presentation on oral health

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Oral health: A window to your overall health

Your oral health is more important than you might realize. Learn how the health of your mouth, teeth and gums can affect your general health.

Did you know that your oral health offers clues about your overall health? Did you know that problems in the mouth can affect the rest of the body? Protect yourself by learning more about the link between your oral health and overall health.

What's the link between oral health and overall health?

Like other areas of the body, the mouth is full of germs. Those germs are mostly harmless. But the mouth is the entry to the digestive tract. That's the long tube of organs from the mouth to the anus that food travels through. The mouth also is the entry to the organs that allow breathing, called the respiratory tracts. So sometimes germs in the mouth can lead to disease throughout the body.

Most often the body's defenses and good oral care keep germs under control. Good oral care includes daily brushing and flossing. Without good oral hygiene, germs can reach levels that might lead to infections, such as tooth decay and gum disease.

Also, certain medicines can lower the flow of spit, called saliva. Those medicines include decongestants, antihistamines, painkillers, water pills and antidepressants. Saliva washes away food and keeps the acids germs make in the mouth in balance. This helps keep germs from spreading and causing disease.

Oral germs and oral swelling and irritation, called inflammation, are linked to a severe form of gum disease, called periodontitis. Studies suggest that these germs and inflammation might play a role in some diseases. And certain diseases, such as diabetes and HIV/AIDS, can lower the body's ability to fight infection. That can make oral health problems worse.

What conditions can be linked to oral health?

Your oral health might play a part in conditions such as:

• Endocarditis. This is an infection of the inner lining of the heart chambers or valves, called endocardium. It most often happens when germs from another part of the body, such as the mouth, spread through the blood and attach to certain areas in the heart. Infection of the endocardium is rare. But it can be fatal.
• Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral germs can cause.
• Pregnancy and birth complications. Gum disease called periodontitis has been linked to premature birth and low birth weight.
• Pneumonia. Certain germs in the mouth can go into the lungs. This may cause pneumonia and other respiratory diseases.

Certain health conditions also might affect oral health, including:

Diabetes. Diabetes makes the body less able to fight infection. So diabetes can put the gums at risk. Gum disease seems to happen more often and be more serious in people who have diabetes.

Research shows that people who have gum disease have a harder time controlling their blood sugar levels. Regular dental care can improve diabetes control.

• HIV/AIDS. Oral problems, such as painful mouth sores called mucosal lesions, are common in people who have HIV/AIDS.
• Cancer. A number of cancers have been linked to gum disease. These include cancers of the mouth, gastrointestinal tract, lung, breast, prostate gland and uterus.
• Alzheimer's disease. As Alzheimer's disease gets worse, oral health also tends to get worse.

Other conditions that might be linked to oral health include eating disorders, rheumatoid arthritis and an immune system condition that causes dry mouth called Sjogren's syndrome.

Tell your dentist about the medicines you take. And make sure your dentist knows about any changes in your overall health. This includes recent illnesses or ongoing conditions you may have, such as diabetes.

How can I protect my oral health?

To protect your oral health, take care of your mouth every day.

• Brush your teeth at least twice a day for two minutes each time. Use a brush with soft bristles and fluoride toothpaste. Brush your tongue too.
• Clean between your teeth daily with floss, a water flosser or other products made for that purpose.
• Eat a healthy diet and limit sugary food and drinks.
• Replace your toothbrush every 3 to 4 months. Do it sooner if bristles are worn or flare out.
• See a dentist at least once a year for checkups and cleanings. Your dentist may suggest visits or cleanings more often, depending on your situation. You might be sent to a gum specialist, called a periodontist, if your gums need more care.
• Don't use tobacco.

Contact your dentist right away if you notice any oral health problems. Taking care of your oral health protects your overall health.

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• Gross EL. Oral and systemic health. https://www.uptodate.com/contents/search. Accessed Feb. 1, 2024.
• Oral health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/oral-health. Accessed Feb. 1, 2024.
• Gill SA, et al. Integrating oral health into health professions school curricula. Medical Education Online. 2022; doi:10.1080/10872981.2022.2090308.
• Mark AM. For the patient: Caring for your gums. The Journal of the American Dental Association. 2023; doi:10.1016/j.adaj.2023.09.012.
• Tonelli A, et al. The oral microbiome and the pathophysiology of cardiovascular disease. Nature Reviews Cardiology. 2023; doi:10.1038/s41569-022-00825-3.
• Gum disease and other diseases. The American Academy of Periodontology. https://www.perio.org/for-patients/gum-disease-information/gum-disease-and-other-diseases/. Accessed Feb 1, 2024.
• Gum disease prevention. The American Academy of Periodontology. https://www.perio.org/for-patients/gum-disease-information/gum-disease-prevention/. Accessed Feb. 1, 2024.
• Oral health topics: Toothbrushes. American Dental Association. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothbrushes. Accessed Feb. 1, 2024.
• Issrani R, et al. Exploring the mechanisms and association between oral microflora and systemic diseases. Diagnostics. 2022; doi:10.3390/diagnostics12112800.
• HIV/AIDS & oral health. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/hiv-aids. Accessed Feb. 1, 2024.
• Dental floss vs. water flosser
• Dry mouth relief
• Sensitive teeth
• When to brush your teeth

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• Find-a-Dentist

Resources for lifelong dental health

Not sure how to choose a dentist? When should your child see a dentist? What can you expect at a visit?

Download printable resources and lesson plans to help children of all ages learn about oral health. 

From welcoming the tooth fairy to keeping your smile safe on the field or court, these activities offer dental health lessons kids can use year-round.

Brushing Calendar

Sports Safety

National Nutrition Month

Back to School

Tooth Fairy

Defeat Monster Mouth

Color and Count

Oral Health Made Easy

Sesame Street

From “floss-some” Valentines to scarily cute Halloween pumpkin carving stencils, we’ve got everything you need to bring good dental health habits into your holiday celebrations!

See all holiday sheets

In February, the ADA celebrates National Children’s Dental Health Month (NCDHM) with resources to help parents, educators, community centers, dental professionals and dental societies engage kids in caring for their teeth. Explore colorful posters, flyers, postcards and tips for planning a successful event around this special awareness month.

Observed annually on March 20, the purpose of World Oral Health Day is “to empower people with the knowledge, tools and confidence to secure good oral health.” An initiative of FDI World Dental Federation, each World Oral Health Day launches a global campaign aimed at governments and policymakers, the healthcare community, schools and individuals to help reduce the burden of oral diseases and raise awareness of the importance of oral hygiene to overall well-being.

Smile Smarts! is a collection of four dental health curriculum plans for preschool through grade eight students offering flexible, modular lesson plans, support materials, hands-on classroom demonstrations, student activity sheets, and suggestions for future dental health activities.

Shining Smiles!

Shining Smiles! helps children ages 4 through 7 develop good dental health habits that can last a lifetime!

This program from the American Dental Association:

• Helps children ages 4 through 7 understand the importance of their teeth.
• Provides basic information, appropriate to their age and experience, about keeping teeth clean and healthy.
• Introduces the dentist as a friendly doctor who helps them take care of their teeth.

Start Teaching: Shining Smiles!

• Tiny Teeth Do Big Jobs (PDF)
• Keeping Teeth Bright and Healthy (PDF)
• A Visit to the Dentist (PDF)

A Lifetime of Healthy Smiles!

An engaging classroom lesson in good dental health habits for 2nd and 3rd grade students.

A Lifetime of Healthy Smiles! will help your students develop good dental hygiene habits that can last a lifetime! This program from the American Dental Association:

• Encourages students to think about and discuss the importance of their teeth.
• Provides information on good dental health appropriate to their age and experience.

