APA PAPER-ID NUMBERS.docx.docx - Katherine Gutierrez
Behcet’s Disease and Oral HealthKatherine GutierrezMilca CampilloDEH 1800 Dental Hygiene Clinic 1Miami Dade Medical CampusBehcet’s Disease and Oral HealthIntroductionSome individuals believe that diseases are intricate but simple to diagnose. What they do not know is that some diseases are very similar to others hence making the diagnostic process difficult. In this case, Behcet’s Disease (BD) is a chronic inflammatory multisystem autoimmune disease with a wide spectrum of clinical features. It is not as simple to diagnose and does not have a perfect science behind it (Wagner, Schar, Tinguely, & Kunz, 2012). As a result, the symptoms frequently appear or develop at a slow pace over a period ranging from months to years. It is important for dental professionals such as dentists and dental hygienists to know that this disease exists and understand how important it is for BD patients to maintain their own dental treatment appointments and oral hygiene instructions. Maintaining their dental treatments is essential and a priority for a healthier oral lifestyle. BackgroundAccording to research, BD is extremely prevalent in young adults from the Mediterranean, Middle Eastern, and Eastern Asian countries and the prevalence of the disease tends to decrease as one ages (Stanford, 2003). It is also known for coinciding with the path of the Silk Road throughout Asia. In order to be diagnosed with BD, an International Criteria or classification has been developed. Basically, patients need to present three symptoms before a physician can diagnose the patient with BD. The main clinical appearance is recurrent oral ulcerations occurring three times in a one-year time frame. In addition to oral ulcerations, two other clinical conditions must be present. This category involves recurrent genital ulcerations, eye lesions, skin lesions, and a pathergy test that must be taken and read by a physician. Unfortunately, the etiologic aspect of the disease is still unknown to mankind even though it has been present for many years. Since the questions on the cause and when it occurs are unanswered, there is no perfect treatment for BD. Currently, medications, therapies, and treatments are used to ease the symptoms, reduce inflammation, and buffer the immune system in hopes of lessening the severity of the disease (Wagner, et al., 2012).BD was first discovered in the following way: A meeting was held on November 15, 1930 by the Medical Association of Athens featuring a Greek ophthalmologist called Benediktos Adamantiade from Turkey. Dr. Adamantiade gave a lecture regarding one of his patients who was 20 years of age, male, and presented three specific symptoms. He called this lecture “A Case of Relapsing Iritis with Hypopyon.” The symptoms were connected through genital ulcers, arthritis, and ocular problems relating to one disease. Later on, Behcet’s disease was named after the Turkish dermatologist, Dr. Hulusi Behcet, in 1937. Behcet described three of his patients with genital and oral ulcerations as well as hypopyon where pus develops in the anterior chamber of the eye. Since then, systemic areas in the body have been affected such as the central nervous system, the veins, the arteries, the heart, the gastrointestinal tract, and kidneys. Researchers believe that BD is a chronic inflammatory disorder involving the autoimmune and auto-inflammatory syndromes. This particular syndrome is thought to have a hypersensitivity delayed reaction to human leukocyte antigens (HLA- B51). Certain environmental factors such as viruses, bacteria, or chemicals may also trigger this in certain individuals. Behcet’s disease can also be referred to as: Behcet syndrome, Morbus Behcet, Silk Road disease, and the least commonly used Adamandiades-Behcet syndrome. Geographically, the individuals that have been affected by BD have mainly resided along the Silk Road extending from eastern Asia to the Mediterranean and Europe (Saadoun & Wechsler, 2012).DiscussionFurthermore, when an individual is diagnosed with BD, certain clinical symptoms must be taken under consideration. Research shows, the prevalence in men is higher than women and the ranges in age are from 18 to 40. After 40, diagnosis can still be made cautiously, but it is known that after that time frame the flare of disease dies down. Also, when an individual is genetically predisposed, oral and pharyngeal infections can flare up (Saadoun & Wechsler, 2012). These symptoms can range from oral, genital and skin ulcerations, uveitis, arthritis, and other cutaneous symptoms (Wagner, et al., 2012). In particular, when an individual is experiencing oral manifestations, painful ulcers are located in the tongue, buccal and labial mucosa, and pharynx. One or more ulcers may appear in one location at a time. Lesions are known to be round, elevated, and one to three centimeters in diameter or larger. Initially, the lesion