• Journal of Oral Medicine and Pain
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• 제46권2호
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• pp.41-48
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• 2021

Purpose: To evaluate compliance by analyzing and comparing treatment duration, degree of improvement after treatment and treatment response of oral lichen planus (OLP) patients according to characteristics of them and the severity of the lesion. Methods: According to treatment process, 132 subjects with OLP who first visited the Department of Oral Medicine at the Pusan National University Dental Hospital from January 2017 to December 2020were classified into three groups: Treatment completed (CT) group, Under treatment (UT) group, and Dropped out during follow-up (DT) group. The reticulation/keratosis, erythema, and ulceration (REU) scoring system was used to assess the severity of OLP. The degree of improvement after treatment was evaluated in CT group. Results: There were 53 (40.15%) CT, 27 (20.45%) UT and 52 (39.39%) DT. In CT group, according to initial REU score there was a statistical difference in the degree of improvement, but not in the length of time to complete treatment. There was no statistical difference between the days it took for patients to feel symptom relief, and the days of entire treatment among three groups. However, there was a positive correlation between the REU score of gingiva and duration of treatment in DT group. In the CT and DT groups, there was a correlation between the length of time taken to relieve symptoms and the duration of treatment. Conclusions: The severity of the gingival lesion and the initial response to treatment have a large effect on the entire treatment period and prognosis, so it should be considered when explaining the disease prognosis and treatment period to patients, and the clinician needs to focus on initial symptom relief.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권6호
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• pp.405-417
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• 2022

Oral lichen planus (OLP) is a chronic inflammatory immune-mediated condition that has been identified as a potentially malignant oral disorder. Various therapies have been proposed for its management as alternative to corticosteroids. However, no definitive treatment has been identified that can result in complete remission or minimal recurrence. Hyaluronic acid has recently been used as an alternative therapy for the management of OLP. This study aimed to systematically review the effectiveness of Hyaluronic acid in the management of symptomatic OLP. Online electronic databases and manual searches were performed for randomized controlled trials (RCTs) published in English between January 2010 and April 2022. RCTs were identified that compared the efficacy of hyaluronic acid and other interventional therapies at baseline and during follow-up. The Cochrane Risk of Bias tool was used to assess the quality of the included studies. Visual analog scale (VAS) scores, Thongprasom sign scores, lesion size, degree of erythema, clinical severity, and disease severity were assessed both quantitatively and qualitatively. Seven studies were analyzed. Five studies reported a high risk of bias while the remaining two studies reported an unclear risk of bias. The overall quantitative assessment of size, symptoms, degree of erythema, and sign score in OLP lesions treated with HA was not statistically significant compared to that in the control group (P > 0.05). In addition, subgroup analysis comparing HA with placebo or corticosteroids did not yield statistically significant (P > 0.05) results. Qualitatively, both HA and tacrolimus resulted in an effective reduction in signs and symptoms. Clinical/disease severity index/scores were inconsistent. A high degree of heterogeneity was observed among the included studies. None of the included studies reported the side effects of HA. These findings suggest that corticosteroids, tacrolimus, placebo, and HA could be equally effective in OLP management. The clinical/disease severity index or score reduction cannot be determined with certainty. Thus, OLP can be treated with HA as an alternative therapy. Owing to limited clinical trials on HA, high heterogeneity, and high risk of bias in the included studies, definitive conclusions cannot be derived.

• Journal of Oral Medicine and Pain
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• 제21권1호
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• pp.141-152
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• 1996

Oral Lichen Planus(OLP) is a idiopathic chronic inflammatory disease with more difficult to clear and higher recurrent rate than cutaneous lesions. But, there has been no estabilished theories about the proper treatment for OLP. The purpose of this study is to examine the clinical feature, relationship with systemic disease and dental treatment of OLP patients of Korea and to gain helpful information about clinical characteristics and treatment of OLP. The subjects chosen for the study were 54 patients who had visited Department of Oral Diagnosis & Oral Medicine at Yonsei University Dental Hospital Dental Hospital and diagnosed as OLP. Previous clinical records has been reviewed and questionnaires, oral examination, laboratory examination were done and recorded. The following results were obtained : 1. Of the 54 patients, 21 were men and 33 were women with an average age of 47.8 years. 2. The most common intraoral site was bilateral buccal mucosa, followed by unilateral buccal mucosa, gingiva, vesibule, lip mucosa, glossal mucosa, palatal mucosa and mouth floor. 3. The mixed, erosive and reticular form of OLP was most frequent(83.3%) clinical form. 4. OLP patients with liver disease were 5, and drug medication patients were 7. But, we could not find its evidence of association with OLP. 5. Associated events on onset of symptom were stress, denture wearing, dental treatemtn, and common cold. 6. Associated symptoms were dry mouth, tingling, sore throat, and altered taste perception. 30.8% of patients had no specific associated symptoms. 7. Aggravating factors of symptom were peppery food, hot food, fatigue, toothpaste, salty food, sour food, tension, and conversation. Reducing factors were cold food, sleeping. 69.2% of patients had no specific reducing factors. 8. There were no significant differences between normal papulation and OLP patients in CBC, SGOT< SGPT, Serum iron, Total iron binding capacity. 66.7% of subjects were positive response to fungus study for Candida Albicans. The incidence of stress and dental treatment on onset of symptom appeared high in OLP patients. Especially, high incidence of positive response to fungus study for Candida albicans, prescription of anti-fungal agents and dental treatment considerations may be helpful to treatment of OLP.

