Is laser acupuncture effective in controlling gag reflex while taking dental impressions? A randomized double-blinded sham-controlled clinical trial.

OBJECTIVE: The purpose of this study was to investigate the effect of laser acupuncture on controlling gag reflexes by stimulating pericardium 6 (PC6) and conception vessel 24 (CV24) acupuncture points in patients in need of taking dental impressions. METHODS: In this randomized controlled double-blinded clinical trial study, in 30 patients aged 20-60 years, alginate impressions were taken in the prosthetic and orthodontic clinic at the Dental School of Mashhad University of Medical Sciences, Mashhad, Iran. The participants were randomly divided into 2 groups. The intervention and the control group each included 15 subjects. Both groups were in the exact status of age, gender, and indexes, including the Gagging Severity Index (GSI), Subjective Severity of Gag Reflex (SSGR), Vomiting Number (VN), as well as the Improvement Index, measured. Both groups underwent alginate impressions pre-and postintervention. PC6 and CV24 acupuncture points were irradiated for 4 seconds in contact mode with a laser prob pressure on the skin that was slightly bleached without causing pain for the patient. The laser energy was 0.8 J with an energy density of 2.854 J/cm2 at the surface of the probe (spot size, 0.28 cm2). The total radiation dose was 45.7 J/cm2, and the power density was 714.2 w/cm2. RESULTS: The findings showed that SSGR and VN significantly improved (P ≤ .05) in the intervention group compared to the control group, but GSI was higher in the intervention group. In the intragroups analysis for the comparison between before and after the intervention, it was found that although the average GSI was elevated after the intervention rather than before, the difference was insignificant (P = .083). Also, after the intervention, the average SSGR was significantly reduced (P< .001), and VN was insignificantly lessened (P = .334). Moreover, it was observed after the intervention rather than before that GSI was significantly increased (P< .001), whereas SSGR significantly declined (P< .001), and VN meaningfully decreased (P = .001). The observations demonstrated that the Improvement Index status was significantly better in the intervention group compared to the control group (P = .002). CONCLUSION: This study found that the application of laser acupuncture on PC6 and CV24 acupuncture points might be effective in reducing the gag reflex and can be used as a noninvasive technique while taking dental impressions.

Diagnosis of an occult gastric adenocarcinoma by oral manifestations (acanthosis nigricans): A case report.

BACKGROUND: Acanthosis nigricans (AN) is a condition with an important characteristics of symmetrical areas of thickened skin with grayish brown hyperpigmentation. The mucosa may show a papillomatous surface, with or without hyperpigmentation. Lips and sites at risk of trauma may be affected and palmoplantar keratosis might also be present. In some rare cases, acanthosis nigricans presents as a sign of internal neoplasia, mostly a gastrointestinal cancer, and is called malignant acanthosis nigricans (MAN). CASE PRESENTATION: In this study, a 55-year-old female Iranian patient with malignant acanthosis nigricans (MAN) is reported. She was seeking esthetic treatment for her oral and perioral regions. The peculiarity of this case is simultaneous skin manifestation consistent with MAN, "tripe palms" (TP) and Leser-Trélat (LT) sign and mucosal changes in the oral cavity such as papillomatosis and roughened surfaces of the lips, hard palate and buccal mucosa. These changes harbored gastric adenocarcinoma stage T3 N3, but the patient was asymptomatic except for pruritis. CONCLUSION: There is an urgent need to suspect a correlation between oral and skin changes and the possibility of an internal neoplasia, therefore it is of utmost importance to refer these patients for early diagnosis of the underlying disease. This would improve the prognosis and lessen the consequences to a great extent.

Evaluation of correlation between transcription factors and IL-17 in oral and cutaneous lichen planus lesions and Leukocytes.

BACKGROUND: Lichen planus (LP) is a chronic autoimmune disease with different clinical subtypes including cutaneous LP (CLP) and oral LP (OLP). We aimed to compare mRNA expression of RORγt and IL-17 in paraffin-embedded blocks of OLP and CLP lesions with normal oral mucosa (NOM), and also its correlation with hematologic parameters. MATERIALS & METHODS: This study included 89 paraffin-embedded blocks contain OLP (44 cases), CLP (45 cases) and NOM from the archive of Mashhad University of Medical Sciences, Mashhad, Iran. The expression of RORγt and IL-17 was evaluated by Real-time RT-PCR method. The result was compared to Leukocyte counts and the other hematological parameters of studied patients. RESULTS: The results of our study showed IL-17 and RORγt expression in OLP lesions were significantly higher than CLP and NOM groups (P = 0.001). Although we found high expression of RORγt and IL-17 in erosive OLP in compared to classic OLP lesion, but this increment was not significant for IL-17 (P = 0.26) and RORγt (P = 0.14). Further, Leukocyte and monocyte counts were substantially high in OLP group in compared to the CLP and NOM groups (P < 0.05). CONCLUSIONS: We concluded that increased expression of RORγt and IL-17 in LP lesions could play role in the pathogenesis of LP. As well, higher expression of RORγt and IL-17 in oral LP more than cutaneous LP might be associated with difference in clinical behavior of the two types of disease and role of these factors in premalignant behavior of OLP lesions.

The diagnostic value of the native fluorescence visualization device for early detection of premalignant/malignant lesions of the oral cavity.