Reinforces dentists' instructions on properly caring for teeth.

Start Teaching: A Lifetime of Healthy Smiles!

• Teeth Are Terrific (PDF)
• Plaque Attack (PDF)
• You Have Power (PDF)

Teeth to Treasure!

A lively classroom lesson for 4th through 6th grade students showing how taking good care of our teeth is something each of us can do.

Teeth to Treasure! reinforces good dental hygiene habits and focuses on special activities and conditions that require extra "tooth attention." This program from the American Dental Association:

• Helps instill in students a sense of competence and responsibility for keeping their teeth clean and healthy.
• Provides information on good dental health and tooth protection appropriate to their age and lifestyle.

Start Teaching: Teeth to Treasure!

• Protect Your Prized Possession (PDF)
• Extra Protection for Terrific Teeth (PDF)

Watch Your Mouth!

A dynamic and thought-provoking classroom lesson for 7th and 8th grade students.

Watch Your Mouth! shows how informed teens can make smart choices to protect their teeth and health. Watch Your Mouth! also reinforces good dental hygiene habits and focuses on special activities and conditions that require extra "tooth attention." This program from the American Dental Association:

Helps instill in students a sense of competence and responsibility for caring for their teeth and mouth.

Provides accurate and timely information on behaviors that can cause dental health problems, such as mouth piercing and tobacco use.

Associated Common Core ELA standards:

CCSS.ELA-LITERACY.L.8.4

CCSS.ELA-LITERACY.L.8.5.B

CCSS.ELA-LITERACY.L.8.6

CCSS.ELA-LITERACY.RI.3.1

CCSS.ELA-LITERACY.RI.8.4

Start Teaching: Watch Your Mouth!

Oral Health and You Presentation (PDF)

Crossword Puzzle (PDF)

Crossword Puzzle Answer Key (PDF)

Be Smart About Your Smile (PDF)

Going the Extra Smile (PDF)

Why are sugary drinks bad for teeth? And what’s the best way to make sure your teeth are clean? Teach kids how to better protect their teeth with these easy (and fun!) demonstrations.

An apple a d(ec)ay

Building egg-celent, healthy teeth

Peanut butter fingers

Use these resources for interactive discussions with children about their oral health.

Easy-to-do Activities

The following activities from the National Children's Dental Health Month Program Planning Guide contain easy-to-do activities that can be done at any time. National Children's Dental Health Month takes place every February and strives to help children get a good start on a lifetime of healthy teeth and gums.

Dental Health Speakers

Contact the local dental society in your area to inquire about having a dental health month speaker come to your classroom.

Print and Video Resources

The American Dental Association produces a wide variety of educational materials, including pamphlets, posters, teaching packets and audiovisuals which can be viewed and purchased through the ADA Store .

Drinks Destroy Teeth

Free app for fun, interactive lessons about the effect of acid and sugar in popular drinks on teeth. Features videos, 3D mouth, vocabulary and a short quiz. Free curriculum resources are available on DrinksDestroyTeeth.org , an educational outreach program of the Indiana Dental Association.

Healthy habits

Name some things that you do to keep your body healthy. There are daily health habits that everyone needs to practice, such as eating a proper diet, exercising, bathing, and sleeping. Caring for your mouth is as important as caring for the rest of your body. Cleaning teeth and gums removes a sticky film of plaque. Plaque contains harmful bacteria that can cause tooth decay.

My Plate explanation

Show the USDA 'Choose My Plate' chart to children. Explain/review the food groups and why each is important for healthy bodies and teeth. List the five main food groups on a chalkboard or easel (grain, fruit, vegetable, dairy and protein). Have children discuss some of their favorite foods and write them under the appropriate group. Bring enough healthy snacks to share with the children and ask them to identify its food group. Free reproducible MyPlate sheets for children are available from the United States Department of Agriculture .

Primary teeth

Have children raise their hand if they had a tooth that fell out. Ask one or two children to describe what it feels like without the tooth. Discuss baby teeth. Some teeth are supposed to come out. They are called the "baby" teeth or "primary" teeth. After a baby tooth comes out, another tooth will come in. This new tooth must last for many, many years. You must take extra special care by brushing each day. (See also: Eruption charts: Primary Teeth and Permanent Teeth )

Tooth Function

Ask children to make a list of what foods can be eaten without teeth and what foods must be chewed. Without teeth you couldn't chew crunchy foods like carrots, nuts, or apples. Have children pronounce the alphabet and tell which sounds are made by using the teeth, tongue, and lips. If you didn't have any teeth, it wouldn't be easy to say teeth, toys, or toothbrush.

Have you had students express an interest in science? Let them know that a career in dentistry opens up a world of professional opportunities. Here are some resources for you to share to get them started!

Why choose dentistry?

There are many reasons to choose dentistry as a career. Dentistry offers an opportunity to make a difference in your patients’ health and well-being. It's a career that allows you a chance to be your own boss and own a dental practice. New exciting scientific breakthroughs in gene therapy and biotechnology offer dentists an opportunity to preserve their patients’ smiles and self-esteem.

Have questions such as:

• What's unique about dentistry?
• What does a dentist do?
• How to prepare for a career in dentistry?
• What career options are available?

Download the Dentistry Fact Sheet  (PDF) and find answers.

Dentistry career options

Dentistry offers stimulating career options. In addition to private practice, excellent opportunities exist in teaching and research, careers with government agencies or in industry.

• Private Practice: Many dentists work either in solo private practice or in partnerships with other dentists. The majority of private practice dentists own their practices.
• Academic Dentistry: An academic dentistry career combines teaching, research, community service and patient care. Faculty members work in an intellectually stimulating and exciting academic environment. Career opportunities for academic dentists are excellent at this time. Additional information is available at the American Dental Education Association .
• Public Health Dentistry: This career focuses on community settings rather than private practice. Promoting dental health, developing health policy and preventing disease are the major roles of a public health dentist. Numerous opportunities exist in research and teaching within public health dentistry. The U.S. Public Health Service offers dentists an opportunity to provide dental care in unique cultural environments (e.g., an Indian Reservation, Coast Guard base, or Federal Prison).
• Research: Research careers offer opportunities to generate new knowledge and be on the cutting edge of scientific discoveries that ultimately impact patient care. Some of the latest research improving patient care includes lasers in surgery, implants to replace damaged bone and computerized X-rays. Many researchers are faculty at universities while others work in federal facilities, such as the National Institute for Dental and Craniofacial Research , and the National Institutes of Health ; or in private industry. A career in research requires an advanced degree or additional training beyond the dental degree.
• International Health Care: Dentists provide services to populations abroad and work for such agencies as the World Health Organization (WHO), the United Nations Educational, Scientific and Cultural Organization (UNESCO), and the Food and Agricultural Organization of the United Nations (FAO). Many dentists volunteer to bring dentistry to aid people in developing countries.
• Hospital dentistry: Hospital dentists treat patients with medical conditions and disabilities alongside physician colleagues, often in operating rooms and emergency departments. Hospital dentists usually have a strong interest in medicine and collaborative care and have spent a year or more training in a hospital-based setting after dental school.

A career as a dental specialist

The majority of the 164,000 practicing dentists today are general practitioners. The remainder (about 20 percent) are dental specialists who limit their practices to one of the 12 ADA recognized dental specialties. The 12 dental specialties are: Dental Anesthesiology, Dental Public Health, Endodontics, Oral and Maxillofacial Pathology, Oral and Maxillofacial Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Orthodontics and Dentofacial Orthopedics, Pediatric Dentistry, Periodontics and Prosthodontics. In addition to four years of dental school, two or more additional years of dental specialty education are required.

