Gingival hypersensitivity reactions to toothpastes: A case series and scoping review.

BACKGROUND: Hypersensitivity reactions to toothpastes are rare. The objective of this study was to present the authors' clinical cases in the past 10 years and perform a scoping review of gingival hypersensitivity responses to toothpastes. TYPES OF STUDIES REVIEWED: The authors reviewed records of documented gingival hypersensitivity reactions to dentifrices at the Postgraduate Clinic of Oral Medicine, Complutense University, Madrid, Spain, from January 2013 through December 2022. Furthermore, the authors conducted a search in PubMed with no date limit for articles reporting these hypersensitivity responses up through October 18, 2023. RESULTS: Eleven cases were collected from the clinic. Eight gingival hypersensitivity reactions occurred in women, and 6 were associated with cinnamon. The most frequent lesions diagnosed were red gingiva. The discontinuation of the toothpaste led to the disappearance of the lesions. The search yielded 643 references. Thirteen articles were included in the scoping review, all of them case series and case reports, reporting 32 cases. Lesions affected middle-aged women most frequently, the most common hypersensitivity reaction was gingival redness, and the cases implicated toothpastes containing cinnamon and herbal composition. PRACTICAL IMPLICATIONS: This study provides clues for diagnosing and treating hypersensitivity reactions to toothpastes, which may improve the identification, management, and reporting of these cases.

Impact and Efficacy of Topical Dry Mouth Products in Haemodialysis Patients with Xerostomia: A Pilot Study.

Purpose: Previous studies have shown that haemodialysis (HD) patients frequently suffer from xerostomia. This problem is associated with difficulties in oral functions, increased risk of oral diseases and interdialytic weight gain (IDWG). The aims of this preliminary study are to evaluate the efficacy and safety of topical dry mouth products in treating xerostomia in HD patients and their impact in reducing IDWG. Materials and Methods: We included 25 HD patients that suffered from xerostomia and complied with inclusion criteria. Subjects received toothpaste, mouthwash and mouth gel for dry mouth. The duration of treatment was 4 weeks. Patients filled out a visual analogue scale (VAS) for xerostomia and Oral Heath Impact Profile (OHIP)-14 questionnaires. Clinical data and IDWG were collected of the medical history of HD patients. Questionnaires and IDWG were collected at baseline, 2 and 4 weeks post-treatment. Results: Twenty-five patients completed the study (56% male and 44% female). The mean age was 63.52 ± 12.50 years. The topical treatment statistically significantly (p = 0.0001) alleviated the symptoms of xerostomia and improved their quality of life (OHIP-14 scores) (p = 0.0001). We observed a statistically significantly IDWG (kg) and IDWG% reduction (p = 0.03) after the use of topical treatment for xerostomia. None of the patients reported side effects. Conclusions: Xerostomia might affect the quality of life and increase the IDWG of these patients. The daily use of topical treatment for xerostomia could decrease thirst and IDWG, improving the quality of life of HD patients. Future randomised studies are needed to confirm these results.

Prevalence of sicca syndrome in the Peruvian population.

OBJECTIVES: Sjögren's syndrome is a complex and heterogeneous autoimmune disease characterised by ocular and oral dryness (1), which mainly affects the exocrine glands. The objective of this study was to determine the prevalence of sicca syndrome (SS) in the Peruvian population. The age and gender of patients with SS and their national prevalence and in each of the departments were defined. METHODS: This was a cross-sectional prevalence study. All the people for whom the Ministry of Health (MINSA) in Peru covered health treatments from January to December 2016 were taken into account. The patients with SS were either newly or previously diagnosed with sicca syndrome (Sjögren's) according to the international classification of diseases version 10 (ICD-10) of the World Health Organization (WHO). The prevalence was determined considering the number of cases of SS in the total population registered by the Ministry of Health (MINSA). RESULTS: 1,301 cases of SS were observed in a total population of 15,417,345 people served in 25 territories. The prevalence of SS in this population was 0.0084%, the prevalence rate was 8.4 cases per 100,000 persons (95% CI: 7.99-8.91). The prevalence of SS was higher in the territories of Tacna, Lima, La Libertad, Arequipa, Callao, and Apurímac. CONCLUSIONS: The results of this study show the prevalence of SS in the Peruvian population and serve to strengthen the health strategies of rheumatology, ophthalmology, and oral health to improve the diagnosis, treatment, follow-up of the disease, and the quality of life of patients with SS.

