Salivary cortisol levels in patients with potentially malignant oral disorders and oral mucosal cancer: a case-control study.

BACKGROUND: The relationship between salivary cortisol secretion and the presence of cancer in the oral cavity has not been completely clarified. Due to this, we proposed carrying out a study to determine salivary cortisol levels in patients with potentially malignant disorders (PMD), oral squamous cell carcinoma (OSCC) and healthy individuals. MATERIAL AND METHODS: Cross-sectional case-control study, among 80 patients seen at the Faculty of Dentistry of the National University of Rosario, Argentina, between January 2018 and April 2020. 40 cases represented by Leukoplakia, Lichen, Erythroplakia and SCC and 40 controls were included. Smoking habit and alcohol consumption were included. The presence of stress was determined. Morning salivary cortisol levels were measured with the Roche electrochemiluminescence method (Traceability: St by ID-MS). RESULTS: Patients with SCC presented elevated salivary cortisol values. Individuals with stage III tumors showed levels higher than 8.74 ng/ml in all cases. A significant association between cortisol levels and stress was detected in patients in the control group (p<0.005) and in individuals with PMD (p=0.009). This association was not significant in patients with SCC (p=0.999). After applying the logistic regression method, when adjusting odds ratios according to tobacco and alcohol consumption and the presence of stress, the association between cortisol levels and presence of stress was highly significant (p<0.001). The possibility of presenting undetectable cortisol results was 94% lower in patients with stress. CONCLUSIONS: The increase in salivary cortisol levels in patients with PMD and SCC, is related to stress conditions, being able to generate alterations tending to immunosuppression of the cellular microenvironment.

Prevalence of chronic hyperplasic candidiasis. Its association to risk factors in an Oral Medicine Service in Rosario, Argentina.

INTRODUCTION: Chronic hyperplasic candidiasis (CHC) is one of clinical forms of infection caused by fungi from genus Candida, basically Candida albicans, and less frequently by other species of the genus, such as Candida tropicalis, Candida guilliermondii, Candida glabrata, Candida parapsilosis, Candida dubliniensis y Candida krusei. OBJECTIVE: The aims of this work were to evaluate CHC prevalence in the oral mucosa of individuals who attended the Oral Medicine Service-School of Dentistry at the National University of Rosario, Argentina during the last 5 years; and to study the significance of association of this clinical form to other risk factors for dysplastic changes in the oral mucosa. PATIENTS AND METHODS: Retrospective study of patients (2785) attending the Oral Medicine Service were conducted. Study included all cases of candidiasis diagnosed and confirmed by mycological and histopathological studies. Analyzed samples indicated that 123 (4.41%) out of 2785 patients (mean age 56.10, SD 18.69) showed candidiasis in its different clinical forms. Nineteen (15.41%) out of those 123 inidividuals manifested CHC, mean age 56.08 (SD 16.76). Twelve out of 19 patients used dental prostheses. RESULTS: It was indicated that 68.42% of patients with CHC were smokers while this number was lower (34.23%) for those individuals displaying other clinical forms of candidiasis. CONCLUSION: A statiscally significant correlation between CHC and dysplastic epithelial changes was determined. Study of the virulence factors in pathogenic species of the genus Candida, which allow for either hyperplasic or dysplastic changes or eventual malignant transformations is currently being explored in numerous papers. The characteristics of the parasite-host interaction are also being examined.

Oral infections caused by yeasts in patients with head and neck cancer undergoing radiotherapy. Identification of the yeasts and evaluation of their antifungal susceptibility.

UNLABELLED: Yeasts occur as part of the normal human microbiota. Nevertheless, some species are opportunistic, affecting immunocompromised patients such as those undergoing oncologic treatment. OBJECTIVE: To detect the presence of yeasts in patients suffering from head and neck cancer who are receiving radiation therapy and display lesions in the oral cavity, compatible with candidiasis; and to evaluate the antifungal susceptibility of the isolates recovered. METHODS: Sixty samples from patients were obtained by swabbing the oral mucosa. Identification of isolates were performed by classical taxonomic, morphological and biochemical methods as well as by using commercial identification kits. Susceptibility to antifungal drugs was determined by the agar diffusion method with Neosensitabs(®) disks. RESULTS: Forty-six samples (77%) yielded positive findings, and species recovered were: Candida albicans (22 isolates), Candida tropicalis (13 isolates), Candida parapsilosis (six strains), Candida krusei (three strains), Candida dubliniensis and Saccharomyces cerevisiae (one each). All strains were susceptible to itraconazole, clotrimazole, voriconazole, nystatin and amphotericin B. On the other hand, 65% of strains were miconazole-susceptible while 35%, showed intermediate susceptibility. With regard to ketoconazole, only three strains (7%) corresponding to C. albicans (one isolate) and C. krusei (two isolates) displayed intermediate susceptibility. Only C. krusei strains were resistant to fluconazole while all the other species were susceptible. Eventually, only six isolates (13%) were susceptible to terbinafine while the remaining strains were resistant in vitro. CONCLUSION: Early detection of etiological agents causing lesions, as well as the evaluation of their susceptibility to commonly used drugs, are crucial in order to choose the appropriate treatment that will minimize complications while improving the quality of patients' lives.

