The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies.

Oral mucositis (OM) is a common, highly symptomatic complication of cancer therapy that affects patients' function, quality of life, and ability to tolerate treatment. In certain patients with cancer, OM is associated with increased mortality. Research on the management of OM is ongoing. Oral mucosal toxicities are also reported in targeted and immune checkpoint inhibitor therapies. The objective of this article is to present current knowledge about the epidemiology, pathogenesis, assessment, risk prediction, and current and developing intervention strategies for OM and other ulcerative mucosal toxicities caused by both conventional and evolving forms of cancer therapy.

Clinical therapeutic effects of topical agents in adult patients with human immunodeficiency virus-related oral mucosa ulcers: A protocol for systematic review and meta-analysis.

BACKGROUND: The number of adult patients affected by the human immunodeficiency virus (HIV) still remains high, mainly in the developing countries. However, only a few affected patients fail to experience oral lesions in the course of their experience with the virus. In particular, oral mucosa ulcers detected among HIV patients may be severe, which depictions may inhibit oral functioning and change patients' quality of life. Thus, it can result in considerable morbidity among this group of patients. To this end, the present study aims to examine the topical agent's clinical therapeutic efficacy among adult patients suffering from HIV-related oral mucosa ulcers. METHODS: For the investigation, only randomized controlled trials on any topical agent used to treat adult patients with HIV oral mucosa ulcers are to be explored from different databases: PubMed, the Cochrane Library, PsycINFO, EMBASE, SCOPUS, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP, and WanFang databases. All databases will be searched from their inceptions to October 2020. Additionally, 2 independent authors will evaluate the possibly eligible studies to be included in the study. They will also perform data's trial extraction and risk of bias assessment. Accordingly, all data will be analysed by means of the RevMan 5.3 software. RESULTS: The present study seeks to evaluate the topical agents' clinical therapeutic efficacy to treat adult patients with HIV-related oral mucosa ulcers. CONCLUSION: The study can be applicable in providing evidence of any topical agents for treating adult patients with HIV-related oral mucosa ulcers for clinical practice. PROTOCOL REGISTRATION NUMBER: DOI 10.17605/OSF.IO/5CYR2 (https://osf.io/5cyr2/).

The Patients' Beliefs Regarding the Role of Food, Mucosal Trauma, Menstruation, and Psychological Stress in the Recurrence of Behçet's Disease Symptoms.

Behçet's disease is a systemic vasculitis. Mucocutaneous involvement is the most prominent finding, but triggering factors are not well-known. We decided to assess the beliefs of patients with Behçet's disease regarding the potential role of food, mucosal injury, menstruation, and stress in the appearance of symptoms. In this cross-sectional study, 60 patients with Behçet's disease who fulfilled the International Study Group criteria for Behçet's disease and referred to the outpatient Behçet's clinic of Motahari, affiliated to Shiraz University of Medical Sciences, were included. A questionnaire was designed by the research team consisting of the rheumatologist involved in the study, two dietitians, and a psychiatrist. The patients were interviewed face-to-face to fill in the questionnaire. The assessed variables were all food categories, menstruation, psychological stress, and oral mucosal injury as the potential triggers of symptoms onset. The most common foods reported as triggers for oral ulcers were eggplant (78.3%), melon (68.3%), walnut (68.2%), and cantaloupe (66.7%). Walnut was reported by three patients (5%) as the most common trigger for genital ulcers. Nervous tension (83%) and annoying arguments (45%) were the two most common psychological stress triggers for oral ulcers. Seven patients (11.7%) reported tooth brushing, as the trigger for oral ulcers. The irregular menstrual cycle was a trigger for oral ulcers in only two patients. Food items such as eggplant, walnut and melon were common self-reported triggers for mucocutaneous lesions in patients with Behçet's disease. Nervous tension and annoying arguments were also common psychological triggers for oral aphthous ulcers.

BET 2: Does topical lidocaine improve oral intake in children with painful mouth ulcers?

A shortcut review was carried out to establish whether topical lidocaine was effective at reducing pain and improving oral intake in children with painful oral lesions. 34 papers were found using the reported searches, of which two presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these two papers are tabulated. It is concluded that in otherwise healthy paediatric patients with painful oral ulcers, treatment with viscous lidocaine does not improve oral intake, although it may provide some pain relief.

[Analysis of the incidence of recurrent oral ulcer and the relationship with type A personality in medical college students].

