Stefano Fedele

University College London, UCL Eastman Dental Institute, Faculty Member

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Papers by Stefano Fedele

Comments on "diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2015

W e read with great interest the recent article "Diagnosis and Management of Osteonecrosis of the... more W e read with great interest the recent article "Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus" by Khan and colleagues. Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents, and although a significant body of literature has been produced, there remains little evidence-based guidance for clinicians with respect to most aspects of this disease. Therefore, we applaud the attempt of Khan and colleagues to provide a much-needed systematic review.

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P1.41. The GEN-VA-BO study (GENetic VAriants in Bisphosphonate-related Ostenecrosis of the jaws): A cooperation proposal

Oral Oncology Supplement, 2009

346764 Dielectrophoretic Detection Of Human Oral Cancer Using 3D Well Electrodes

[Electrostimulation for the treatment of dry mouth]

Harefuah, 2010

Xerostomia is a very common condition, which not only involves dry mouth feeling, but can also le... more Xerostomia is a very common condition, which not only involves dry mouth feeling, but can also lead to psychosocial distress, impaired quality of life, and complications, such as dental caries and oral candidiasis. It is generally induced by hypofunction of salivary glands, which has a wide variety of etiologies, such as Sjögren's syndrome, radiotherapy to the head and neck and side effects of medications. Current therapies rely on saliva substitutes and pharmacological stimulation of the parasympathetic system. These treatment modalities are somewhat limited by their short-term efficacy, high cost and drug interactions or other adverse effects. Local transcutaneous or permucosal electrostimulation in areas close to the nerves participating in the salivary autonomic reflex has been found to increase salivary secretion in animal and clinical experiments and to relieve symptoms of dry mouth in patients with salivary gland hypofunction. This concept is reviewed to update the reader...

Extranodal NK/T-cell lymphoma, nasal type

A 30-year-old Southeast Asian man with facial swelling, fever, and unintentional weight loss was ... more A 30-year-old Southeast Asian man with facial swelling, fever, and unintentional weight loss was found to have leukopenia and thrombocytopenia. He underwent endoscopic sinus surgery, which confirmed extranodal NK/T-cell lymphoma, nasal type, and a blood and bone marrow examination, which was negative for involvement but yielded the diagnosis of alpha-E thalassemia. The patient received chemotherapy, radiotherapy, and a stem cell transplant with 100% engraftment.

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Summary of: Halitosis: a new definition and classification

BDJ, 2014

ABSTRACT Background There is no universally accepted, precise definition, nor standardisation in ... more ABSTRACT Background There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis.Objective To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised.Results A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health.Conclusion This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.

Gingival involvement of oral lichen planus in a series of 700 patients

Journal of Clinical Periodontology, 2005

Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvemen... more Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvement is very frequently observed, and it is characterized by wide variations in clinical appearance and symptoms, leading, in many cases, to misdiagnosis or undiagnosis. This can be potentially harmful since OLP patients require appropriate management in oral and periodontal care, together with an adequate systemic evaluation. In this paper, we have analysed the prevalence and clinical aspects of gingival lesions in our series of 700 patients affected by OLP. Furthermore, we have discussed the possible periodontal implications on the basis of the available literature. Data from 700 patients affected by OLP, clinically and histologically assessed, have been studied; the location and morphology of lesions, the symptoms and the progression of the disease have been considered, with particular attention given to gingival involvement. Gingival lesions have been diagnosed in 48% of cases, usually associated with diffuse oral involvement. Only 7.4% of patients had OLP lesions confined to the gingiva. The morphology of lesions included all the forms originally described for OLP (reticular, papular, plaque, atrophic, erosive and bullous). The symptoms, if present, varied from mild discomfort to severe oral pain, with the general trend increasing from the keratotic to the erosive forms. The gingiva was involved in four out of 21 of our oral cancer cases, which developed from pre-existing OLP lesions. OLP is a very proteiform disorder; considering the high frequency of gingival involvement and its influence on oral health, it is our opinion that periodontologists should be involved in OLP management and should become familiar with its clinical aspects and related themes.

OI0242 Prognosis of squamous cell carcinoma associated with oral lichen planus

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2014

Oral lichen planus: Different clinical features in HCV-positive and HCV-negative patients

by Stefano Fedele and Lorenzo Lo Muzio

Hepatitis C virus (HCV) infection induces variable dermatologic manifestations. To determine whet... more Hepatitis C virus (HCV) infection induces variable dermatologic manifestations. To determine whether differences exist in the clinical features and behavior of oral lichen planus (OLP) between HCV-positive (HCV+ve) and HCV-negative (HCV-ve) patients. Two hundred and sixty three patients (156 women and 107 men), with a mean age of 55.5 years, with OLP (76 HCV+ve and 187 HCV-ve) were clinically evaluated. Previously, all local factors that could modify the clinical characteristics were removed and were monitored carefully following morphology. In both groups, the prevalent clinical form of OLP was the mixed form (33.1% in HCV-ve and 35.5% in HCV+ve patients), in which reticular-plaque lesions coexist with atrophic-erosive ones. The reticular form was more frequent in HCV+ve (25%) than in HCV-ve (18. 7%) patients, whereas plaque lesions were more prevalent in HCV-ve (15.5%) than in HCV+ve (5.2%) patients (P &amp;amp;lt; 0.01, chi-squared test). There were no significant differences in the frequency of erosive (27.2% in HCV-ve and 27.6% in HCV+ve) and atrophic (5.3% in HCV-ve and 5.2% in HCV+ve) forms between the two groups. Our findings show that there were statistically significant differences between OLP-HCV-ve and OLP-HCV+ve groups for reticular and plaque clinical forms. These findings underline the importance of liver examination in all OLP patients, including cases with mild, asymptomatic keratotic forms of the disease.

