Oral Health-Related Quality of Life in Patients with Dystrophic Epidermolysis Bullosa

Background: Dystrophic epidermolysis bullosa (DEB) is a devastating mucocutaneous inherited disorder that can have a remarkable impact on the oral cavity. Objective: To understand the relationships between oral health-related quality of life and general quality of life in DEB patients versus a control group. Methods: Twenty-eight DEB patients and 26 healthy individuals completed the following battery of scales: Oral Health Impact Profile (OHIP-49), RAND Short Form-36 (SF-36), Hamilton Rating Scale for anxiety (HAM-A) and depression (HAM-D). Results: All 7 dimensions in OHIP-49 demonstrated significant difference in functional limitations (Median:13.0; IQR:10.3-20.0 vs Median:7.0; IQR:2.0-9.0; p<0.001) and physical disability (Median:11.5; IQR:4.0-15.0 vs Median:0.0; IQR:0.0-2.3; p<0.001) in DEB patients vs controls, respectively. In SF-36, physical functioning and general health were highly significant (p<0.001), whereas limitation due to physical health (p=0.043) and pain (p=0.010) were moderately significant. A positive correlation was found between oral health-related quality of life and anxiety (p=0.005 and p=0.03 in DEB patients and controls, respectively) and depression (p=0.045 and p=0.001 in DEB patients and controls, respectively). In DEB patients, no correlation was found between general quality of life and anxiety/depression, oral health-related quality of life and oral-pharyngeal severity score, number of oral-pharyngeal sites involved and general quality of life, as well as oral health-related quality of life between patients with dominant and recessive DEB forms (p>0.05). Conclusions: The oral health-related quality of life is highly impaired in patients with DEB. General quality of life was affected only for some dimensions and was not correlated with oral health-related quality of life.

Dermoscopic Evaluation Improves Clinical Diagnosis of Oral Melanotic Macules: A Study in 50 Patients with Oral Pigmented Lesions

BACKGROUND: Dermoscopy is a non-invasive in vivo method rarely used for the diagnosis of oral pigmented lesions. OBJECTIVE: To analyze clinical, dermoscopic, and histologic features of Oral Melanotic Macules (OMMs), and to evaluate the usefulness of dermoscopy in the diagnosis of OMMs. METHODS: Fifty patients presenting solitary or multiple circumscribed pigmented lesions in the oral mucosa were included. RESULTS: OMMs were diagnosed in 19 patients (84% women and 16 % men); 52 % of patients had multiple lesions, 48% had one lesion. Lesion sites in decreasing order of frequency were the labial mucosa (63 %), gingiva (31.57 %), cheek mucosa (26.31%), labial semimucosa (21%), palate (10.52 %), alveolar ridge (5.26 %) and tongue (5.26 %). The dermoscopic pattern of OMMs was linear in 89 % of cases (47% parallel line, 35% fish scale-like, and 17% hyphal patterns). Histological analysis showed increased melanin in the basal cell layer in all cases with a linear dermoscopic pattern, slight acanthosis in 14 cases, and a slight increase in number of basal melanocytes in 13 cases. Globules were seen in 21% of cases corresponding histologically with increased melanin or melanophages in the lamina propria. The dermoscopic observation of symmetrical lines further enhances the diagnostic ability of dermoscopy in OMMs, with 73.68% sensitivity, 87.1% specificity, 77.78% positive predictive value, 84.38 % negative predictive value, 5.71 positive likelihood ratio, and 0.30 negative likelihood ratio. CONCLUSIONS: Dermoscopy may play a role in improving noninvasive diagnosis of oral pigmented lesions occurring on several areas of non-keratinized mucosa.

Correlation between Loss of E-cadherin, Matrix-metalloproteinases and c-Jun expression in Oral Carcinogenesis

Background: Earlier invitro studies have observed that loss of E-cadherin is responsible for progression and metastasis of cancer by upregulation of c-Jun protein. There being lack of simultaneous evaluation of matrix metalloproteinase (MMP) -2 and -9, E-cadherin and c-Jun mRNA and protein. Objective: This study aimed to correlate the above-mentioned parameters to evaluate the pathway of oral carcinogenesis. Methods: The study included 100 controls, 50 patients with oral precancerous conditions (OPC) and 100 oral cancer patients. MMPs were evaluated by gelatin zymography, ECAD and CJUN mRNA and protein expression by semi quantitative RT-PCR and western blot respectively. Results: The levels of active and total MMP-2 and MMP-9 were significantly higher in patients with OPC and oral cancer patients as compared to controls. A significant increase in truncated E-cadherin and c-Jun protein was observed in malignant tissues as compared to adjacent normal tissues while CJUN mRNA levels were comparable. Higher values of c-Jun protein and MMPs, and lower values of ECAD mRNA were associated with reduced overall survival. A positive correlation was observed between truncated E-cadherin, MMPs and c-Jun protein. Conclusions: MMPs modulate cell-cell adhesion by increasing truncation of E-cadherin resulting in loss of E-cadherin which is responsible for upregulation of c-Jun protein in oral cancer.

Temporomandibular Disorders in Patients Undergoing Mandibular Advancement Device Therapy for Obstructive Sleep Apnea: A Systematic Review

Background: Mandibular advancement device (MAD) therapy is a popular and effective treatment for snoring and obstructive sleep apnea (OSA). However, there have been several reports in the literature of patients developing temporomandibular disorders (TMDs). Objective: The objective of this review is to evaluate the prevalence of TMD, both in the initial phase of therapy and at follow up appointments, amongst patients wearing a MAD for OSA. Methods: The authors conducted a systematic review of published articles in which the presence of TMDs in patients undergoing MAD therapy for OSA was investigated. Eligible studies met the following criteria: a diagnosis of TMD following mandibular advancement using a custom-made and titratable MAD using either the Diagnostic Criteria for TMD (DC/TMD), Helkimo Anamnestic Dysfunction Index or reproducible clinical signs/symptoms. Results: The average prevalence of TMD during the initial phase of MAD therapy was found to be 25%. The prevalence of TMD reduced in the follow up periods. The adherence to MAD, especially long term, appears to be variable and from our results, it appears an average of 20% of patients discontinue MAD therapy over six to one hundred and twenty months, and this number has been reported to be as high as 62.5%. Conclusions: There was some difficulty in comparing the studies due to the differences in follow up time, methodology, sample size and diagnostic criteria. Longer clinical follow-up studies, with an objective method of monitoring patient adherence and with a larger sample size are needed to evaluate the long-term effects of MADs