PURPOSE: To explore the incidence of recurrent oral ulcer and the relationship with A personality, and to provide evidences for making strategies for oral health education and premunition in universities. METHODS: Stratified cluster sampling was used to select 492 college students in Gannan Medical University. They were investigated with the question about occurrence of recurrent oral ulcers in the past year and the questionnaire of type A behavior. The data were analyzed by descriptive statistics, Chi-square test, t test and Logistic test using SPSS 19.0 software package. RESULTS: The results showed that only 109(22.15%) students had no recurrent oral ulcer. The proportion of type A personality students were significantly higher than M and type B students. Students with or without recurrent oral ulcer in the past year had significant difference in TH+CH(t=4.596，P<0.001),TH (t=4.145，P<0.001), CH(t=3.781，P<0.001).The risk factors of recurrent oral ulcer with college students was type A personality(OR=2.322，CI=1.355-3.980，P=0.002). CONCLUSIONS: College students have a higher incidence of recurrent oral ulcer. Type A personality is one of the important factors for recurrent oral ulcer in college students.

Oral Health Quality of Life in Children with Cerebral Palsy: Parental Perceptions.

OBJECTIVE: To assess the parents' perception of the oral health-related quality of life (OHRQOL) in children with Cerebral Palsy (CP) and compare it with normally developing children. STUDY DESIGN: 63 children with CP were recruited from 8 disability centers, and 99 healthy controls were recruited from 5 elementary schools. The ages of the children in both groups were from 6-12 years. The Franciscan Hospital for Children Oral Health-Related Quality of Life (FHC-OHRQOL) was used to measure the OHRQOL and an oral examination was conducted in the schools/centers of the children to assess the teeth, gingival health, and oral hygiene. RESULTS: The FHC-OHRQOL showed a significant difference in 3 out of 4 sections indicating lower OHRQOL in the CP group. The examination showed no significant difference in the dental and gingival health and in the level of oral hygiene. CONCLUSION: The OHRQOL of children with CP is significantly lower than that of normally developing children although the oral health status of children with CP is not significantly different from that of normally developing children.

Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan.

BACKGROUND: Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan. METHODS: The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants' socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable. RESULTS: All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores. CONCLUSIONS: Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

'Surviving the sting': the use of solicited diaries in children and young people with oral mucosal disease.

BACKGROUND: Chronic oral mucosal conditions, including oral ulcers, commonly affect children and young people and are capable of significant pain and morbidity. Little is known about patient perception of paediatric oral medicine services offered in relation to these conditions. The concept of a diary is increasingly recognised as a valuable way to capture patient events and perspective in healthcare research. AIM OF THE PAPER: This article provides the background to the use of solicited diaries as a method of accessing the perspective of children and young people and describes a service evaluation that aimed to explore the experiences of young people with chronic oral ulcers attending the paediatric oral medicine clinic in a UK Dental Hospital. RESULTS: Chronic oral ulcers were found to significantly impact on a variety of physical and psychosocial aspects of young people's lives. Overall, feedback regarding the specialist service was positive but suggestions were made for improvements. CONCLUSION: This article reviews the use of the solicited diary within healthcare research. It also illustrates the value of the diary in exploration of children and young people's perspective on their chronic oral mucosal disease. In addition, a need for further research in this area has been highlighted.

Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and their influence on anxiety, depression and somatisation: a comparative study.

OBJECTIVES: In this study we evaluated the frequency of autoimmune rheumatic disease associated major symptoms in fibromyalgia (FM) patients, and the association between their presence and anxiety, depression and somatisation. METHODS: Two hundred and thirty-two FM, 78 systemic lupus erythematosus (SLE) patients and 70 healthy controls were included. All subjects were questioned face-to-face for the presence of autoimmune rheumatic disease-associated symptoms and antinuclear antibody (ANA) was determined. All FM patients were questioned for the severity of pain and symptoms of FM by using a visual analogue scale. In addition, all subjects were interrogated for anxiety, depression, somatic symptoms and neuropathic pain by using different validated questionnaires. RESULTS: FM patients had significantly higher frequency of photosensitivity (27.6% vs. 11.4%) and Raynaud phenomenon (22% vs. 10%) when compared to controls (p-values, 0.005 and 0.026). FM patients had significantly lower frequencies of photosensitivity, oral ulcers, xerostomia, and xerophthalmia than SLE patients (all p-values <0.001). ANA positivity was 11.8% in FM patients and 7.1% in healthy controls. ANA-positive and negative FM patients had similar frequencies of autoimmune rheumatic disease symptoms. FM patients with photosensitivity had higher anxiety (p=0.002), somatic symptoms (p=0.015) and neuropathic pain (p=0.03) scores than others. FM patients with Raynaud had higher anxiety (p=0.004), depression (p=0.001), somatic symptom (p<0.001) and neuropathic pain scores than others. CONCLUSIONS: The presence of which findings in FM seems to be associated with anxiety, depression, and somatization rather than ANA positivity and disease severity.