Select a dental school

There are more than 60 dental schools in the United States accredited by the ADA's Commission on Dental Accreditation (CODA). Each program is rigorously evaluated for its content and quality. Typically, DDS/DMD programs take four years to complete with an additional year for dental specialties like Oral and Maxillofacial Surgery and Pediatric Dentistry.

Admission to dental school is highly competitive, but the application process has never been easier. Most U.S. dental schools accept a single online application through the American Association of Dental Schools Application Service (AADSAS) .

Dental school admissions

Prerequisites

Students should contact individual dental schools for specific prerequisite information. Required courses generally include:

• 8 hours Biology with lab
• 8 hours Physics
• 8 hours English
• 8 hours General Chemistry with lab
• 8 hours Organic Chemistry with lab

Majoring in science is not a must, but completion of predental science requirements is necessary.

A college undergraduate degree is recommended in preparation for dental school. Most dental students have completed four years of college.

Dental Admissions Test (DAT)

Take the DAT at least a year prior to seeking admission to dental school. This computerized test measures general academic ability, comprehension of scientific information and perceptual ability. Completion of at least one year of college level courses in biology and general and organic chemistry is recommended before taking the DAT.

Admissions committees review credentials such as academic qualifications, the results from the Dental Admissions Test (DAT), grade point average (GPA), letters of recommendation, personal interviews and dental office shadowing experiences. Admission requirements can vary from school to school.

Most dental schools require personal interviews with candidates to assess qualities such as desire to help people, self-confidence, ability to meet challenges, ability to get along with people and capacity to work independently. The personal interview also provides an opportunity to ask about the school.

Apply for admission at least a year in advance of the planned enrollment date. Most dental schools participate in the Associated American Dental Schools Application Service (AADSAS). For a fee, students can subscribe to this service and complete a single application to apply to multiple dental schools. An online application to the schools participating in AADSAS is available here . The AADSAS toll-free number is 800-353-2237.

• Get the most current information on how to apply for the DAT
• View a list of ADA Commission-accredited U.S. and Canadian dental schools

Pay for dental school

Dental school, like other graduate and professional programs, is a significant investment. Over 90 percent of dental students take out loans to finance their education. Consult the ADA’s Financial Resources for Students  for detailed information about financial planning and effective debt management.

Be a Dental Team Member

There is a great demand for dental team positions like dental hygienists, dental assistants and dental lab technicians. Hygienists and assistants interact closely with patients to ensure a high level of care, while dental lab technicians work behind-the-scenes, designing the dentures, crowns and braces used by dentists.

All dental team careers are well paid with flexible hours and the educational costs and commitment aren’t as significant as dental school. Learn more about accredited training programs .

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Oral Health Education and Training

The information and resources below will help you to identify oral disease, provide caries prevention services, and establish referral relationships with dental professionals.

Smiles for Life National Oral Health Curriculum

Developed by the Society for Teachers of Family Medicine, the Smiles for Life National Oral Health Curriculum has 2 child-focused modules:

• Child Oral Health
• Caries Risk Assessment, Fluoride Varnish, and Counseling

These modules are endorsed by the AAP and approved for continuing medical education.

Bright Futures Oral Health Resources

The Bright Futures Guidelines for Health Supervision for Infants, Children, and Adolescents prioritizes oral health as a major health topic to be included in practice. View the Bright Futures: Oral Health Pocket Guide as well as practice guides and other Bright Futures resources .

Pediatric Oral Health Flip Chart and Reference Guide

The Pediatric Guide to Children’s Oral Health Flip Chart and Reference Guide includes pictures and speaker’s notes to help you to counsel patients about oral health and apply fluoride varnish, and take action against oral injuries and disease. It is available for purchase through shopAAP .

PediaLink is the AAP's online learning center offering a variety of educational opportunities and resources, including the below focused on oral health. This video series is free for AAP members and others.

• Providing fluoride varnish in the medical setting (30 minutes)
• Providing preventative oral health services in practice (30 minutes)

Training Videos

Minnesota Oral Health Coalition (MOHC) Videos : MOHC has many helpful video resources focused on collaborating with communities and schools, improvements through innovation and integration, and the lifelong importance of oral health.

Smiles for Life Training Videos : Smiles for Life has several demonstration videos of patient care including knee-to-knee, fluoride varnish application, and palpation of the temporomandibular (TMJ) and the floor of the mouth.

How To Apply Fluoride Varnish (From the First Tooth) : From the First Tooth has instructional videos of how to apply fluoride varnish in a primary care setting for very young children.

Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program

Educators can use the below oral health educational content (downloadable PowerPoint presentations) for medical students and pediatricians in training. The content is for educational purposes only. CME credit for presenting this content is not available from the AAP. This content is no longer available as an online module.

Each PowerPoint presentation includes an outline, learner objectives, speaker notes, references, and a question-and-answer series following the presentation.

Presentations may be downloaded and tailored to meet the needs of your learners. If you plan to significantly edit the content of your presentation, please contact us  for permission to update the AAP copyrighted material. The content is for educational purposes only.

• Basic Oral Anatomy
• Oral Health Screening
• Oral Injury
• Dental Development
• Oral Pathology
• Preventive Care
• Oral Findings
• Special Needs
• Oral Habits
• Systemic Diseases
• Oral Health in Adolescents

PACT Post-Test – Learners can be directed to this link to complete a comprehensive post-test. If you require a hard copy of the post-test and answer key, please e-mail [email protected].

PACT Instructor Guide –This guide will help instructors implement the PACT materials within their educational settings.

Dental caries is the most common chronic disease in children. Pediatricians and other medical providers play an important role in improving children's oral health outcomes. Access issues prevent many children from visiting a dentist. If you are knowledgeable about oral health, you can discover problems, emphasize cavity prevention, and make life saving referrals.

Last Updated

American Academy of Pediatrics

Oral Health is Essential to General Health

• Source Text

• Oral health is essential to general health and well-being across the lifespan.
• Image: Pregnant woman. During pregnancy, women may be more prone to gum disease and cavities.
• Image: Woman holding infant. A mother’s oral health status is a strong predictor of her child’s oral health status.
• Image: Molar with decay. If mothers have high levels of untreated cavities or tooth loss, their children are 3X more likely to have cavities.

Available for Download [PDF – 829 KB]

• Dental Care is Safe and Important During Pregnancy

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Teaching Kids Healthy Habits

Show your young students an 8 minute video about tooth-healthy snacks for school. This is an edited segment of the 1st grade presentation by our hygienist, Dianne Powers, that focuses on snacks. Many thanks to Karen Robinson and the students in her Londonderry High School TV Production and Radio Broadcasting class! 

Healthy Snacks  (8 min)

Oral health is an important part of overall health, and so Children’s Dental Network offers teachers in participating schools the opportunity to have a dental hygienist deliver an oral health presentation to their students. These presentations are available for students in kindergarten through grade 5, and may be offered at various times during the school year. February is National Children's Dental Health Month. That is a wonderful time for teachers to utilize our oral health videos listed below. Thank you to the Salem High School technology department for making these videos possible.

Oral Health Practices for K & Grade 1  (16 min)

Oral Health Practices for Grades 2 & 3  (20 min)

Oral Health Practices for Grades 4 & 5  (20 min)

Our hygienists collaborate with school nurses, secretaries and principals to notify teachers when dates and times are available for their school.

