Turkiye Klinikleri Journal of Dental Sciences

.: REVIEW
Behçet Hastalığının Yönetiminde Oral Sağlık ile İlişkili Klinik Parametreleri ve Hasta Kaynaklı Çıktıları Nasıl Değerlendirmeliyiz?
How Do We Assess the Clinical Parameters Related to Oral Health and the Patient Resources?
Gonca MUMCUa, Ümit KARAÇAYLIb, Nevsun İNANÇc, Tülin ERGUNd, Turhan ATALAYe, Haner DİRESKENELİc
aMarmara Üniversitesi Sağlık Bilimleri Fakültesi, Sağlık Yönetimi ABD, İstanbul, TÜRKİYE
bSağlık Bilimleri Üniversitesi Gülhane Diş Hekimliği Fakültesi, Ağız Diş Çene Cerrahisi ABD, Ankara, TÜRKİYE
cMarmara Üniversitesi Tıp Fakültesi, Romatoloji ABD, İstanbul, TÜRKİYE
dMarmara Üniversitesi Tıp Fakültesi, Dermatoloji ABD, İstanbul, TÜRKİYE
eİstanbul Diş Hekimleri Odası, İstanbul, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2020;26(2):268-75
doi: 10.5336/dentalsci.2019-64665
Article Language: TR
Full Text
ÖZET
 Behçet hastalığı (BH); oral ve genital ülserler, oküler, vasküler, kas-iskelet sistemi, nörolojik ve gastrointestinal tutulum ile karakterize bir inflamatuar hastalıktır. Oral ülserin varlığı hastalığın tanısı için temel bir klinik bulgudur. Ayrıca, oral ülserler erken dönemde hastalığın ilk belirtisi olarak da görülebilmektedir. Bu nedenle, oral ülserin varlığı BH'li hastalarda hastalık aktivitesinin ve tedaviye yanıtın değerlendirilmesinde önemli bir faktördür. Etiyolojisi tam olarak bilinmemekle birlikte, BH'de çevresel faktörlerin ve bazı tetikleyici ajanların, klinik bulguların aktivasyonuna neden olduğu düşünülmektedir. BH'nin etiyopatogenezinde oral floranın etkin rolünün olduğu da gözlenmiştir. Ayrıca bu hasta grubunda oral ülserler nedeni ile oral hijyen uygulamalarının kısıtlandığı ve oral sağlık düzeyinin kötü olduğu da belirlenmiştir. Kompozit indeks, BH'li hastalarda geçerlilik ve güvenirlilik çalışması yapılmış oral ülsere özel olarak geliştirilmiş bir aktivite indeksidir. Bu hasta kaynaklı aktivite indeksi kullanılarak oral ülserlerin ağrı ve fonksiyonel durum üzerine etkisi değerlendirilebilmektedir. Oral ülsere bağlı ağrı '0-100' puan aralığında görsel analog skala kullanımı ile değerlendirilmektedir. Bu indekste fonksiyonel durum değerlendirmesi ise oral ülsere bağlı olarak oluşan tat almada değişim, konuşmada ve yemede/çiğnemede/yutmada güçlüğü içermektedir. Sonuç olarak; oral ülserlerin hasta kaynaklı bir aktivite ölçeği ile değerlendirilmesi bu hasta grubunun izleminde oldukça önemlidir. Böylelikle, bu çalışmada, bu hasta grubunda oral sağlığın, oral hijyenin ve oral sağlıkla ilişkili hasta kaynaklı çıktıların önemi üzerine odaklanmıştır.

Anahtar Kelimeler: Behçet sendromu; oral ülser; ağız sağlığı
ABSTRACT
 Behçet's disease (BD) is an inflammatory disease characterized by mucocutaneous, ocular, vascular, musculoskeletal, neurological and gastrointestinal involvement. Oral ulcer is a keystone for the diagnosis of the disease. In addition, it could be seen as the initial symptom. Therefore, it is an important factor in the evaluation of the disease activity and treatment response in BD. Although its etiology is unknown, environmental factors and some triggering agents are suggested to cause the activation of clinical manifestations. It has been observed that oral flora has effective roles in the etiopathogenesis of BD. Moreover, oral hygiene applications are limited and oral health is also found to be poor due to oral ulcers in this patient group. Composite index (CI) is a validated oral ulcer activity index in BD. The effects of oral ulcer on pain and functional status are evaluated by using this patient-reported activity index. Oral ulcer pain is evaluated with the use of visual analogue scale between 0-100 points. Unpleasant taste, difficulty in speaking and eating/chewing/swallowing due to oral ulcers are assessed in functional limitation. Finally, the use of patient-reported activity index has an important role for followup periods of patients in BD. Therefore, this review focuses on the importance of oral health, oral hygiene and oral health related patient-reported outcomes in BD.