Influence of oral mucosal lesions and oral symptoms on oral health related quality of life in dermatological patients: a cross sectional study in Sudan.

BACKGROUND: There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan. METHODS: A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50% females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms. RESULTS: An oral impact (OIDP > 0) was reported by 190 patients (35.6%) (mean OIDP total score 11.6, sd=6.7). The prevalence of any oral impact was 30.5%, 36.7% and 44.1%, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with>1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95% CI 1.9-4.5), 2.3 (95% CI 1.5-3.5), 1.8 (95% CI 1.1-3.2) and 6.7 (95% CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP. CONCLUSION: OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.

Awareness of oral cancer in the Mersey region.

The purpose of this study was to assess the levels of awareness and knowledge about oral cancer in the Liverpool area. This included the awareness of oral cancer compared to other cancers, risk factors, symptoms and where people would go to seek advice in the event of experiencing oral cancer symptoms. Five hundred and thirty-five people agreed to take part in a street survey that was done in four locations (Liverpool city centre, Bootle, Crosby, and Southport). A quota sampling approach was used to achieve a reasonable balance by sex, age, and locality. When asked without prompting to name all the cancers they had heard of, oral cancer was stated first by only 1%; it was given within the first three responses by 4%, and by 11% overall. Cervical cancer was mentioned without prompting by 22%, and two-thirds thought that it was more common than oral cancer. When asked without prompting 74% were aware that smoking could be a likely cause, but only 21% mentioned alcohol. Without prompting, 35% said that a non-healing mouth ulcer was a symptom of oral cancer. When asked without prompting what they would do if a painful mouth ulcer had lasted for more than three weeks, 61% said they would see their doctor and 27% their dentist, which is encouraging.

Eosinophilic ulcer: the role of stress-induced psychoneuroimmunologic factors.

INTRODUCTION: Eosinophilic ulcer (EU) is a rare pathology and its etiology is still slightly known. It is a benign lesion characterized by fast-growing ulceration with elevated and indurated borders, most commonly affecting the tongue. CASE REPORT: The authors describe a case of EU on a lingual border that was initiated and had its clinical behavior altered by the psychological stress the patient was experiencing. DISCUSSION: This paper discusses the stress effects that alter the individual's immunologic response, thus attracting mast cells and eosinophils towards the mucosal epithelium, which are involved in eosinophilic ulcer. The authors make an association between eosinophilic ulcer and atopic dermatitis, two diseases that appear to have a similar, though not fully defined, etiology. The psychological stress factor was considered a predisponent factor for eosinophilic ulcer etiology and its interference in the etiology and evolution of this disease should be considered.

Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective.

Patients with oral and oropharyngeal cancer (OOC) often delay presenting to their doctor or dentist. The aims of this study were to ask a consecutive cohort following treatment for OOC about their initial symptoms and the time spent before presentation to the healthcare profession. Also to discover their views on how to reduce delays in presentation. From a 2-year cohort treated within 2 years, 71 completed a short survey and 44 were subsequently interviewed by telephone. A non-healing ulcer or sore was the commonest symptom patients first related to having cancer. Around half interpreted their symptoms as something minor, staying much the same initially, and something that probably would get better by itself. Most would have sought advice earlier if they had been more aware of oral cancer. Although many patients talked about their symptoms to spouse, partner, family or friends, over one-third said they spoke to nobody about it. Our sample did not find that access to a doctor or a dentist was a barrier to seeking advice. This study highlights that from the patients perception they generally thought their symptoms were trivial, would get better by themselves and gave little thought as to whether it might be cancer. Patients commented they knew nothing more about the disease. In their views the best way to get patients to self refer earlier was through improved awareness of the disease, as many felt there was a gross lack of knowledge in this field of cancers compared to other cancers.