Topics that we cover include the following:

PreK and Kindergarten  Introduction to good dental care: visiting the dentist, brushing technique, flossing and fluoride

Grade 1 Choosing healthy snacks for teeth, proper brushing habits, flossing, fluoride and a unique movie about sealants

Grade 2 and Grade 3 Focused on prevention: review of toothbrushing and flossing techniques, introduction to ADA-approved dental products, importance of daily fluoride exposure, appropriate snacks to maintain good oral and overall health and lastly, a hands-on brushing activity. An interactive true or false game to review optimal dental health; a true test to see how much they have absorbed from previous years!

Grade 4 and Grade 5 A modern Power Point to introduce how oral health is part of overall health. We include information on the effects of sugary beverages and their acid content on teeth and gums. Basic home care is reviewed and students are encouraged to put their best efforts into the responsibility of personal hygiene and healthy habits. Gingivitis is discussed, how cavities develop and how ADA approved products containing fluoride can help keep teeth stronger. A Ted-Ed video wraps up sharing a basic history on what causes cavities and how they have been treated through the years. 

A double-sided handout is available for each grade. You can download handouts here.

Pre-K and Kindergarten Toothbrush Chart Toothbrush Count Activity

Grade 1 Choose Healthy Snacks Parent Letter

Grade 2 Brushing Chart Prevent Dental Problems

Grade 3 Test Yourself and Your Family How to Floss

Grade 4 Grade 5

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Oral Health: Periodontal Disease

Oral health: periodontal disease presentation, free google slides theme, powerpoint template, and canva presentation template.

Any periodontal disease is an oral health condition that affects the tissues supporting the teeth, including the gums, ligaments, and bone. These diseases can be caused by poor oral hygiene, smoking, genetic factors, and certain medical conditions. We hope you brush your teeth regularly, and we also hope you download this template to create informative or educational presentations about periodontal diseases. Make your own slides by using the simple-to-edit layouts included, use the editable map to indicate the prevalence of a certain disease, customize the infographics to enhance data visualization... To save time, there's no better choice than this template!

Features of this template

• 100% editable and easy to modify
• 20 different slides to impress your audience
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Oral Health.

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How to prepare and deliver an effective oral presentation

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• Peer review
• Lucia Hartigan , registrar 1 ,
• Fionnuala Mone , fellow in maternal fetal medicine 1 ,
• Mary Higgins , consultant obstetrician 2
• 1 National Maternity Hospital, Dublin, Ireland
• 2 National Maternity Hospital, Dublin; Obstetrics and Gynaecology, Medicine and Medical Sciences, University College Dublin
• luciahartigan{at}hotmail.com

The success of an oral presentation lies in the speaker’s ability to transmit information to the audience. Lucia Hartigan and colleagues describe what they have learnt about delivering an effective scientific oral presentation from their own experiences, and their mistakes

The objective of an oral presentation is to portray large amounts of often complex information in a clear, bite sized fashion. Although some of the success lies in the content, the rest lies in the speaker’s skills in transmitting the information to the audience. 1

Preparation

It is important to be as well prepared as possible. Look at the venue in person, and find out the time allowed for your presentation and for questions, and the size of the audience and their backgrounds, which will allow the presentation to be pitched at the appropriate level.

See what the ambience and temperature are like and check that the format of your presentation is compatible with the available computer. This is particularly important when embedding videos. Before you begin, look at the video on stand-by and make sure the lights are dimmed and the speakers are functioning.

For visual aids, Microsoft PowerPoint or Apple Mac Keynote programmes are usual, although Prezi is increasing in popularity. Save the presentation on a USB stick, with email or cloud storage backup to avoid last minute disasters.

When preparing the presentation, start with an opening slide containing the title of the study, your name, and the date. Begin by addressing and thanking the audience and the organisation that has invited you to speak. Typically, the format includes background, study aims, methodology, results, strengths and weaknesses of the study, and conclusions.

If the study takes a lecturing format, consider including “any questions?” on a slide before you conclude, which will allow the audience to remember the take home messages. Ideally, the audience should remember three of the main points from the presentation. 2

Have a maximum of four short points per slide. If you can display something as a diagram, video, or a graph, use this instead of text and talk around it.

Animation is available in both Microsoft PowerPoint and the Apple Mac Keynote programme, and its use in presentations has been demonstrated to assist in the retention and recall of facts. 3 Do not overuse it, though, as it could make you appear unprofessional. If you show a video or diagram don’t just sit back—use a laser pointer to explain what is happening.

Rehearse your presentation in front of at least one person. Request feedback and amend accordingly. If possible, practise in the venue itself so things will not be unfamiliar on the day. If you appear comfortable, the audience will feel comfortable. Ask colleagues and seniors what questions they would ask and prepare responses to these questions.

It is important to dress appropriately, stand up straight, and project your voice towards the back of the room. Practise using a microphone, or any other presentation aids, in advance. If you don’t have your own presenting style, think of the style of inspirational scientific speakers you have seen and imitate it.

Try to present slides at the rate of around one slide a minute. If you talk too much, you will lose your audience’s attention. The slides or videos should be an adjunct to your presentation, so do not hide behind them, and be proud of the work you are presenting. You should avoid reading the wording on the slides, but instead talk around the content on them.

Maintain eye contact with the audience and remember to smile and pause after each comment, giving your nerves time to settle. Speak slowly and concisely, highlighting key points.

Do not assume that the audience is completely familiar with the topic you are passionate about, but don’t patronise them either. Use every presentation as an opportunity to teach, even your seniors. The information you are presenting may be new to them, but it is always important to know your audience’s background. You can then ensure you do not patronise world experts.

To maintain the audience’s attention, vary the tone and inflection of your voice. If appropriate, use humour, though you should run any comments or jokes past others beforehand and make sure they are culturally appropriate. Check every now and again that the audience is following and offer them the opportunity to ask questions.

Finishing up is the most important part, as this is when you send your take home message with the audience. Slow down, even though time is important at this stage. Conclude with the three key points from the study and leave the slide up for a further few seconds. Do not ramble on. Give the audience a chance to digest the presentation. Conclude by acknowledging those who assisted you in the study, and thank the audience and organisation. If you are presenting in North America, it is usual practice to conclude with an image of the team. If you wish to show references, insert a text box on the appropriate slide with the primary author, year, and paper, although this is not always required.

Answering questions can often feel like the most daunting part, but don’t look upon this as negative. Assume that the audience has listened and is interested in your research. Listen carefully, and if you are unsure about what someone is saying, ask for the question to be rephrased. Thank the audience member for asking the question and keep responses brief and concise. If you are unsure of the answer you can say that the questioner has raised an interesting point that you will have to investigate further. Have someone in the audience who will write down the questions for you, and remember that this is effectively free peer review.

Be proud of your achievements and try to do justice to the work that you and the rest of your group have done. You deserve to be up on that stage, so show off what you have achieved.

Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.

• ↵ Rovira A, Auger C, Naidich TP. How to prepare an oral presentation and a conference. Radiologica 2013 ; 55 (suppl 1): 2 -7S. OpenUrl
• ↵ Bourne PE. Ten simple rules for making good oral presentations. PLos Comput Biol 2007 ; 3 : e77 . OpenUrl PubMed
• ↵ Naqvi SH, Mobasher F, Afzal MA, Umair M, Kohli AN, Bukhari MH. Effectiveness of teaching methods in a medical institute: perceptions of medical students to teaching aids. J Pak Med Assoc 2013 ; 63 : 859 -64. OpenUrl

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• Open access
• Published: 13 May 2024

The relationship between clinical symptoms of oral lichen planus and quality of life related to oral health

• Maryam Alsadat Hashemipour 1 , 2 ,
• Sahab Sheikhhoseini 3 ,
• Zahra Afshari 4 &
• Amir Reza Gandjalikhan Nassab 5  

BMC Oral Health volume  24 , Article number:  556 ( 2024 ) Cite this article

Metrics details

Introduction

Oral Lichen Planus (OLP) is a chronic and relatively common mucocutaneous disease that often affects the oral mucosa. Although, OLP is generally not life-threatening, its consequences can significantly impact the quality of life in physical, psychological, and social aspects. Therefore, the aim of this research is to investigate the relationship between clinical symptoms of OLP and oral health-related quality of life in patients using the OHIP-14 (Oral Health Impact Profile-14) questionnaire.