Keywords: Behçet syndrome; oral ulcer, oral health
REFERENCES:
  1. Direskeneli H. Autoimmunity vs autoinflammation in Behcet's disease: do we oversimplify a complex disorder? Rheumatology (Oxford). 2006;45(12):1461-5. [Crossref]  [PubMed] 
  2. Alpsoy E. Behcet's disease: a comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocutaneous lesions. J Dermatol. 2016;43(6):620-32. [Crossref]  [PubMed] 
  3. International Study Group for Behcet Disase's Criteria for diagnosis of Behcet's disease. Lancet. 1990;335(8697):1078-80. [Crossref] 
  4. Mumcu G. Behcet's disease: a dentist's overview. Clin Exp Rheumatol. 2008;26(4 Suppl 50):S121-4.
  5. Mumcu G, Inanc N, Yavuz S, Direskeneli H. The role of infectious agents in the pathogenesis, clinical manifestations and treatment strategies in Behcet's disease. Clin Exp Rheumatol. 2007;25(4 Suppl 45):S27-33.
  6. Mumcu G, Inanc N, Aydin SZ, Ergun T, Direskeneli H. Association of salivary S. mutans colonisation and mannose-binding lectin deficiency with gender in Behcet's disease. Clin Exp Rheumatol. 2009; 27(2 Suppl 53):S32-6.
  7. Karacayli U, Mumcu G, Simsek I, Pay S, Kose O, Erdem H, et al. The close association between dental and periodontal treatments and oral ulcer course in behcet's disease: a prospective clinical study. J Oral Pathol Med. 2009;38(5):410-5. [Crossref]  [PubMed] 
  8. Coit P, Mumcu G, Ture-Ozdemir F, Unal AU, Alpar U, Bostanci N, et al. Sequencing of 16S rRNA reveals a distinct salivary microbiome signature in Behcet's disease. Clin Immunol. 2016;169:28-35. [Crossref]  [PubMed] 
  9. Mumcu G, Ergun T, Elbir Y, Eksioglu-Demiralp E, Yavuz S, Atalay T, et al. Clinical and immunological effects of azithromycin in Behcet's disease. J Oral Pathol Med. 2005;34(1):13-6. [Crossref]  [PubMed] 
  10. Kaneko F, Oyama N, Yanagihori H, Isogai E, Yokota K, Oguma K. The role of streptococcal hypersensitivity in the pathogenesis of Behcet's disease. Eur J Dermatol. 2008;18(5):489-98.