may appear red, raised from the skin, as well as covered with yellow pseudomembrane. These particular oral ulcers can flare up from dental procedures, trauma, or from a food reaction. Once the lesions become enlarged, speaking and eating habits may become difficult and uncomfortable for the individual. Fortunately, these lesions heal well, usually leaving no traces of scarring. In a dental office, it is important to describe and document these lesions once they are present in a patient in order to compare previous ulcers to the new ulcers that reappear for BD susceptible patients (Saadoun & Wechsler, 2012).Additionally, a second manifestation can be found in the genital area. For men, it is usually found on the scrotum. In women, it is most commonly found on the vulva and vagina. These lesions are larger, deeper and more painful than oral lesions, and cause scarring to the tissue. Also, one of the most significant of the symptoms of BD is the eye manifestation. The disease may involve both eyes, causing visual impairment. Intense therapy is performed in order to slow down the process or eliminate the loss of vision. This particular involvement may be associated with a neurological problem involving the cranial nerve palsy and optic neuropathy (Saadoun & Wechsler, 2012).Another complication that is taken extremely serioulys is venous thrombosis. BD may affect the superior and inferior vena cava, pulmonary arteries, suprahepatic vessels and cardiac cavities. Abnormalities in the cardiac region have also appeared in some patients involving the following: myocarditis, endocarditis, fibroblastic endocarditis, and relapsing pericarditis. A particular feature of the disease may involve knee and ankle joints. This manifestation tends to show prior to the aforementioned symptoms. Conversely, patients presenting symptoms of headaches, meningitis, seizures, hemiplegia, or cranial nerve palsy have experienced neurologic involvement. Unfortunately, this can cause personality changes making the diagnostic aspect difficult. It is also believed that when the gastrointestinal tract is taken under consideration, the physician must be cautious because BD also causes inflammation. BD and gastrointestinal problems can cause nausea, abdominal pain, diarrhea, and anorexia making diagnostic process difficult to determine. Also, cases of vasculitis involving the pulmonary circulation have been reported along with lymphatic occurrences. These two particularly go hand-in-hand. If one symptom is involved, the other symptom will be too. Skin manifestations known as pseudofolliculitis and erythema nodosum lesions can be present as well. Once the lesions involve the skin, a pathergy test, a skin prick test to see if inflammation and ulceration occur due to BD, can be performed (Saadoun & Wechsler, 2012).In addition, the pathergy test can help as a diagnostic source for Behcet’s disease. The pathergy test can be performed orally or on the skin. In the oral pathergy test, the lower lip is pricked using a disposable needle. Results are read after 48 hours and it is considered positive if a pustule or ulcer is present. For the skin pathergy test, the hairless forearm is pricked using either a sterile needle, intradermal injection of saline, monosodium urate crystals, or streptococcal antigens. The skin can be pricked two or more times and it will not negatively affect the testing process. The depth must be of three to five millimeters reaching the dermis. Results are read after 48 hours. The positive result would be indicated by a one to five or larger millimeter pustule. The pathergy reaction test can only be performed on recurrent ulcerations. This testing procedure has lost some of its sensitivity, but is still considered to be a valued diagnostic test (Daryani & Sequeira, 2011).Particularly, interesting findings were observed on a clinical research study performed by a group of oral and maxillofacial surgeons. The purpose of this study was to assess the patients presenting oral ulcers caused by Behcet’s disease in order to determine the influence between dental and periodontal treatments. This research was based on 58 patients and their progressions with oral ulcers as they were observed during dental treatments. The 58 patients were divided into two groups being the intervention and control group. The intervention group consisted of 29 individuals and they were given dental and periodontal treatments along with oral hygiene instructions. The control group consisted of 29 patients as well but they were only educated with oral hygiene instructions. The patients were observed for a one month pre-treatment time frame, followed by the one month treatment, then six months post-treatment (Karacayli, Mumcu, Simsek, Pay, Kose, Erdem, Direskeneli & Gunaydin, 2009). Subsequently, during the treatment period of two days, results showed an increase in the amount of new oral ulcers, in comparison to treatment