Materials and methods

This descriptive-analytical study has a cross-sectional design, with case–control comparison. In this study, 56 individuals were examined as cases, and 68 individuals were included as controls. After recording demographic characteristics and clinical features by reviewing patients' records, the OHIP-14 questionnaire including clinical severity of lesions assessed using the Thongprasom scoring system, and pain assessed by the Visual Analog Scale (VAS) were completed. The ADD (Additive) and SC (Simple Count) methods were used for scoring, and data analysis was performed using the T-test, Mann–Whitney U test, Chi-Square, Spearman's Correlation Coefficient, and SPSS 24.

Nearly all patients (50 individuals, 89.3%) reported having pain, although the average pain intensity was mostly mild. This disease has affected the quality of life in 82% of the patients (46 individuals). The patient group, in comparison to the control group, significantly expressed a lower quality of life in terms of functional limitations and physical disability. There was a statistically significant positive correlation between clinical symptoms of OLP, gender, location (palate), and clinical presentation type (erosive, reticular, and bullous) of OLP lesions with OHIP-14 scores, although the number or bilaterality of lesions and patient age did not have any significant correlation with pain or OHIP scores.

It appears that certain aspects of oral health-related quality of life decrease in patients with OLP, and that of the OLP patient group is significantly lower in terms of functional limitations and physical disability compared to the control group. Additionally, there was a significant correlation between clinical symptoms of OLP and pain as well as OHIP scores.

Peer Review reports

Lichen planus (LP) is a chronic and relatively common mucocutaneous disease that often affects the oral mucosa. The exact cause of the disease is yet to be discovered; however existing evidence suggests the involvement of immunologic processes in the etiology of the lesions. The disease is more common in women and middle-aged people, with an estimated prevalence ranging from 1% to 2.2% [ 1 ].

In the oral mucosa, LP typically presents as white lesions, often with erosions. The most common clinical pattern is the reticular form [ 1 , 2 , 3 , 4 ]. The most frequently affected oral sites are the buccal mucosa and, subsequently, the tongue and gingiva. Furthermore, the reticular, erosive, and bullous clinical patterns are common [ 5 , 6 ].

The prevalence of LP lesions and other epidemiological parameters reported in various studies vary significantly. One major reason for these variations is the differences in research methodologies, study populations, sampling techniques, and sample sizes. Many studies have been conducted in dental clinics and hospitals [ 2 , 3 , 4 ], and population-based studies are limited [ 5 , 6 ]. Given that many cases of oral LP are asymptomatic, and the possibility that these studies may not encompass all cases, this issue is raised. Moreover, the presence of lichenoid lesions as a broad spectrum of lesions with similar clinical and sometimes histological features can complicate the accurate diagnosis of LP [ 7 ].

Numerous clinical indices have been developed and refined based on clinical experience for the classification of oral LP [ 5 ]. Clinical features includes size, color, and location-based distribution [ 5 ]. The common clinical signs and symptoms of oral LP range from a burning sensation to severe chronic pain [ 4 ]. The measurement of pain associated with oral LP has been widely used in clinical practice and research [ 8 , 9 , 10 , 11 ].

Despite the availability of pain rating scales, none are capable of comprehensive assessment of the multidimensional aspects of pain [ 12 ]. Oral lichen planus is generally not life-threatening. However, the consequences of oral lichen planus can lead to the worsening of the quality of life in physical, psychological, and social dimensions. Effects such as difficulty eating certain foods, which can lead to weight loss or malnutrition in severe cases, have been reported. Dietary satisfaction is at risk and can impact happiness and social abilities [ 13 , 14 ].

Furthermore, speech problems that may result from dry mouth have also been reported [ 15 ]. Additionally, the presence of an ulcerative lesion can restrict the performance of daily oral hygiene activities [ 16 ]. In terms of sleep disturbances, patients with oral lichen planus have more sleep disorders compared to healthy individuals [ 17 ]. It appears that sleep deprivation can amplify pain signals and increasing pain sensitivity [ 18 ].

Some studies have shown that patients with oral lichen planus experience higher levels of stress and anxiety compared to healthy individuals [ 19 , 20 ]. Dissatisfaction with the appearance of oral lichen planus lesions on the lips, including whiteness, keratotic plaques, atrophic erythematous areas, or ulcers, as well as hyperpigmented coffee-colored or black areas following inflammation, has been reported [ 21 , 22 , 23 , 24 , 25 ], and this potentially affects the quality of life of patients due to its impact on aesthetics.

In relation to the social burden, it was investigated the aspects of OLP, including social cost, work loss or school absence, are related to the economy [ 26 ]. Lastly, it was revealed that the impact of OLP could cause the avoidance of social interactions, such as social gatherings or eating-out parties [ 13 ].

The concept of Oral Health-Related Quality of Life ( OHRQoL) had been developed and introduced into all fields of dentistry, including oral medicine [ 24 ]. For clinicians, the application of OHRQoL revealed the importance of understanding the disease from the patient’s perspectives. Moreover, the goal of OLP treatment should focus, not only on healing the lesion and reducing pain, but also improving OHRQoL. Taking these factors into considerations, we believe that using merely clinical indicators is not sufficient, and the added value of subjective patients’ symptoms and OHRQoL in the research studies are anticipated [ 5 , 24 ]. A number of previous studies have examined OHRQoL in OLP patients [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Most studies were conducted with the cross-sectional design. Various patient-based outcomes were used, for example, pain, self-perceived oral health, oral health satisfaction, as well as OHRQoL indices. Among the studies that applied the OHRQoL index, the Oral Health Impact Profile index (OHIP) was most frequently used [ 11 , 28 , 31 , 32 , 33 , 34 , 36 , 39 ]. The OHIP consists of 49 or 14 items (short form) covering a wide range of patient’s symptoms and problems of oral functioning. Therefore, the OIDP measures the changes in daily life performances which are considered as the ultimate oral impacts caused by various perceived symptoms [ 40 ].

Therefore, the aim of the present study was to assess OHRQoL of OLP patients using the OHIP index. Furthermore, the associations of OHRQoL and pain perception with OLP clinical characteristics in terms of localization, type, number and severity, according to Thongprasom sign scoring system were examined.

This study employed a descriptive-analytical and cross-sectional design with a case–control approach. Inclusion criteria for the case group included patients aged 18 or older who had been clinically and histopathologically diagnosed with oral lichen planus and confimed diagnosis. The clinical diagnosis of lichen planus was based on white lesion with Wickham’s striae in the forms reticular (fine white striae cross each other in the lesion), popular, erythematousor atrophic (areas of erythematous lesion surrounded by reticular components), ulcerative or erosive, plaque and Bullous. Also, the three classical histological feature of oral lichen planus what were put forward first by Dubreuill in 1906 and Shklar was used in this study (liquefaction degeneration of basal layer, overlying keratinization, lymphocytic infiltrate within the connective tissue that is dense and resembles a band) [ 24 ].

Additionally, the onset of their lesions should have occurred less than 3 years ago. On the other hand, exclusion criteria for the case group consisted of patients with other oral mucosal lesions, pregnant, smokers, and people with other oral mucosal changes and medical conditions which can have an additive role in the psychology of the patient and that could potentially affect their quality of life.