  11. Kaneko F, Oyama N, Nishibu A. Streptococcal infection in the pathogenesis of Behcet's disease and clinical effects of minocycline on the disease symptoms. Yonsei Med J. 1997;38(6):444-54. [Crossref]  [PubMed] 
  12. Gadjeva M, Thiel S, Jensenius JC. The mannan-binding-lectin pathway of the innate immune response. Curr Opin Immunol. 2001;13(1):74-8. [Crossref] 
  13. Inanc N, Mumcu G, Birtas E, Elbir Y, Yavuz S, Ergun T, et al. Serum mannose-binding lectin levels are decreased in behcet's disease and associated with disease severity. J Rheumatol. 2005;32(2):287-91. [Crossref]  [PubMed] 
  14. Mumcu G, Cimilli H, Karacayli U, Inanc N, Ture-Ozdemir F, Eksioglu-Demiralp E, et al. Salivary levels of antimicrobial peptides HNP 1-3, Ll-37 and S100 in Behcet's disease. Arch Oral Biol. 2012;57(6):642-6. [Crossref]  [PubMed] 
  15. Mumcu G, Cimilli H, Karacayli Ü, Inanc N, Türe-Özdemir F, Eksioglu-Demiralp E, et al. Salivary levels of HNP 1-3 are related to oral ulcer activity in Behcet's disease. Int J Dermatol. 2013;52(10):1198-201. [Crossref]  [PubMed] 
  16. Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, et al. Oral health is impaired in Behcet's disease and is associated with disease severity. Rheumatology (Oxford). 2004;43(8):1028-33. [Crossref]  [PubMed] 
  17. Akman A, Ekinci NC, Kacaroglu H, Yavuzer U, Alpsoy E, Yegin O. Relationship between periodontal findings and specific polymorphisms of interleukin-1alpha and -1beta in Turkish patients with Behcet's disease. Arch Dermatol Res. 2008;300(1):19-26. [Crossref]  [PubMed] 
  18. Akman A, Kacaroglu H, Donmez L, Bacanli A, Alpsoy E. Relationship between periodontal findings and Behcet's disease: a controlled study. J Clin Periodontol. 2007;34(6):485-91. [Crossref]  [PubMed] 
  19. Yay M, Çelik Z, Aksoy A, Alibaz-Öner F, Inanç N, Ergun T, et al. Oral health is a mediator for disease severity in patient with Behcet's disease: a multiple mediation analysis study. J Oral Rehabil. 2019;46(4):349-54. [Crossref]  [PubMed] 
  20. Mumcu G, Niazi S, Stewart J, Hagi-Pavli E, Gokani B, Seoudi N, et al. Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease. J Oral Pathol Med. 2009;38(5):406-9. [Crossref]  [PubMed] 
  21. Direskeneli H, Mumcu G. A possible decline in the incidence and severity of Behcet's disease: implications for an infectious etiology and oral health. Clin Exp Rheumatol. 2010;28(4 Suppl 60):S86-90.
  22. Hatemi G, Ozguler Y, Direskeneli H, Mahr A, Gul A, Levi V, et al. Current status, goals, and research agenda for outcome measures development in Behcet syndrome: report from OMERACT 2014. J Rheumatol. 2015;42(12):2436-41. [Crossref]  [PubMed]  [PMC] 
  23. Mumcu G, Sur H, Inanc N, Karacayli U, Cimilli H, Sisman N, et al. A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis. J Oral Pathol Med. 2009;38(10):785-91. [Crossref]  [PubMed] 
  24. Mumcu G, Inanc N, Taze A, Ergun T, Direskeneli H. A new mucocutaneous activity index for Behcet's disease. Clin Exp Rheumatol. 2014;32(4 Suppl 84):S80-6.
  25. Bhakta BB, Brennan P, James TE, Chamberlain MA, Noble BA, Silman AJ. Behcet's disease: evaluation of a new instrument to measure clinical activity. Rheumatology (Oxford). 1999;38(8):728-33. [Crossref]  [PubMed] 
  26. Yazici H, Tüzün Y, Pazarli H, Yurdakul S, Ozyazgan Y, Ozdoğan H, et al. Influence of age of onset and patient's sex on the prevalence and severity of manifestations of Behcet's syndrome. Ann Rheum Dis. 1984;43(6):783-9. [Crossref]  [PubMed]  [PMC] 
  27. Alibaz-Oner F, Mumcu G, Kubilay Z, Ozen G, Celik G, Karadeniz A, et al. Unmet need in Behcet's disease: most patients in routine follow-up continue to have oral ulcers. Clin Rheumatol. 2014;33(12):1773-6. [Crossref]  [PubMed] 
  28. Mumcu G, Lehimci F, Alpar U, Inanc N, Ergun T, Direskeneli H. Oral Health Related Outcome Measures, Mucocutaneous Index and Ohip-14. Matera Italy: Correlate Well With The Clinical Assessment of Oral Ulcers In Bd 17th International Conference on Behçet's Disease; 2016. p.164.