• Journal of Oral Medicine and Pain
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• 제44권3호
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• pp.118-122
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• 2019

Paraneoplastic pemphigus (PNP) is a rare and often fatal autoimmune blistering disease accompanied by both benign and malignant neoplasms. Usually, oral, skin, and mucosal lesions are the earliest manifestations shown by PNP patients. Oral ulcers are initial lesions in various autoimmune diseases like pemphigus, bullous pemphigoid, erythema multiforme, graft-versus-host, lichen planus, it does not improved despite of high-dose steroid therapy. We report a-35-year-old female who presented oral ulceration, lip crust and skin lesions. By doing several examinations, such as enzyme-linked immunosorbent assay, incisional biopsy with indirect immunofluorescence, she was diagnosed PNP with non-Hodgkin's lymphoma on pancreas.

• Journal of Oral Medicine and Pain
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• 제37권1호
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• pp.27-33
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• 2012

피부와 구강점막에서 발견되는 편평태선은 만성 염증성 질환으로 세포매개성 면역반응이 주로 언급되고 있으나 아직 정확한 원인은 밝혀지지 않았다. 따라서 완전한 치료법은 아직 없으며 증상의 완화를 치료목표로 하고 있다. 본 연구에서는 구강편평태선의 일차적인 치료법으로 사용되는 corticosteroid의 두 가지 가글용액의 효과를 비교하였다. 2002년부터 2010년까지 부산대학교 치과병원 구강내과에서 구강편평태선으로 진단받은 환자들 중 corticosteroid 가글용액을 처방받은 환자들 총 180명의 환자기록을 조사하였다. 사용된 두 종류의 가글용액은 각각 dexamethasone(dexamethasone disodium phosphate, 0.05%)과 prednisolone($solondo^{(R)}$)을 포함하는 용액이었으며 약물 사용 후 증상의 완화 및 재발의 시기를 기록하여 분석하였다. Dexamethasone gargle(dexa gargle) 처방군은 33명(여성 25명, 남성 8명), prednisolone gargle(solon gargle)처방군은 147명(여성 114명, 남성 33명)이었으며 환자군의 평균연령대는 50대였다. 약물투여 후 초기 2주이내에 증상이 호전된 경우는 dexa gargle을 사용한 환자군에서 유의성 있게 나타났으나 증상재발의 경우는 두가지 가글용액의 차이가 나타나지 않았다. 구강편평태선 환자에 대한 도포용 스테로이드 가글을 이용한 치료에서 증상의 빠른 호전을 기대하기 위해서는 solon gargle보다는 dexa gargle을 사용할 수 있으나 재발율에 있어서는 두 약물의 차이가 발견되지 않았다.

• 대한치과의사협회지
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• 제55권7호
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• pp.468-480
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• 2017

A wide variety of benign and malignant lesions and other diseases can develop on oral mucosa. Oral mucosal lesions can also be associated with an underlying systemic disease, so their correct diagnosis, which may even share similar clinical and demographic features, is always a challenge for a dentist. Common oral mucosal lesions include candidiasis, herpes viral infection, leukoplakia, recurrent aphthous stomatitis, pemphigus, lichen planus and benign migratory glossitis. The differential diagnosis of these lesions are based on a thorough review of the patient's past medical and dental history and a complete oral examination. The knowledge of clinical features such as size, location, morphology, color, and pain is helpful in establishing a diagnosis. In addition, diagnostic tests, including microbiologic and laboratory tests and biopsies are usually required for establishing a proper diagnosis.

• 대한치과의사협회지
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• 제52권12호
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• pp.726-733
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• 2014

The gingiva consists of an epithelial layer and an underlying connective tissue layer. The oral epithelium is a keratinized, stratified, squamous epithelium. The epithelium can be divided into the following cell layer: basal layer, prickle cell layer, granular cell layer and keratinized cell layer. The desquamative disease of gingiva means exfoliative diseases of epithelial layer on the gingiva. The chronic desqumative gingivitis is usually related to the dematologic disorders that produce cutaneous and mucous membrane blisters. The cicatricial pemphigoid and lichen planus are representative diseases of the dermatologic cases. Patients may be asymptomatic or symptomatic. When symptomatic, their complaints range from a mild burning sentation to an severe pain. The clinical examination must be considered with a thorough history, and routine histologic and immunofluorescence studies. A systemic approach needs to achieve accurate diagnosis and treatment of the gingival desquamative diseases.