Combination of alpha lipoic acid and gabapentin, its efficacy in the treatment of Burning Mouth Syndrome: a randomized, double-blind, placebo controlled trial.

UNLABELLED: Burning Mouth Syndrome (BMS) is a disease that manifests as burning in the tongue or in any area of the oral mucosa, in the absence of clinically verifiable injuries. OBJECTIVES: To verify the efficacy of alpha lipoic acid (ALA) and gabapentin (GABA), used individually and jointly, to reduce the burning in patients with burning mouth and establish a drug therapy for the BMS. STUDY DESIGN: During April and May 2008, we conducted a randomized, double-blind, placebo-controlled trial in the Department of Clinical Stomatology, Faculty of Dentistry, Rosario, Argentina. The gathering of patients was between those ones with BMS who were treated in our service between March 2003 and March 2008 without complying with the applied treatments. The 120 patients were randomly divided into 4 groups and were provided, by lot and in a blinded fashion, with four different treatment cycles consisting of the following drugs: Group A (n = 20) 600 mg / day of alpha lipoic acid for two months, Group B (n = 20) 300 mg / day of gabapentin for two months, Group C (n = 20) a combination of both drugs for two months and Group D (n = 60) 100 mg / day of cellulose starch for two months (control group). RESULTS AND CONCLUSIONS: all 120 patients completed the treatment. The best response was obtained with the combination of ALA + GABA, with a 70% of the cases with reduced burning in this group and a 13.2 times greater chance of presenting positive changes for these patients than those taking placebo. The combined use of drugs that act at different levels of the nociceptive system can be useful for the treatment of this syndrome.

Loss of A, B, and H antigens in oral cancer

Los antígenos ABH, productos de la interacción de dos sistemas genéticos Hh y ABO, están sujetos a leyes de herencia y pueden estar localizados no sólo en los eritrocitos sino también en la mayoría de las células humanas. El objetivo del este trabajo fue investigar la expresión de antígenos ABH en pacientes con lesiones orales pre-malignas y malignasorales. Se trabajó con muestras incluidas en tacos de parafina de pacientes con lesiones orales. Los pacientes fueron clasificados en 2 grupos: a) Pacientes con lesiones premalignas y malignas diagnosticadas clí-nica y anatopatológicamente y b) pacientes con lesiones benignas. Sei nvestigaron los antígenos ABH por la técnica de inmunoadherencia específica modificada. Se utilizó la adherencia al tejido vascular como control positivo y al tejido adiposo como control negativo. Los resultados fueron valorados de forma semicuantitativa desde adherencia fuertemente positiva a negativa. Hemos encontrado una significativa relación entre la expresión antigénica ABH y el grado de malignidad de las lesiones analizadas (P Yates= 0.005). Una pérdida de reactividad ABH en los sitios de mayor invasividad tumoral se correlaciona con el grado del desarrollo del tumor, el grado histológico y su malignidad (AU)

In most human carcinomas, including oral carcinoma, a significant event is decreased expression of histo-blood-group antigens A,B and H. The mechanisms of aberrant expression of blood-group antigens are not clear in all cases. The aim of this work was to investigate the association of ABO blood groups with oral cancer. We studied the expression of ABH antigen in tissues of premalignant lesions and in diagnosed malignant tumors. In total, 132 patients were examined, half of whom suffered from oral pre-cancerous and cancerous lesions, while the other half were the control group (benign lesions).All tumors were histologically confirmed. We found a significant relationship between antigen expression and the malignancy of the lesions analyzed (P Yates= 0.005). A loss of ABH reactivity within the most invasive sites of the tumors correlated significantly with the stage of tumor development and histological grade of malignancy. These findings support the view that features regarding the cells of deeper parts of the carcinomas are very important for the clinical behavior of the tumors and that loss of ABH-antigen expression is linked to the stage of the tumor and invasion of carcinoma cells (AU)

Efectividad del té verde en el tratamiento de periodontitis crónica / Greentea effectiveness in chronic periodontitis treatment

