring the impact of research with an emphasis on the public engagement with the research output. In this study, we aimed to identify and analyze research articles about oral cancer that provoked the most online attention. METHODS: Altmetric Explorer was used to identify articles about oral cancer that generated the highest online attention. Descriptive and correlational statistics were performed, and the top 100 articles were identified and analyzed. RESULTS: A total of 7,940 articles were identified. Topics were mostly discussed on Facebook, Twitter, Mendeley, and news outlets. The top 100 articles that generated the highest online attention discussed mainly topics related to treatment outcomes and quality of life. Human papilloma virus (HPV) was the most commonly discussed individual topic in the list of top 100 outputs (n = 20). Most articles originated from the USA (n = 46) and Europe (n = 33; mainly from UK [24 articles]). Articles were published in 47 journals that belong to different specialities; journals with a social media account had significantly higher Altmetric scores for their articles compared to those without an account. CONCLUSION: Topics of general interest to the public such as HPV transmission and vaccination, risk factors, and treatment generated the highest online attention.