• Journal of Oral Medicine and Pain
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• 제25권4호
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• pp.355-364
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• 2000

This study was to find dental materials causing hypersensitivity reactions by carrying out patch tests in the patients with oral mucosal lesions to investigate the possibility of hypersensitivity reactions in etiology of oral mucosal lesions. 31 patients (female 26, male 5, age range 24-72 years) with oral mucosal lesions were classified as patient group, and 41 volunteers (female 24, male 17, age range 23-40 years) without oral mucosal lesion, systemic disease and history of allergy as control group. The obtained results were as follows: 1. There were various dental restorations in most of patient group and control group, 29(94%) in 31 patient group, 35(85%) in 41 control group. 2. Among sites of oral mucosal lesions, buccal mucosa was the most common site with 60%, followed by gingiva with 24%, tongue with 16%. Lesions in contact with restorations were highly 90% in tongue and 89% in buccal mucosa, but comparatively lower 53% in gingiva. 3. The ratio of positive reactions to the patch test in patient group was significantly higher than the control group (p<0.05). 4. Dental materials causing positive reactions to the patch test were mainly mercury(19%), potassium dichromate(16%), cobalt chloride(16%) in patient group, cobalt chloride(17%) in control group. 5. In 20 patients with lichen planus, 8 patients(40%) showed positive reactions to the patch test.

• Journal of Oral Medicine and Pain
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• 제35권4호
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• pp.259-264
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• 2010

만성 궤양성 치은 병소는 편평태선, 양성점막유천포창, 심상성 천포창 등과 같은 다양한 질환에 의해 유발될 수 있으며 코티코스테로이드 약물요법이 주된 치료로 이용된다. 코티코스테로이드를 복용하는 경우 위장장애, 체중증가 등의 부작뿐만 아니라 장기 복용 시 골다공증, 당뇨 및 고혈압 발생 또는 악화, 부신기능 저하, 쿠싱증후군 등의 심각한 부작용이 발생 할 수 있어 병소가 국소 부위에 제한되어 발생하거나 전신증상을 동반하지 않는 경우 스테로이드 약물의 국소 도포가 만성 궤양성 치은 병소의 주된 치료로 이용되고 있다. 하지만 국소 스테로이드 치료를 구강 내에 사용하는 경우 타액 분비, 혀, 입술, 협점막 등의 움직임에 의해 도포한 약제가 소실되어 효과가 감소되고 병소가 넓은 부위에 분포하거나 구강 내 깊숙한 부위에 발생하는 경우 환자 스스로 약물을 도포하기가 용이하지 않으며, 질병에 이환 되지 않은 정상 점막에도 약제가 도포 되는 등의 단점이 있다. 국소 스테로이드 적용 방법의 단점을 극복하고 효과를 최대화함으로써 스테로이드 복용을 최소화할 수 있는 방법으로 스텐트를 이용한 스테로이드 밀폐 요법이 보고된 바 있으나 실제 임상에서 적극적으로 활용되지는 않고 있다. 따라서 만성 궤양성 치은 병소가 발생한 환자에게 스텐트를 이용한 국소스테로이드 치료를 시행하여 양호한 치료 효과를 보인 증례를 통해 그 효용성과 임상적 활용 방안을 알아보고자 한다.

• Journal of Oral Medicine and Pain
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• 제36권2호
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• pp.91-97
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• 2011

H. pylori는 위 뿐만 아니라 구강의 치태, 타액 등에 존재하여 구강편평태선, 재발성 아프타성 구내염, 치주질환 그리고 구취와 같은 많은 구강질환과 관련되여 있다. 구강작열감증후군은 어떠한 임상적 징후를 나타내지 않는 구강 내 통증장애로 주로 혀나 구강점막에 타는 듯 한 통증을 특징적으로 나타낸다. 구강작열감증후군의 원인으로는 국소적, 전신적 및 정신적 요인 등이 제시되고 있으나, H. pylori 균의 감염과 관련된 연구는 매우 부족하다. 이에 본 연구에서는 구강 내 H. pylori 발현 상태가 구강작열감증후군과 관련성이 있는지를 알아보고자 21명의 구강작열감증후군 환자와 21명의 대조군의 협점막, 혀의 배면 그리고 타액에서 표본을 채취한 후 nested PCR을 시행 하여 다음과 같은 결과를 얻었다. 1. Nested PCR 분석을 시행한 후 표본채취 부위 중 한 개 이상에서 양성으로 나타난 경우가 구강작열감증후군환자에서 6명(29%), 대조군에서 3명(14%)이었다 (p>0.05). 2. 구강작열감증후군 환자의 협점막, 혀의 배면 그리고 타액에서 3명(14%), 2명(10%), 4명(19%)이 양성을 나타내었으며, 대 조군에서는 혀의 배면과 타액에서만 2명(10%) 과 1명(5%)이 양성을 나타내었다(P>0.05). 이상의 결과로 구강 내 H. pylori와 구강작열감증후군과는 관련성이 없음을 추론할 수 있었다.