Furthermore, a total of 68 individuals with healthy oral mucosa were included as the control group. Inclusion criteria for the control group were participants aged 18 or older with no oral lesions or medical conditions such as diabetes that could affect their quality of life.

To conduct the study, patient records were reviewed, and demographic information, including gender, age, lesion type, time since the initial diagnosis of oral lichen planus, and clinical characteristics, were recorded. Additionally, phone contact was established with patients to assess pain severity and complete the OHIP-14 questionnaire.

A total of 56 individuals were examined in the case group and 68 individuals with healthy oral mucosa were included as the control group based on similar studies' sample sizes (z: 1.96, p  = q = 0.5, d = 0.05).

The clinical severity of lesions was assessed using the Thongprasom scoring system [ 6 ], where scores ranged from 1 to 5, with 1 meaning only mild white lines, 2 meaning white lines with atrophic area < 1 square centimeter, 3 meaning white lines with atrophic area ≥ 1 square centimeter, 4 meaning white lines with erosive area < 1 square centimeter, and 5 meaning white lines with erosive area ≥ 1 square centimeter. In the case of multiple oral lichen planus lesions, the highest score among all lesions was recorded.

Regarding pain assessment, participants were asked to rate their current pain intensity related to oral lichen planus on a Visual Analog Scale (VAS), ranging from 0 to 10, where 0 indicated no pain, and 10 represented the worst imaginable pain. Pain scores were categorized into mild (0–3), moderate (4–7), and severe (8–10) [ 12 ].

The Oral Health Impact Profile (OHIP-14) questionnaire, which had a valid Persian version, was used to evaluate the quality of life of the patients [ 26 ]. This questionnaire comprised 14 items assessing various aspects of mental functioning and quality of life. It included seven subdomains: functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap, with each subdomain containing two questions.

Two methods were employed to assess the responses: The Additive method and the Simple Count (SC) method. In the first method, the options of the questionnaire were scored as follows: 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = always. The OHIP-14 score ranged from 0 to 56, with lower scores indicating better quality of life. Additionally, a "severity" measure was calculated to represent better mental perception. The severity scores were categorized into five groups: very low, low, moderate, severe, and very severe. In the SC method, options were scored as 0 for never and rarely, and 1 for sometimes, often, and always. This method was considered to account for the possibility that some individuals might not perceive the real difference between the questionnaire options. The OHIP-14 score ranged from 0 to 14 [ 27 ].

Data analysis was conducted using the T-test, the Mann–Whitney U test, the Chi-Square, Spearman's Correlation Coefficient, and SPSS Version 24. The significance level for data analysis was set at P  < 0.05.

In this case–control study, 56 patients with histopathologically confirmed oral lichen planus and 68 healthy individuals, who had no complaints of oral mucosal diseases and had either accompanied patients or visited the School of Dentistry for routine dental examinations, were respectively enrolled as the case and control groups. The case group consisted of 36 females and 20 males, with a mean age of 48.2 ± 4.3 years, a minimum age of 39, and a maximum of 64 years. These two groups were matched in terms of age, gender, and oral health status ( P  = 0.12, 0.41, 0.23, respectively). Table 1 displays the demographic characteristics and oral health status of the participants.

Twenty-two individuals (39.3%) among the participants had oral lichen planus lesions for one year, 18 of them (32.1%) between one to three years, and 16 of them (28.6%) had lesions for less than one year. Almost all patients (50 individuals—89.3%) complained of pain; however, the average pain intensity was primarily mild (34 individuals—60.7%), followed by moderate (14 individuals—25%), and the rest (8 individuals—14.3%) reported severe pain. The mean pain score was 3.1 ± 0.9.

Considering the clinical features of oral lichen planus, the commonly affected mucosal sites were buccal mucosa (78.2%), followed by gingiva (62.5%), tongue and lips (17.6%), palate (16.1%), and floor of the mouth (3.9%). Equal to 46.2% (23 individuals) had a reticular and popular type of oral lichen planus, 22% (13 individuals) had a combination of reticular, atrophic, and erosive types, 14.3% (8 individuals) had atrophic, 10.7% (6 individuals) had ulcerative, and finally, 10.7% (6 individuals) had bullous lesions. Regarding the distribution of oral lichen planus lesions, approximately 46.3% were bilateral, and the rest involved more than two sites.

The impact of oral lichen planus on the quality of life is presented in Table  2 . About 82% (46 individuals) of patients stated that oral lichen planus have affected their quality of life. The total OHIP-14 score was 10.12 ± 18.15 in the case group and 8.71 ± 15.11 in the control group, with no statistically notable difference between the two groups ( P  = 0.05). The mean and standard deviation of OHIP-14 subgroups in each of the case and control groups using two evaluation methods are shown in Tables  2 , 3 and  4 . As observed, the case group had a greater functional limitation compared to the control group ( P  = 0.03). Also, using the SC evaluation method, the patient group reported significantly lower quality of life in terms of functional limitation and physical disability ( P  = 0.01, 0.02, respectively). There was a statistically noticeable difference between the mean total OHIP-14 score and its subgroups among genders (men more than women, P  = 0.01). There was no significant difference between the mean total OHIP-14 score and its subgroups concerning age ( P  = 0.09).

This study demonstrated a positive statistical correlation between clinical symptoms of oral lichen planus, pain, and the OHIP-14 questionnaire score. With an increase in the Thongprasom Sign Score, the OHIP-14 score increased. Pain in patients with oral lichen planus was associated with clinical severity, and a significant relationship was observed in this regard Table 3 .

The location and clinical manifestation type of oral lichen planus lesions were related to the OHIP-14 questionnaire score. The study showed that oral lichen planus in the palate significantly affected the OHIP-14 score, leading to a significant increase in the score. Patients with ulcerative, erosive, and bullous types of oral lichen planus reported remarkably higher pain levels compared to other types. Although the number of lesions did not have any correlation with pain and questionnaire score. Table 4

Lichen planus is a relatively common chronic skin disease that often affects the oral mucosa. Patients with oral lichen planus suffer from symptoms that affect their daily life in various fields. Although the etiology of oral lichen planus is not known, the role of mental disorders, especially stress, anxiety and depression, in the pathogenesis of the disease is discussed [ 23 , 24 , 25 ].

Chronic diseases of the oral mucosa can definitely affect the quality of life. Therefore, several studies have investigated the quality of life related to oral health of patients with oral symptoms [ 28 , 29 , 30 , 31 ]. Patients with erosive lichen planus suffer from symptoms that affect their daily life in various fields. There are different tools and questionnaires for evaluating the quality of life related to oral health. These tools are used to complete clinical evaluations and strengthen the relationship between patients and physician, also patients can have a better understanding of the consequences of oral diseases in their daily life and their impact on quality of life [ 31 ].

OHIP-14 is a questionnaire that was first used by Slade in 1997 to evaluate the quality of life related to oral health. This questionnaire examines 7 aspects of the quality of life related to oral health, including functional limitation, physical pain, mental discomfort, physical disability, mental disability, social disability and disability [ 28 , 32 ]. LOCKER model shows the effect of oral conditions on these 7 aspects of quality of life. Based on this model, the first level of factors affecting the quality of life related to oral health are functional limitations, physical pain and mental discomfort. At the next level, there are many factors that cause more problems in people's lives, which include physical, mental, and social disability, and finally, people may feel disabled in life due to oral diseases, which includes the last level of this model [ 31 ].

In this case–control study, 56 patients with confirmed lichen planus were considered as the case group and 68 healthy individuals who had visited Kerman Dental School for routine dental examinations \ without any muco-oral disease, were included in the study under the title of control group. The case group included 36 women and 20 men. The average age was 48.2 ± 4.3 years and they were at least 39 and at most 64 years old.

