Research Articles (Oral Medicine and Periodontics)
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Item Oral medicine case book: epidermolysis bullosa acquisita(South African Dental Journal, 2018) Negi, Marwa Milad; Mulder-van Staden, Sune; Holmes, Haly; Jeftha, AntheaA 49-year-old female was referred from the Dermatology department to the Oral Medicine Department at the University of the Western Cape (UWC), Oral Health Center, Tygerberg campus. The patient complained of a sore mouth and difficulty In brushing her teeth. She had been diagnosed with epidermolysis bullosa acquisita (classical type) 12 years ago and was being managed by her Dermatologist with topical and systemic steroids (Dovate® ointment and 10mg prednisone daily). The extra oral examination revealed extensive sloughing of the skin of the hands, chest and back. The hands showed atrophic scarring, skin fragility and nail loss on numerous fingers, which also demonstrated restricted movement (Figures 1,2). The patient had malted mouth opening because of scarring related to repeated episodes of ulceration (Figure 3) and poor oral hygiene. Her gingiva was Inflamed (Figure 4). The middle to anterior dorsal surface of her tongue was atrophic, smooth and erythematous, while the posterior dorsal tongue had white yellowish plaques (Figure 5). The orthopantomogram demonstrated multiple carious teeth with generalised, severe horizontal boneless (Figure 6). An appointment was scheduled for a scaling as well as extraction of root remnants and teeth with a hopeless prognosis. The patient was booked for a follow-up at the Oral Medicine and Periodontology Department two weeks later, but failed to return for her appointment.Item Diabetic status of patients presenting for dental treatment(South African Dental Journal, 2018) Negi, Marwa Milad; Holmes, Haly; Stephen, LXGIntroduction: Untreated Diabetes mellitus (OM) has severe long-term complications. In 2008, DM affected 4.6% of the South African population. Glycemic status is an indicator of the blood glucose levels. Aim and objectives: To assess the glycemic status and presence of intra-oral soft tissue lesions in a sample of patients presenting at UWC Maxiliofacial outpatient clinic. Design and Methods: A cross-sectional observational study was carr1ed out on 400 adult patients, 18 years or older. Pregnant patients were excluded. Random blood glucose levels (RBG) were measured in mmoVL on samples of peripheral blood (finger prick) using a glucometer. Results: Of the 400 patients, 51 (12.7%) were either known diabetic patients or newly diagnosed (prediabetic Md diabetic) and 15 (20.4%) of these 51 patients were unaware of their status (undiagnosed). Of the diabetic patients (n=40). 17 (42.5%) had soft tissue lesions. which occurred in 137 of the 340 patients having normal blood glucose levels (39.2%). Oral candidiasis was seen in 25% (n=10) of diabetic patients, compared with the prevalence of 18.3% amongst those with normal blood glucose levels (n=64 out of 349). Conclusion: The study supports the need for general screening of all patients to facilitate early diagnosis of this disease.Item BRAF p.V600E-negative langerhans cell histiocytosis associated with a periapical cyst: a case presentation with broad review of the differential diagnosis and disease pathophysiology(Springer, 2025) Odendaal, Anneze; van Rensburg, Leon Janse; Afrogheh, Amir HBackground: Langerhans cell histiocytosis (LCH) rarely presents in the oral and maxillofacial region, and while isolated and small collections of Langerhans-type cells have been found in periapical cysts, there have been no reported cases of LCH arising in periapical cysts. Methods: A 58-year-old female presented with isolated erythematous dry skin lesions and a radiolucent lesion of the anterior maxilla. Microscopic examination of the enucleation specimen revealed a periapical cyst with large collections of atypical cells with grooved folded nuclei with eosinophils consistent with LCH. Immunohistochemistry (IHC) was performed to confirm the diagnosis. BRAF mutation status was evaluated with the BRAF p. V600E antibody and the automated real-time PCR-based Idylla™ assay, capable of qualitative detection of 5 mutations in codon 600 of the BRAF gene. Results: The LCH cells were positive for S100, CD1a, and Langerin (CD 207) and negative for BRAF p. V600E mutations. Ki-67 was 45%. Conclusion: The association of LCH with a periapical cyst could be explained by the active surveillance and migration of neoplastic Langerhans-type cells in blood to the site of apical chronic inflammation, in a patient with LCH. Careful attention to morphologic features in conjunction with Langerin IHC, helps exclude other closely-related dendritic tumours. BRAF p. V600E testing, ideally with real-time PCR assays, can help identify patients who may benefit from BRAF inhibitor therapies. New generations of sequencing that cover a large panel of genetic alterations beyond the frequent BRAF p. V600E mutations (e.g. rare in-frame BRAF deletions), could provide valuable information about the extent, prognosis and treatment of LCH patients. © The Author(s) 2025.Item Exploring optimal methods for age-at-death estimation using pulp/tooth area ratios: a South African study(Springer Science and Business Media Deutschland GmbH, 2024) Kotze, Daniël; Phillips, Vincent M.; Mole, Calvin G.Age-at-death estimation is pivotal in the identification of unknown human decedents in forensic medicine. The pulp/tooth area ratio (PAR) method, assessing pulp cavity size as a marker of secondary dentine apposition, is widely utilised for adult age estimation. Despite extensive evaluation of this technique, the influence of image type and enamel area inclusion on method accuracy is insufficiently explored. The present study evaluated the PAR method’s applicability using maxillary canines from a South African cadaveric sample, examining reliability, sex bias, and accuracy across different image types and enamel area considerations. An observational, cross-sectional study design was followed. Fifty-two adult maxillary canines were radiographed, sectioned, and analysed using stereomicroscopy. Labiolingual and mesiodistal periapical radiographs, alongside labiolingual stereomicroscopic tooth section images, were analysed using ImageJ to calculate PARs. Age estimation linear regression models were developed for each image type, with and without enamel area inclusion. Models were compared for performance and accuracy using best-subsets regression and cross-validation analyses. Results