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Concept: Aphthous ulcer

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BACKGROUND: Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. METHODS: Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 +/- 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. RESULTS: Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). CONCLUSION: We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

Concepts: Interferon, Hepatitis C, Candida albicans, Candidiasis, Aphthous ulcer, Oral pathology, Lichen planus, Stomatitis

28

BACKGROUND:: Patients with Celiac Disease (CD) have a wide variety of symptoms, from being asymptomatic to having chronic diarrhea, abdominal pain and extra-intestinal symptoms. In the oral cavity, enamel defects and recurrent aphthous stomatitis are the most common symptoms. AIM:: To assess oral health, bacterial colonization and salivary buffering capacity of patients with CD at diagnosis were compared with CD patients on gluten free diet (GFD) and healthy children. METHODS:: Three groups were prospectively investigated: newly diagnosed celiac disease, celiac disease treated with GFD and a control group. All children were examined by pediatric dentists and saliva samples were collected for bacterial and pH analysis. RESULT:: Ninety children were enrolled in the study, thirty in each group. A higher prevalence of enamel hypoplasia (66%) was found in celiac children. Plaque Index was significantly lower in the celiac treated group, which correlated with oral health behavior: teeth brushing and frequency of eating between meals. Children on GFD brushed their teeth and used fluoride significantly more often than other children in the study. No difference between groups was found in snacks consumption, Mutans Streptococci and Lactobacilli counts in saliva, as well as pH and buffer capacity, CONCLUSIONS:: A lower degree of plaque was found in celiac children on GFD. This finding could not be explained by salivary properties or bacteria, but rather by better oral hygiene. The results should raise the awareness of pediatric gastroenterologists to oral health related issues in children with CD.

Concepts: Bacteria, Wheat, Crohn's disease, Buffer solution, Coeliac disease, Gluten, Aphthous ulcer, Gluten-free diet

27

Microstomia is a term used to describe a small oral aperture. Most of the reported cases are caused by scar contracture after facial trauma, burn injury, and tumor excision. We experienced a rare case of microstomia in a patient with antilaminin 332 mucous membrane pemphigoid, which was an acquired autoimmune disease and showed blisters and erosive lesions mainly on the mucous membranes. The patient had recurrent aphthous stomatitis and presented microstomia caused by scar contracture of oral mucosa. We surgically corrected microstomia by 5-flap Z-plasty for commissuroplasty and 2 Z-plasty of both upper and lower lips for an enlargement of oral aperture. The patient could achieve an enough oral aperture and was satisfied with the result. There was no recurrence of microstomia for 2 years.

Concepts: Mucous membrane, Oral mucosa, Aphthous ulcer, Lip, Stomatitis

23

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is considered the most common periodic fever syndrome of childhood. Although it was first described three decades ago, the pathogenesis has been poorly understood. Recent studies on the heritability and immunology of the disorder have begun to shed light into the mechanisms of this autoinflammatory disorder. This review will focus on the pathogenesis of PFAPA, especially as it pertains to the genetic susceptibility, tonsillar immunology, and the role of the microbiome.

Concepts: Immune system, Genetics, Immunology, Aphthous ulcer, Stomatitis, Periodic fever syndrome, Adenitis, Periodic fever, aphthous stomatitis, pharyngitis and adenitis

3

Neutrophils are essential for host defense at the oral mucosa and neutropenia or functional neutrophil defects lead to disordered oral homeostasis. We found that neutrophils from the oral mucosa harvested from morning saliva had undergone NETosis in vivo. The NETosis was mediated through intracellular signals elicited by binding of sialyl lewis(X) present on salival mucins to L-selectin on neutrophils. This led to rapid loss of nuclear membrane and intracellular release of granule proteins with subsequent NET release independent of elastase and NADPH-oxidase activation. The saliva-induced NETs were more DNase-resistant and had higher capacity to bind and kill bacteria than NETs induced by bacteria or by PMA. Furthermore, saliva/sialyl lewis(X) mediated signaling enhanced intracellular killing of bacteria by neutrophils. Saliva from patients with aphthous ulcers and Beh├žet’s disease prone to oral ulcers, failed to induce NETosis, but for different reasons, demonstrating that disordered homeostasis in the oral cavity may result in deficient saliva-mediated NETosis.

Concepts: White blood cell, Oral mucosa, Cell membrane, Neutrophil granulocyte, Elastase, Aphthous ulcer, Oral ulcer, Absolute neutrophil count

2

The syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA syndrome) is the most common cause of periodic fever in childhood. The current pharmacological treatment includes corticosteroids, which usually are efficacious in the management of fever episodes, colchicine, for the prophylaxis of febrile episodes, and other medication for which efficacy has not been proven so far. Tonsillectomy is an option for selected patients. Usually PFAPA syndrome resolves during adolescence, but there is increasing evidence that this condition may persist into adulthood.

Concepts: Aphthous ulcer

2

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder of unclear etiopathogenesis. Although recent studies of the oral microbiota by high-throughput sequencing of 16S rRNA genes have suggested that imbalances in the oral microbiota may contribute to the etiopathogenesis of RAS, no specific bacterial species associated with RAS have been identified. The present study aimed to characterize the microbiota in the oral mucosa and saliva of RAS patients in comparison with control subjects at the species level.

Concepts: DNA, Archaea, Bacteria, Oral mucosa, Ribosomal RNA, 16S ribosomal RNA, Aphthous ulcer, Stomatitis

1

Minor Recurrent Aphthous Stomatitis (RAS) represents a disease which is very difficult to prevent. This case-control study focused on possible associations between minor Recurrent Aphthous Stomatitis in children, their oral health, and underlying behavioral indexes of children’s attitudes and habits pertaining to (home) oral hygiene, with the further goal of enabling the dentist to prevent these specific kind of lesions, both from a clinical and a broader psychosocial perspective.

Concepts: Epidemiology, The Association, Aphthous ulcer, Stomatitis

1

Recurrent aphthous stomatitis (RAS) is a common disease of the oral mucosa with an unknown etiology. This study aimed to determine if food additives play a role in the etiology of RAS as well as to determine if patch testing can be used to detect which allergens cause RAS.

Concepts: Oral mucosa, Aphthous ulcer, Stomatitis

0

Diagnosis of Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is currently based on a set of criteria proposed in 1999 modified from Marshall’s criteria. Nevertheless no validated evidence based set of classification criteria for PFAPA has been established so far. The aim of this study was to identify candidate classification criteria PFAPA syndrome using international consensus formation through a Delphi questionnaire survey.

Concepts: The Canon of Medicine, Evidence-based medicine, Aphthous ulcer, Oral ulcer, Stomatitis, Periodic fever syndrome