Twenty-two (39.3%) of the participants had oral lichen planus lesions for 1–5 years. 18 people (32.1%) had the lesion for more than 5 years and 16 people (28.6%) for less than 1 year. Almost all patients (50 people—89.3%) complained of pain. However, the average intensity of pain was mostly mild (34 people-60.7%), followed by moderate (14 people-25%) and the rest (8 people-14.3%) severe. The average pain score was 3.1 ± 0.9.

In Khalili and Shojaei's study [ 32 ], the mean age of the patients was 42 ± 14.2, and the patients ranged in age from 6 to 73 years. Silverman et al. [ 33 , 34 ] in 2 studies reported the mean age as 52 years (22–80 years) and 54 years (21–82 years).

Equal to 46.2% (23 people) of the patients had reticular and popular type of lichen planus. 22% (13 persons) were a combination of reticular, atrophic and erosive types, 14.3% (8 persons) were atrophic, 10.7% (6 persons) were ulcers and finally 10.7% (6 persons) were bullous. According to the number of oral lichen distribution, about 46.3% were bilateral and the rest involved more than two places.

In Khalili and Shojaei's study [ 32 ], it was reported that the frequencies of female and male patients are 49.6% and 50.4%, respectively. The studies by Silverman and colleagues [ 33 , 34 ] revealed that 65 to 67% of patients are women, and Vincent and colleagues reported this rate to be 76% [ 35 ]. Silverman et al. [ 33 ] found that the frequency of reticular lesions as 34% and the type of injury as 59.9%, and in another study, the frequency of reticular lesions was 28.5% and the type of injury was 71.58% [ 34 ]. In Vincent et al.'s research work [ 35 ], the frequencies of reticular, atrophic and ulcreated lesions were 24.3%, 33.6% and 41.9%, respectively.

Due to the fact that reticular lesions are not biopsied in most cases, the results of this study do not reflect the actual distribution of the disease in the population. In the mentioned studies, the amount of atrophic and injured type is more than the reticular type, and the reason for this is the examination of patients referred to diagnostic and treatment centers. It is obvious that because the reticular type has no pain and clinical symptoms, the referrals of affected people and even their awareness of the lesion are less than other types of diseases.

According to the clinical features of oral lichen planus, the three most common sites were buccal mucosa (78.2%), followed by gums (62.5%), tongue and lips (17.6%), palate (16.1%) and floor of the mouth (3.9%).

In the study by Khalili and Shojaei [ 32 ], the most common sites of involvement were the mucous membrane of the cheek and gums, followed by the tongue, and in 67% of cases, involvement was seen in only one anatomical site. The common conflict is consistent with all the researches that have been done before [ 33 , 34 , 35 ]. In the studies by Khalili and Shojaei [ 32 ] and Myers et al. [ 36 ], lesions have been presented in several areas of the mouth in most cases.

Based on the results of this research, the quality of life related to the oral health of the patient group was lower than that of the healthy group, and the patients with oral lichen planus expressed significantly more functional limitations and physical disability than the healthy group. Functional limitation in many patients was due to their dissatisfaction with the change in the taste of the mouth, and their physical disability was mostly due to dissatisfaction with the type of food they were eating. This finding is in accordance with the research of Tebelnejad et al. [ 27 ]. Based on the investigation by Lopez-Jornet et al. [ 28 ], who examined the quality of life related to oral health in patients with oral lichen planus in Spain the patients' quality of life was slightly lower than the control group and the patients' quality of life was reported to be lower in terms of mental disability, social disability and disability.

The difference between the findings in the study by López-Jornet et al. [ 28 ] and those obtained in the present work can be related to the different population under study and the sample size.

Ashshi et al.'s research [ 37 ] showed that oral lichen planus has significantly poorer quality of life in Chronic Oral Mucosal Disease Questionnaire-26 (COMDQ-26) and Oral Potential Malignant Disorder QoL Questionnaire (OPMDQoL) compared to dysplasia. In addition, patients with oral lichen planus aged 40 to 64 years were independently associated with higher COMD-26 scores compared to older patients (> 65 years).

The present investigation depicted that there is a significant relationship between the type of ulcerative, atrophic and bullous lesion and the presence of a lesion in the palate and increased pain intensity.

The increase in pain and irritation in the oral mucosa of patients with oral lichen planus can be a reason for the effect on the functional and physical aspects of the patients' quality of life and on the effect of lichen disease, which has also been found in the study of Hegarty and colleagues [ 30 ]. The oral plan emphasizes the quality of life and its physical, social and psychological aspects.

In the research of Saberi et al. [ 38 ] on patients with erosive/ulcerative OLP, there was a significant relationship between oral pain and the total score of COMDQ as well as its physical, social and emotional domains.

In this research, the total score of OHIP-14 in the case group was 18.15 ± 10.12 and in the control group was 15.11 ± 8.71, without any statistically significant relationship between the two groups, such that the case group had more functional limitations than the control group. Also, by using the SC evaluation method, the patient group expressed a significantly lower quality of life compared to the healthy group in terms of aspects of functional limitation and physical disability.

The study of Daume et al. [ 39 ] showed that the average score of OHIP-14 in the case group is 13.54 and there is a significant difference between the two groups. There was a significant difference in the areas of physical pain, mental discomfort, physical disability and social disability. Physical pain score and eating restriction score were significantly different between clinical forms.

Although in the present study it seems that oral lichen planus disease has caused the quality of life of people to decrease, "according to the decrease in the quality of life in the first and second levels of the LOCKER model, it has not led to the third level of disability in the LOCKER model, which is confirmed by the research by Tebelnejad et al. [ 27 ].

The quality of life related to oral health of patients referred to oral diseases England, and also people with oral diseases and functional limitation, physical pain and discomfort was studied by Llewellyn and colleagues [ 31 ] and Slade [ 40 ]. They faced more mental problems than the general population. Although these diseases have caused a lower quality of life according to the first level of the LOCKER model, they have not caused disability.

Osipoff et al. [ 41 ] showed that erosive lichen planus is not significantly related to the increase in pain intensity, which is consistent with the findings of Gonzalez-Moles et al. [ 42 ]. Research by Suliman et al. [ 43 ] and Hegarty et al. [ 44 ] reported more severe pain and quality of life problems in patients with erosive lichen planus.

Our findings showed that pain intensity doesn’t have any relation with bilateral lesions. These results are in accordance with other findings [ 13 , 27 , 45 , 46 , 47 ]. However, Osipoff et al. [ 41 ] found that lichen planus is the most painful lesion, which is not in agree with our results.

The results of Wiriyakijja et al.'s study [ 48 ], which is consistent with previous researchs [ 49 , 50 ], showed that patients with ulcerative lichen planus experienced a greater impact on quality of life than those with other clinical types. Also, patients with ulcerative lichen planus reported significant levels of oral discomfort when eating certain foods, performing health care, more concerns about medication use, and more psychosocial burden. This finding is consistent with a previous study, which showed the change and avoidance of diet in patients with lichen planus regardless of the presence of ulcerative/erosive lesions [ 51 ]. Therefore, it seems that regardless of the clinical type, the presence of lichen planus have a negative effect on various types of patient activities and all oral symptoms such as pain [ 52 , 50 ].

Vilar-Villanueva et al. [ 53 ] found a higher OHIP-14 score for patients with atrophic/ulcerative lichen planus compared to patients with reticular lichen planus. Karbach et al. [ 54 ] reported similar findings. However, Parlatescu et al. [ 55 ] did not find a significant difference between asymptomatic and symptomatic lichen planus patients. They attributed this observation to the small number of clinical subtypes of lichen planus, but Wiriyakijjia et al. observed a poor quality of life score in ulcerative lichen planus patients compared to keratotic lichen planus patients [ 56 ].