Surgical Treatment of a Peripheral Ossifying Fibroma and Reconstruction with a Porcine Collagen Matrix: A Case Report.

A 35-year-old woman was referred to the Department of Oral Medicine and Orofacial Surgery after several recurrences of an ossifying fibroma (OF) that affected the free and attached gingiva of the maxillary right central incisor. Surgery was performed with a complete excision of the lesion together with the surrounding healthy tissue up to the bone. To guide the healing of the anterior esthetic framework and the excised tissues, a porcine collagen matrix as an alternative to connective tissue graft was used. After an 18-month follow-up, the lesion had not recurred and keratinized gingiva had formed around the area.

Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients.

The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%-53.5% versus 0-30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG) is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%). In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection.

Successful treatment of oral pemphigus vulgaris in an insulin-dependant geriatric patient.

OBJECTIVE: To present a clinical report of a patient treated with corticosteroids for oral pemphigus vulgaris (PV) lesions. BACKGROUND: PV is the type of pemphigus that most often affects the oral mucosa and tends not to appear in elderly people. METHODS: Two biopsies were needed for diagnosis. She was treated with oral prednisone and topically with 0.05% clobetasol propionate. CONCLUSION: An early diagnosis and treatment is needed for a good prognosis, especially in elderly patients with multiple systemic pathology.

Acute periodontal lesions.

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

Oral candidiasis in patients with renal transplants.

OBJECTIVES: Oral candidiasis (OC) is a frequent oral lesion in renal transplant patients (RTPs). Despite the increased prevalence of OC in RTPs, no study has examined related risk factors. The aims of this study were to analyze the prevalence of and risk factors for OC in RTPs compared with age- and gender-matched healthy control group (HC) as well as determine the incidence of OC after transplantation. STUDY DESIGN: [corrected] We analyzed the prevalence and risk factors of OC in a group of 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HC subjects (314 men, 187 women, mean age 52.25 years). Demographic and pharmacological data were recorded for all subjects. Incident cases of OC were ascertained retrospectively from outpatient clinical records only in the RTP group. RESULTS: The prevalence of OC was 7.4% in RTPs compared with 4.19% in HC (P<0.03). The most frequent type of OC in the two groups was denture stomatitis. Statistical association was found between OC and age, mycophenolate mofetil dose and blood levels, dentures and tobacco. The multiple logistic regression model only chose for denture variable. According to the outpatient clinical records, 24 RTPs suffered OC during the first moth post-transplant. Severe lesions affecting the oral cavity and pharynx appeared in 79% of the OC cases. CONCLUSIONS: This study shows a lower prevalence of OC in RTPs than previous reports. Denture stomatitis was the most frequent OC prevalence form described in RTPs. Severe candidiasis is more frequent in the immediate posttransplant period. The presence of denture is an important risk factor of OC. These results emphasise the importance of adequate pre- and post-transplant oral health and denture cleaning and adjustment is recommended for these subjects to prevent this infection.

Lip cancer in renal transplant patients.

The aims of this study were to establish the incidence of lip cancer (LC) in a population of renal transplant patients (RTPs), identifying possible risk factors and predictable variables, and to describe the clinical appearance, treatment, and course of LC in this group. The study included 500 patients (307 men, 193 women; mean age 53.63±13.42 years, range 19-95 years; mean period since transplant 59.66±55.81 months, range 4-330 months). Incident cases of LC were ascertained retrospectively from outpatient records. All LC lesions were sampled by biopsy and examined histopathologically. Six of the men (1.2%) suffered lower LC, and LC cases showed significant differences on univariate analysis for tobacco habit, tobacco consumption, and sun exposure. All patients who had LC were taking prednisolone and cyclosporine A (CsA) at the time of LC diagnosis. The median interval for LC incidence after renal transplant was 80.50±31.25 months. Five of six LCs were squamous cell carcinomas. Multiple logistic regression showed that the LCs were not significantly associated with any independent risk factor. The results show that the appearance of LC in RTPs is associated with immunosuppressant treatment, sun exposure, and tobacco and indicate that these patients should avoid unprotected exposure to sunlight and smoking. Because of the high incidence of LC in RTPs, periodic checking of the lips is important to ensure prompt diagnosis and correct management of LC. Our data suggest that the clinical profile of LC in this patient group is similar to that of the general population.