indicated that the PAR method is a reliable, sex-independent technique, providing relatively accurate age-at-death estimates for South African adults. Image type significantly influenced accuracy, with tooth section images exhibiting the best/lowest error values, followed by labiolingual and mesiodistal radiographs, respectively. Exclusion of enamel area consistently enhanced model performance across all image types. This study contributes valuable data to the underexplored field of dental age estimation techniques for South African adults, highlighting optimal approaches when applying the PAR method to maxillary canines. Additionally, it introduces a refined stereomicroscopic technique, augmenting and enhancing existing practices.Item Investigating the association between Catechol-O-Methyltransferase gene activity and pain perception in South African patients with different temporomandibular disorders diagnoses(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Chetty, Manogari; Meyer, Mark Keith; Ismail, EnasBackground: Temporomandibular disorders (TMD) affect a significant portion of the population, with profound psychological, behavioral, and social repercussions. Recent investigations have explored the genetic basis underlying pain perception in individuals with TMD, aiming to elucidate the role of specific genetic factors in modulating the condition. Notably, genetic variations have been implicated in the pathogenesis of TMD, particularly genes involved in pain perception pathways. One of the primary candidates is the Catechol-O-Methyltransferase (COMT) gene, which plays a crucial role in the catecholaminergic system and has been associated with the regulation of nociceptive processes. This study seeks to investigate the correlation between COMT gene activity and pain perception among South African patients diagnosed with varying forms of TMD. Methodology: In this study, a total of 196 participants were enrolled, comprising 97 patients diagnosed with TMD and 99 control participants. The control group was meticulously matched with the TMD group for age, gender, and ethnicity. Data collection involved clinical and radiological investigations, and saliva sampling. The English version of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I was utilized to evaluate all TMD participants, focusing on standard diagnostic measures based on clinical signs and symptoms of TMD, which primarily describe common physical manifestations of the disorder. Genomic DNA was extracted from saliva samples, enabling the analysis of single-nucleotide polymorphisms (SNPs) in the COMT gene, specifically targeting polymorphisms rs165774, rs9332377, rs6269, rs4646310, rs165656, and rs4680. Results: The current study demonstrated a pronounced gender disparity, with 80.41% of the participants being female and 19.59% male, suggesting that women in South Africa either exhibit a higher susceptibility to TMD or are more likely to seek treatment for the condition compared to men. The highest prevalence of TMD was observed in the white population (58.76%). Additionally, over 65% of TMD patients were diagnosed with at least two Axis I diagnoses, a figure that increased to 89% for those diagnosed with three Axis I diagnoses. The findings further indicated significant associations between several single-nucleotide polymorphisms (SNPs) in the Catechol-O-Methyltransferase (COMT) gene—specifically rs165656, rs9332377, rs4646310, rs6269, and rs165774—and both TMD and TMD-related pain. Myofascial pain with referral and myalgia showed a strong association with the COMT SNPs rs9332377 and rs4646310. Furthermore, COMT SNP rs4646310 was also associated with disability related to TMD. Conclusions: This study substantiates the hypothesis that pain is prevalent in a considerable proportion of patients affected by TMD. Furthermore, the findings reveal a significant association between COMT gene activity and pain perception in South African patients diagnosed with TMD.Item Efficacy and safety of propolis for treating recurrent aphthous stomatitis (ras): A systematic review and meta-analysis(MDPI, 2024) Roberts, Tina; Kallon, Idriss Ibrahim; Schoonees, AnelThe systematic review assessed the efficacy and safety of propolis for treating recurrent aphthous stomatitis (RAS). The review adopted the PICO framework to examine the effects of topical and systemic propolis on RAS while also comparing it to established treatments, placebos, or no treatment. The main focus was on the healing time, pain levels, adverse effects, the likelihood of ulcer recurrence, and accompanying symptoms such as redness. The team included randomised controlled trials (RCTs) and quasi-randomised trials, excluding case reports and studies on oral ulcers other than RAS. In May 2022, the review team comprehensively searched nine databases and trial registries following the PRISMA guidelines. The protocol was registered in the PROSPERO database under the registration number CRD42022327123. Two review authors conducted a comprehensive and autonomous search for pertinent papers and extracted essential data. Where data permitted, the team utilised Review Manager 5 to conduct a random-effects meta-analysis, assessing the risk of bias and heterogeneity of the included studies. Where possible, the GRADE Pro programme was used to assess the certainty of the evidence for all the outcomes. This review included 10 RCTs, comprising 825 participants aged between 18 and 69 years. Seven studies evaluated the efficacy and safety of propolis when applied topically, all of which used different formulations, concentrations, and carriers. The remaining three studies assessed systemic administration in tablet form. The duration of investigations ranged from 5 days to 3 years. The review team classified two studies as having an overall ‘high risk’ of bias, while the remaining studies were categorised as having an overall ‘uncertain risk’. The overall certainty of the evidence was ‘very low’. The results indicate that topical and systemic propolis may decrease the duration of healing, alleviate pain, and reduce redness in patients with RAS compared to a placebo. However, the certainty of the evidence is very low. These may be due to the high risk of bias, substantial heterogeneity, and limited sample sizes in the included studies. For these reasons, the results of this review should be interpreted with caution. Nevertheless, the limited number of adverse effects observed suggests that propolis may have a favourable safety profile when used for a short period in treating RAS.