As discussed above, these preliminary results of association analyses from current investigation were subject to certain limitations. First, our cross-sectional data would not allow for evaluating the effects of OLP treatment on OHRQoL. The data were mostly derived from follow-up patients, while 15.2% of patients were newly diagnosed who never previously been treated. For recall patients, information on OLP treatment was not available. Treatment experience in terms of type and duration of treatment might affect patient’s quality of life. Two previous longitudinal studies following OLPpatients after treatments reported significantly improved clinical signs, as well as OHRQoL [ 33 , 34 ].

Therefore, further longitudinal study to assess overtime change of OIDP intensity, taking into account previous or ongoing treatment, would be required for better understanding on the impacts of OLP treatment on patients’ quality of life. Second, some of the previous studies performed multivariate analysis where confounding factors were taken into account [ 28 , 35 ]. The others limitation was non-cooperation of a number of patients and Incomplete number of files.

However, this study applied only univariate analyses due to a relatively small sample size. The small sample size led to the third limitation on the generalization of our findings to OLP patients, particularly for reticular OLP as discussed earlier. Therefore, future study with larger sample size is required in order to corroborate the present study’s findings.

The current study demonstrated that nearly all patients had oral impacts affecting their daily activities. The impacts were frequently related to eating, cleaning the oral cavity and emotional stability. There were significant associations between OLP clinical signs and OHRQoL. However, some increasing clinical scores did not correspond with the increase of OHRQoL. Therefore, using only an OLP sign scoring index or other clinical indicators might fail to acknowledge patient’s perceptions. The results supported the application of OHRQoL assessment to complement OLP clinical measures.

It seems that some aspects of the quality of life related to oral health are reduced in patients with lichen planus. The quality of life related to oral health in the group of patients with lichen planus is significantly lower in terms of functional limitations and physical disability was more than the control group. There was also a significant relationship between the clinical symptoms of lichen planus and pain.

Non-cooperation of a number of patients.

Incomplete number of files.

Otherwise the limitation of this finding was relatively small numbers of patient with soft palate involvement.

Our cross-sectional data would not allow for evaluating the effects of OLP treatment on OHRQoL.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

This study is part and in parts identical of the doctoral thesis ‘The relationship between clinical symptoms of oral lichen planus and quality of life related to oral health’ by Sahab Sheikhhoseini at the Dental school, University of Kerman, Iran, under the supervision of Maryam Alsadat Hashemipour

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Maryam Alsadat Hashemipour

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Zahra Afshari

Department of Otorinology, University of Medical Sciences, Isfahan, Iran

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Maryam Alsadat Hashemipour: writing, critical evaluation of the manuscript and designed the study. Sahab Sheikhhoseini &  Zahra Afshari: data collection. Amir Reza Ganjalikha Nassab: manuscript editing

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The study was approved by the ethics committee of Kerman University of Medical Sciences and the research deputy of Kerman University of Medical Sciences. All experimental protocols were approved by the research deputy of Kerman University of Medical Sciences.

The verbal informed consent is approved by the ethics committee of Kerman University of Medical Sciences. The informed verbal consent was obtained from the participants for examinations and participation in the study following the provision of the needed explanations by the research deputy of Kerman University of Medical Sciences. All the information on the subjects will remain confidential. The authors would like to express their gratitude to the Vice Deputy of Research at Kerman University of Medical Sciences for their financial support (Reg. No. 401000588). This project was approved by the Ethics Committee of the university with the code IR.KMU.REC.1401.560. All experiments were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki).

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Hashemipour, M.A., Sheikhhoseini, S., Afshari, Z. et al. The relationship between clinical symptoms of oral lichen planus and quality of life related to oral health. BMC Oral Health 24 , 556 (2024). https://doi.org/10.1186/s12903-024-04326-2

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On Friday, April 19, Old Dominion University's College of Health Sciences (COHS) held its annual Research Day to include oral and poster presentations from undergraduate, master's and doctoral students. The symposium showcased a wide array of research with 39 presentations, including 5 podium talks and 34 poster displays, from students across various degree levels: 7 undergraduate, 8 master's, 7 doctor of physical therapy, and 17 PhD students. This diversity not only highlighted the depth of research being undertaken at ODU but also emphasized the university's commitment to fostering an interdisciplinary and inclusive academic environment.

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Dr. Brittany Samulski’s keynote creatively paralleled her academic journey with Taylor Swift's thematic eras, illustrating the evolution from foundational experiences to periods of bold exploration and significant collaborations. "Becoming a researcher is like becoming a pop star, right?" she quipped. From her initial "Fearless" beginnings to the collaborative "Red" era, she described her academic path with infectious enthusiasm, from her beginnings in clinical work to developing impactful community partnerships and innovative research projects.

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Reflecting on the day’s achievements, it's evident that Old Dominion University’s College of Health Sciences is a vibrant hub of scholarly activity, continuously evolving and pushing the boundaries of knowledge and practice in health sciences.

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ORIGINAL RESEARCH article

This article is part of the research topic.

Microbial-Immune Cross-Talks in Periodontal Diseases

MHC-II Presentation by Oral Langerhans Cells Impacts Intraepithelial Tc17 Abundance and Candida albicans Oral Infection via CD4 T cells Provisionally Accepted

• 1 University of Minnesota - Twin Cities, United States

The final, formatted version of the article will be published soon.

In a murine model (LC ΔMHC-II ) designed to abolish MHC-II expression in Langerhans cells (LCs), ~18% of oral LCs retain MHC-II, yet oral mucosal CD4 T cells numbers are unaffected.In LC ΔMHC-II mice, we now show that oral intraepithelial conventional CD8ab T cell numbers expand 30-fold. Antibody-mediated ablation of CD4 T cells in wild-type mice also resulted in CD8ab T cell expansion in the oral mucosa. Therefore, we hypothesize that MHC class II molecules uniquely expressed on Langerhans cells mediate the suppression of intraepithelial resident-memory CD8 T cell numbers via a CD4 T cell-dependent mechanism. The expanded oral CD8 T cells co-expressed CD69 and CD103 and the majority produced IL-17A (CD8 T cytotoxic [Tc]17 cells) with a minority expressing IFN-g (Tc1 cells). These oral CD8 T cells showed broad T cell receptor Vb gene usage indicating responsiveness to diverse oral antigens. Generally supporting Tc17 cells, transforming growth factor -b1 (TGF-b1) increased 4-fold in the oral mucosa. Surprisingly, blocking TGF-b1 signaling with the TGF-R1 kinase inhibitor, LY364947, did not reduce Tc17 or Tc1 numbers. Nonetheless, LY364947 increased gd T cell numbers and decreased CD49a expression on Tc1 cells. Although IL-17A-expressing gd T cells were reduced by 30%, LC ΔMHC-II mice displayed greater resistance to Candida albicans in early stages of oral infection. These findings suggest that modulating MHC-II expression in oral LC may be an effective strategy against fungal infections at mucosal surfaces counteracted by IL-17A-dependent mechanisms.

Keywords: Langerhans Cells, Candida albicans, T cytotoxic 17 cells (Tc17), CD4 T cells, MHC-II antigen presentation, oral mucosa

Received: 27 Mar 2024; Accepted: 13 May 2024.

Copyright: © 2024 Bittner-Eddy, Fischer, Parachuru and Costalonga. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Massimo Costalonga, University of Minnesota - Twin Cities, Minneapolis, Minnesota, United States

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