PURPOSE: The present study aimed to determine the diagnostic value of a native fluorescence visualization device in the identification of oral malignant/dysplastic lesions. METHODS: This study involved 45 patients who had oral lesions that were suspected to be malignant, potentially malignant, or benign. The patients visited the Oral Medicine Department of the Mashhad Dental School. The sensitivity, specificity, positive and negative predictive values, and likelihood ratio of this device were determined. RESULTS: The histopathological assessment of samples showed 9 cases of oral squamous cell carcinoma and 12 lesions with dysplasia. Ten samples of dysplastic lesions and all malignant lesions appeared dark or red/orange when examined with the native fluorescence visualization device. In 90% of the dysplastic/malignant lesions, the label-free fluorescence results were positive. The sensitivity, specificity, and positive and negative predictive values of this device were 90%, 15%, 40%, and 71%, respectively. CONCLUSIONS: The native fluorescence visualization device can be used in specialized centers as an adjunctive device to increase the sensitivity of a clinical examination, but is not capable of distinguishing benign lesions from malignant and dysplastic ones due to its low specificity.

The association between oral lichen planus and hepatitis C virus infection; a report from northeast of iran.

BACKGROUND: The association between hepatitis C virus (HCV) infection and oral lichen planus (OLP) has been the focus of many studies. Fifteen percent of HCV infections lead to sets of extrahepatic manifestations including lichen planus (LP). The prevalence of HCV is heavily influenced by geographical location. OBJECTIVES: This study aimed to evaluate the relationship between OLP and HCV infection in Mashhad, northeast of Iran. MATERIALS AND METHODS: Blood samples were taken from 134 OLP patients and 134 healthy controls (without OLP) to screen for anti-HCV by ELISA (third generation) and reverse transcription polymerase chain reaction (RT-PCR) for HCV-RNA. RESULTS: Of the 134 OLP patients only three (2.23 %) had HCV infection where both anti-HCV and HCV-RNA were positive. All controls were negative for both anti-HCV and HCV-RNA (P = 0.082). CONCLUSIONS: Our investigation illustrated that the prevalence of hepatitis C was higher among OLP patients compared to the control group. These findings are in line with previous results that reported a hepatitis C prevalence of 0.19% among the general population of Mashhad.

A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus.

Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (TRIAL REGISTRATION NUMBER: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.

Effect of cedar honey in the treatment of oral lichen planus.

INTRODUCTION: Oral Lichen Planus (OLP) is a chronic mucocutaneous disease with an immunological etiology. This study was conducted to evaluate the effect of cedar honey in the treatment of erosive- atrophic OLP. MATERIALS AND METHODS: Thirty patients with a confirmed clinical and histopathologic diagnosis of OLP participated in this randomized clinical trial in Mashhad Dental School. Patients were randomly allocated into one of two groups. Both groups received standard OLP treatment (dexamethasone mouthwash 0.5 mg three times daily and fluconazole capsule 100 mg daily). The intervention group received cedar honey (20 ml three times daily, via a swish and swallow technique) in addition to standard treatment. The patients were followed for 4 weeks. The pain and severity of the lesions were recorded at the initial visit and follow ups. All recorded data were analyzed using the chi-square test, T-test, and analysis of variance (ANOVA) using SPSS version 11.5. A p-value less than 0.05 was considered significant. RESULTS: Both groups had a marked reduction in pain, size of erosive area, and atrophic lesions, particularly in the first follow-up period, but there was no significant difference between the two groups (P>0.05). Honey was effective in the healing of ulcerative lesions (average recovery in the experimental group was 69% while the average relief of ulcerative lesion in the control group was 50%), but the difference was not significant (P=0.896). CONCLUSION: No significant difference was found in the treatment of atrophic and erosive lesions of OLP through use of honey as an alternative treatment. However, this approach may be effective in managing ulcerative lesions of OLP; although more research with a larger sample size is necessary.

Survey of reactive hyperplastic lesions of the oral cavity in mashhad, northeast iran.

BACKGROUND AND AIMS: Reactive hyperplasias (RHs) are common oral mucosal lesions caused by irritation of the mu-cosa. The aim of this study was to evaluate the frequencies of various types of oral RHs in a university clinic. MATERIALS AND METHODS: Oral RH cases, undergone biopsy in a four-year period, were studied retrospectively. Data including age and gender as well as the location and clinical characteristics of the lesion were collected and analyzed. RESULTS: A total of 123 cases (age range 7-79 years old; mean: 38.8 ± 18.50 years; male: female ratio, 1.9:1) were evalu-ated. Over a half of the lesions including pyogenic granuloma, giant cell granuloma, and peripheral ossifying fibroma were found in gingiva (52%). Fibroma involved mostly the buccal mucosa. Most lesions had smooth surface and sessile base. CONCLUSION: The clinical features of oral inflammatory hyperplasia in the studied sample were similar to those previously reported.

Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer.

OBJECTIVES: To determine diagnostic value of modified Liquid Based Brush Biopsy technique. STUDY DESIGN: 26 oral premalignant and malignant lesions in 25 patients (12 females; 54.23+/-19.77 years and 13 males; 53.77+/-15.43 years) underwent Modified (Liquid Based) Brush Biopsy and scalpel biopsy simultaneously from the same area. RESULTS: There were 16 positive and 10 negative brush biopsy results, with no inadequate readings. Histological findings were compatible with oral leukoplakia (n=5) with dysplasia, Oral lichen planus and lichenoid reaction (n=7) (with or without dysplasia) oral squamous cell carcinoma (n=11),verrucous carcinoma (n=1) and granular cell tumors (n=2). Sensitivity, specificity, positive predictive value, negative predictive value, positive diagnostic likelihood ratio (LR+) and negative diagnostic likelihood ratio (LR-) were 88.8%, 100%, 100%, 80%, infinity and 0.11 respectively (no false positive results). CONCLUSION: It is the first attempt to do LBC with a specialized oral brush. Our results show that modified technique is a useful tool for screening of oral premalignant and malignant lesions.