El té verde ha mostrado un amplio rango de efectos fisiológicos y farmacológicos. En los últimos años se han llevado a cabo estudios sistemáticos principalmente por investigadores japoneses en los cuales se evidenciaron las acciones antimicrobianas útiles y variadas que poseen los extractos de té. El objetivo de este trabajo fue determinar, mediante el uso de registros cuantificables, la efectividad clínica y microbiológica del té verde en el tratamiento de las periodontitis crónicas. Fueron evaluados 50 pacientes de ambos sexos, con diagnóstico de periodontitis crónica y con un mínimo de tres bolsas periodontales por cuadrante con profundidad de sondaje ≥ 5 mmy pérdida de inserción ≥ 2 mm por proximal, que concurrieron a la Cátedra de Periodoncia de la Facultad de Odontología de la Universidad Nacional de Rosario, Argentina. Las variables clínicas consideradas fueron Indice Gingival (Loe y Silness, 1963), Sangrado al Sondaje (Val del Verden, 1979), Profundidad de sondaje con sonda milimetrada tipo Marquis y Nivel de inserción epitelial vertical. Para determinar la eficacia microbiológica del tratamiento se extrajeron muestras de placa subgingival con conos de papel estéril del fondo de las bolsas periodontales. Se sembró en medio de Agar Schlaeder – sangre enriquecido con 1% de hemina y vitamina K en atmósfera anaeróbica a 37°C durante 5 días. La tipificación fue realizada con el método comercial semi-automatizado Api 20 A Biomerieux – France. El uso de extracto de té verde asociado a la terapia periodontal mecánica ha sido sensiblemente eficaz en la reversión de estas variables en el tratamiento de la periodontitis crónica, si bien su uso asociado o no al raspaje y alisamiento radicular no mostró diferencias significativas respecto del raspaje y alisamiento como monoterapia para el control de la flora anaeróbica en esta patología (AU)

Green tea has been shown to have a wide range of physiological and pharmacological effects. In recent years, systematic studies performed mainly by Japanese researchers have evidenced the wide range of very useful antimicrobial properties of tea extracts. The aim of the present study was to quantitatively evaluate the clinical and microbiological efficacy of green tea in the treatment of chronic periodontitis. Fifty male and female patients who attended the Department of Periodontics, Faculty of Dentistry, National University of Rosario, Argentina, and had been diagnosed with chronic periodontitis were included in the study. The selected patients had at least 3 periodontal pockets per quadrant, depth on probing ≥ 5 mm and proximal attachment loss ≥ 2 mm. The clinical endpoints assessed were Gingival Index (Loe y Silness, 1963), Bleeding on Probing (Val del Verden, 1979), Depth on Probing with a Marquis type probe and Level of Vertical Epithelial Attachment. Samples of subgingival plaque were obtained with sterile paper cones from the bottom of the periodontal pockets to evaluate microbiological efficacy. The samples were seeded in Agar Schlaeder medium – blood enriched with 1% hemine and vitamin K in anaerobiosis at 37°C for 5 days. Typification was performed employing the commercial semi-automatic method Api 20 A Biomerieux – France. The use of green tea extract coupled to mechanical periodontal therapy for chronic periodontitis was efficient in controlling these variables. However, when it was used coupled to root scaling and planing it did not significantly improve the control of anaerobic flora as compared to scaling and planing used alone (AU)

Esclerosis tuberosa: Presentación de un caso clínico con manifestaciones estomatológicas / Tuberous sclerosis: Presentation of a clinical case with oral manifestations

La esclerosis tuberosa (E.T) es una enfermedad genética que afecta a múltiples sistemas del organismo. Es un trastorno de la diferenciación y proliferación celular, que se caracteriza por la formación de tumores hamartomatosos benignos: neurofibromas y angiofibromas localizados en la piel, el sistema nervioso central, las mucosas y otros órganos de la economía. La migración anormal de las neuronas desempeña un papel importante en las disfunciones neurológicas, siendo las predominantes el retraso mental, las crisis convulsivas y las alteraciones de la conducta. Se produce por mutaciones de los genes TSC1 del cromosoma 9q34 y TSC2 del cromosoma 16p13.3.Se hereda con un rasgo autosómico dominante, pero el 60 por ciento-70 por ciento de los casos son esporádicos y representarían nuevas mutaciones. El fenotipo es muy variable. La prevalencia de esta enfermedad varia entre 1/ 6000 a 1/10000 de los niños nacidos vivos. El motivo de este trabajo es comunicar el caso de un paciente de 21 años de edad que padecía esclerosis tuberosa, con manifestaciones estomatológicas. Se describen las características clínicas, los criterios de diagnóstico y las terapéuticas utilizadas; efectuando una revisión bibliográfica de esta enfermedad (AU)

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[Cowden's disease]. / Enfermedad de Cowden.

We report a typical case of Cowden disease or Multiple Hamartoma Syndrome in a 32 year old female without a family history of this illness. The patient suffered bilateral fibrocystic disease of the breast, having been subjected to mastectomy because of carcinomatous degeneration. She complained of gastric symptoms, and the x-ray examination showed multiple polyposis. On physical examination an asymptomatic thyroid nodule was noted. The skin showed multiple wart-like lesions, lichenoid papules, localized hyperkeratosis and pigmented spots. She had many papillomas in her mouth a rasberry tongue and bilateral perleches.