  29. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25(4):284-90. [Crossref]  [PubMed] 
  30. McGrath C, Comfort MB, Lo EC, Luo Y. Can third molar surgery improve quality of life? A 6-month cohort study. J Oral Maxillofac Surg. 2003;61(7):759-63. [Crossref] 
  31. Llewellyn CD, Warnakulasuriya S. The impact of stomatological disease on oral health-related quality of life. Eur J Oral Sci. 2003;111(4):297-304. [Crossref]  [PubMed] 
  32. Mumcu G, Inanc N, Ergun T, Ikiz K, Gunes M, Islek U, et al. Oral health related quality of life is affected by disease activity in Behcet's disease. Oral Dis. 2006;12(2):145-51. [Crossref]  [PubMed] 
  33. Mumcu G, Hayran O, Ozalp DO, Inanc N, Yavuz S, Ergun T, et al. The assessment of oral health-related quality of life by factor analysis in patients with Behcet's disease and recurrent aphthous stomatitis. J Oral Pathol Med. 2007;36(3):147-52. [Crossref]  [PubMed] 
  34. Hayran O, Mumcu G, Inanc N, Ergun T, Direskeneli H. Assessment of minimal clinically important improvement by using Oral Health Impact Profile-14 in Behcet's disease. Clin Exp Rheumatol. 2009;27(2 Suppl 53):S79-84.
  35. Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gul A, et al. EULAR recommendations for the management of Behcet disease. Ann Rheum Dis. 2008;67(12):1656-62. [Crossref]  [PubMed] 
  36. Yurdakul S, Mat C, Tüzün Y, Ozyagan Y, Hamuryudan V, Uysal O, et al. A double-blind trial of colchicine in Behcet's syndrome. Arthritis Rheum. 2001;44(11):2686-92. [Crossref] 
  37. Hamuryudan V, Hatemi G, Tascilar K, Sut N, Ozyazgan Y, Seyahi E, et al. Prognosis of Behcet's syndrome among men with mucocutaneous involvement at disease onset: long-term outcome of patients enrolled in a controlled trial. Rheumatology (Oxford). 2010;49(1):173-7. [Crossref]  [PubMed] 
  38. Calgüneri M, Ertenli I, Kiraz S, Erman M, Celik I. Effect of prophylactic benzathine penicillin on mucocutaneous symptoms of Behcet's disease. Dermatology. 1996;192(2):125-8. [Crossref]  [PubMed] 
  39. Labro MT. Immunological effects of macrolides. Curr Opin Infect Dis. 1998;11(6):681-8. [Crossref]  [PubMed] 
  40. Mumcu G, Inanç N, Özdemir FT, Tulunay A, Ekşioğlu-Demiralp E, Ergun T, et al. Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in Behcet's disease. Int J Dermatol. 2013;52(12):1561-6. [Crossref]  [PubMed] 
  41. Mumcu G, Alibaz-Öner F, Öner SY, Özen G, Atagündüz P, İnanç N, et al. Oral ulcer activity in Behcet's disease: poor medication adherence is an underestimated risk factor. Eur J Rheumatol. 2017;4(2):109-12. [Crossref]  [PubMed]  [PMC] 
  42. Mumcu G, Yağar F, Alibaz-Öner F, İnanç N, Direskeneli H, Ergun T. Does illness perception associate with disease symptoms in Behcet's disease? Intern Emerg Med. 2018 Nov 30. Doi: 10.1007/s11739-018-1983-y. [Epub ahead of print]. [Crossref]  [PubMed] 
  43. İris M, Özçıkmak E, Aksoy A, Alibaz-Öner F, İnanç N, Ergun T, et al. The assessment of contributing factors to oral ulcer presence in Behcet's disease: dietary and non-dietary factors. Eur J Rheumatol. 2018;5(4):240-3. [Crossref]  [PubMed]  [PMC] 
  44. Mumcu G, Lehimci F, Fidan Ö, Gük H, Alpar U, Ünal AU, et al. The assessment of work productivity and activity impairment in Behcet's disease. Turk J Med Sci. 2017;47(2):535-41. [Crossref]  [PubMed] 
  45. Mumcu G, Direskeneli H. Triggering agents and microbiome as enviromental factors on Behcet's syndrome. Intern Emerg Med. 2018 Dec 6. Doi: 10.1007/s11739-018-2000-1. [Epub ahead of print]. [Crossref]  [PubMed] 

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www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com