Facticia en niños y adolescentes manifestaciones bucales: revisión de la literatura / In children and adolescents factitious oral manifestations: a review of the literature

Las lesiones facticias constituyen un gran número de traumas físicos, que pueden presentarse en niños y adolescentes, bien sea sanos o con padecimientos psiquiátricos de diversos órdenes. El común denominador en todas estas afecciones, es la originada por autoagresión del paciente, dando como resultado lesiones ulcerativas, tumorales y otras formas de agresiones inducidas de manera traumática. Esta revisión pretende analizar las características clínicas más frecuentes de dichas lesiones, con la finalidad de realizar correctos diagnósticos y descubrir su posible etiología para establecer correctos tratamientos de los mismos, a la vez de orientar a los pacientes de posibles autoagresiones

Facticial lesions are the most common physical trauma that we can found in children and adolescents, healthy or suffering from various psychiatric orders. The most common lesions can be originated by auto aggression, resulting ulcerative, tumoral, and other forms of aggressions of traumatically induced.This investigation want to analyze the most frecuense characteristic of this lesions, to have more correct diagnoses, found the etiology, and do right treatments, at a time to guide pacients of possible self- aggression

Factitial pemphigus-like lesions.

The maxillofacial region is rarely subjected to self-inflicted conditions such as factitious disease. Nasal ulceration, facial emphysema, periorbital ecchymosis, mandibular subluxation, gingival and mucosal ulceration, dental and salivary gland pain and glossopharyngeal neuralgia have been reported as possible manifestations of factitious disease. We report a case of a young woman who presented with unilateral bullous and ulcerative oral and erythematous facial lesions that were initially diagnosed as pemphigus vulgaris but was later determined to be secondary to self-inflicted injuries. To the best of the authors knowledge, this clinical scenario has not been previously reported in the context of a factitious disease and, therefore, may be considered in the differential diagnosis of oral vesiculobullous disorders.

Factitial pemphigus-like lesions

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The maxillofacial region is rarely subjected to self-inflicted conditions such as factitious disease. Nasal ulceration, facial emphysema, periorbital ecchymosis, mandibular subluxation, gingival and mucosal ulceration, dental and salivary gland pain and glossopharyngeal neuralgia have been reported as possible manifestations of factitious disease. We report a case of a young woman who presented with unilateral bullous and ulcerative oral and erythematous facial lesions that were initially diagnosed as pemphigus vulgaris but was later determined to be secondary to self-inflicted injuries. To the best of the authors’ knowledge, this clinical scenario has not been previously reported in the context of a factitious disease and, therefore, may be considered in the differential diagnosis of oral vesiculobullous disorders

Self-reported toothache experience in an adult population in Benin City, Edo State, Nigeria.

PURPOSE: This pilot study was conducted to estimate the prevalence of self-reported toothache, bleeding gums and oral ulcer experiences, reasons for dental visits and associated sociodemographic factors among adults living in Benin City, Edo State, Nigeria. MATERIALS AND METHODS: This cross-sectional study was based on a convenience sample in an urban setting. Out of the 540 persons surveyed, 508 had complete usable information, 48% males and 52% females, and aged 18 - 54 years. A closed questionnaire was used to collect the data at two large medical outpatient facilities and a university community. RESULTS: The proportion reporting toothache experience in the previous 12 months was 34%; painful/ bleeding gums 28%, and oral ulcers/painful spots 14%. Univariate analysis showed that toothache experience was associated with time since last dental visit (p < 0.001), age (p < 0.001), gender (p < 0.001) and education (p < 0.001). Experience with bleeding gums was associated with gender (p < 0.001), education (p < 0.001) and last dental visits (p < 0.001). Oral ulcers were associated with gender (p = 0.004), age (p < 0.001) and last dental visits (p < 0.001). Fewer males than females reported toothache (25% vs. 42%, OR 1.65) but more males reported bleeding gums (37% vs. 19%, OR = 0.34) and oral ulcers (19% vs. 10% OR = 0.33). CONCLUSIONS: Toothache experience was the most prevalent oral health problem reported by adults. Oral health problems were associated with age, gender and last dental visits.

Alteraciones psicológicas en la etiopatogénesis de patología de la mucosa oral / Psychological disorders in the etiopathogenesis of the oral mucous pathology

El liquen plano oral, la úlcera recurrente oral y el síndrome de boca urente son tres entidades patológicas de la mucosa oral que se caracterizan por tener una etiología multifactoral y por ser de difícil manejo terapéutico en cuanto a lograr un tratamiento que resuelva el padecimiento. Uno de los factores que probablemente juegue un rol en el desarrollo de estas patologías es el estado psicológico del paciente a través de alteraciones tales como el estrés, ansiedad, depresión. La consideración de aspectos psíquicos en el desarrollo de lesiones de la mucosa oral está sustentada por diversas investigaciones, tanto clínicas como de laboratorio, aunque ninguna ha sido absolutamente concluyente. Sin embargo las evidencias logradas abren una nueva perspectiva tanto en la comprensión de la etiopatogénesis de estas enfermedades como en su prevención y manejo terapéutico