within three to 30 days that showed the oral ulcers decreasing in amount. The post-treatment time frame of six months showed alarming and useful results. The results indicated that a considerably lower amount of oral ulcers in the 29 individuals from the intervention group were present. Comparing all the three different time frames, the pre-treatment and treatment observations indicated a higher amount of oral ulcers present. The findings demonstrate that dental and periodontal treatment can benefit patients with Behcet’s disease because even though the studies showed a flare up of the ulcers in the short term, it also demonstrated that after a 6 month follow up the ulcers decreased in number, proving to be beneficial and improving oral health. As dental hygienists we have to understand that patients with BD may be in pain or discomfort because of the oral ulcers and they may not be inclined to brush their teeth as often which, in turn, leads to unhealthy gingiva and causes periodontal problems. When treating patients with BD, the dental hygienist can help the patient improve their oral health by providing them with good oral hygiene instructions and dental treatment maintenance as well as keeping up with their follow up appointments. This clinical research study clearly indicates that it is crucial for BD patient’s to maintain good oral hygiene as well as have dental and periodontal treatments in order to lower the rate of recurrent oral ulcers (Karacayli et al., 2009).Another study performed validates the previous clinical research study. The study examined 120 patients with BD and two groups were divided. One group of 65 healthy patients was observed and the other group contained 35 patients with oral ulcers which was the control group. This study was done by using a plaque- index score sheet identifying the patient’s plaque score, probe readings including the bleeding sulcus, probing depth, and the amount of extracted teeth were also noted. The higher percentage of the plaque index score was related to the patients pertaining to the control group containing the oral ulcers. This shows there was an increased risk for patients to suffer from oral health more than the non- affected BD healthy individuals. Once the oral health technique is changed, the patient’s prognosis may also improve (Mumcu, Ergun, Inanc, Fresko, Atalay, Hayran & Direskeneli, 2004). ConclusionIn conclusion, many have studied the cause and effects of BD’s occurrence. Why do men seem to be more at risk? Why does it decrease in appearance as a patient becomes older in age? What is the perfect treatment to cure the disease? Unfortunately, no one seems to know these answers yet. Research has shown that some environmental and genetic factors do have some influence on the disease. Fortunately, the International Criteria or classification was developed providing a guideline in order to diagnose Behcet’s disease. Mainly, patients will be presenting symptoms of oral and genital ulcers, along with ocular problems or skin lesions. Also, there has been a correlation between the maintenance of oral hygiene and dental treatments improving the prognosis of reducing the amount of painful oral ulcers as well as the general oral health of the patients. This is why it is essential for dental professionals to understand this disease and know that these oral ulcers are not contagious. With that said, helping the BD patients improve their oral hygiene should be the goal in the care plan. One can be thankful that so far, Hulsi Behcet found these connections among patients and their clinical symptoms. Physicians and scientists will continue documenting and researching these cases in hopes of solving the enigma of this ancient disease. ReferencesDaryani, D., & Sequeira, F. (2011). The oral and skin pathergy test. Indian Journal of Dermatology, Venereology and Leprology, 77(4), 526. Retrieved from , U., Mumcu, G., Simsek, I., Pay, S., Kose, O., Erdem , H., Direskeneli, H., & Gunaydin, Y., Dinc, A., (2009, May). The close association between dental and periodontal treatments and oral ulcer course in behcet's disease: A prospective clinical study. Retrieved from Mumcu, G.,Ergun, T., Inanc, N., Fresko, I., Atalay, T., Hayran, O., & Direskeneli, H. (2004, August). Oral health is impaired in beh?et’s disease and is associated with disease severity. Retrieved from Saadoun, D., & Wechsler, B. (2012). Behcet's disease. Orphanet Journal of Rare Diseases, 7, 20. Retrieved from , M. R. (2003). Behcet syndrome: new treatments for an old disease. (Behcet's Disease). British Journal of Ophthalmology, 87(4), 381+. Retrieved from , C., Schar, D., Tinguely, M., & Kunz, I. (2012). Persistent fever, neck swelling, and small vessel vasculitis following tonsillectomy in a patient with Behcet’s disease: a case report. Journal of Medical Case Reports, 6, 371. Retrieved from ................
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