Metastases in small thickness oral squamous-cell carcinoma arising in oral lichen planus

by Stefano Fedele and Lorenzo Lo Muzio

Clinical guidelines in early detection of oral squamous cell carcinoma arising in oral lichen planus: A 5-year experience

by Stefano Fedele and Lorenzo Lo Muzio

In recent years, studies on the malignant potential of oral lichen planus (OLP) provided clinical... more In recent years, studies on the malignant potential of oral lichen planus (OLP) provided clinical evidence that patients aected by OLP have an increased risk to develop oral squamous cell carcinoma (OSCC); nevertheless, controversies still exist as to whether OLP has inherent predisposition to become malignant, or not. We believe extremely careful management of OLP patient is mandatory, and the aim of this paper is to illustrate our clinical guidelines in evaluating the possible risk of transformation in OLP lesions. Five-hundred and two patients (311 women and 191 men) aected by OLP regularly undergo follow-up examination in our Department. Patients' ages range from 18 to 83 years, with a mean of 55.4 years (57.5 for women and 53.9 for men); minimal follow-up period is 4 months, with a maximum of 12 years. In our group of OLP patients in the past 5 years we detected 24 carcinomas: excluding three cases in which diagnoses of OLP and OSCC were synchronous and three patients who had a history of tobacco use, thus possible malignant transformation of OLP would appear to be 3.7%. Clinical criteria used in our follow-up allowed us to detect 28.5% of tumours as in situ OSCC, 38% as microinvasive OSCC, 28.5% as stage I OSCC and 4.7% as stage II OSCC, with a remarkable improvement in prognosis compared to our previous study in which we adopted dierent criteria. #

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Sjogren's syndrome: the diagnostic potential of early oral manifestations preceding hyposalivation/xerostomia

by Stefano Fedele and Lorenzo Lo Muzio

Journal of Oral Pathology & Medicine, 2005

Sjögren&amp;amp;#39;s syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainl... more Sjögren&amp;amp;#39;s syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional &amp;amp;#39;untouchable&amp;amp;#39; association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.

Anorexia/bulimia-related sialadenosis of palatal minor salivary glands

Journal of Oral Pathology & Medicine, 2004

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A Case of Oral Localized Histoplasmosis in an Immunocompetent Patient

by Stefano Fedele and Lorenzo Lo Muzio

European Journal of Clinical Microbiology & Infectious Diseases, 2001

... BRIEF REPORT MD Mignogna · S. Fedele · L. Lo Russo · E. Ruoppo L. Lo Muzio A Case of Oral Loc... more

Lack of public awareness toward alcohol consumption as risk factor for oral and pharyngeal cancers

by Stefano Fedele and Lorenzo Lo Muzio

Preventive Medicine, 2001

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Erythema multiforme and related disorders

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007

Erythema multiforme (EM) and related disorders comprise a group of mucocutaneous disorders charac... more Erythema multiforme (EM) and related disorders comprise a group of mucocutaneous disorders characterized by variable degrees of mucosal and cutaneous blistering and ulceration that occasionally can give rise to systemic upset and possibly compromise life. The clinical classification of these disorders has often been variable, thus making definitive diagnosis sometimes difficult. Despite being often caused by, or at least associated with, infection or drug therapy, the pathogenic mechanisms of these disorders remain unclear, and as a consequence, there are no evidencebased, reliably effective therapies. The present article reviews aspects of EM and related disorders of relevance to oral medicine clinical practice and highlights the associated potential etiologic agents, pathogenic mechanisms and therapies.

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Dysplasia/neoplasia surveillance in oral lichen planus patients: A description of clinical criteria adopted at a single centre and their impact on prognosis

Oral Oncology, 2006

The concept of dysplasia/neoplasia surveillance has been applied to long-standing conditions asso... more The concept of dysplasia/neoplasia surveillance has been applied to long-standing conditions associated with an increased risk of cancer. Although still controversial, periodic direct clinical examination as well as endoscopic techniques are currently performed in patients with inflammatory bowel diseases, Barrett&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s esophagus, and melanocytic skin lesions in order to detect and treat dysplastic or early malignant changes and therefore improve the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; prognosis. It is not known if patients with oral lichen planus (OLP), a chronic inflammatory condition associated with an increased risk of cancer development, might benefit from such surveillance as well, nor how this should be performed. Here we present the clinical criteria we have adopted over a 12-year period to detect early malignant transformation of OLP, and report on their impact on the management and prognosis of patients. Overall data from 45 patients affected by 117 neoplastic events arising from OLP have been evaluated. Our dysplasia/neoplasia surveillance has led us to diagnose most episodes (94.9%; n.: 111) of OLP malignant transformation in early intraepithelial and microinvasive phases, namely stage 0 and I oral cancers (T(is) N0M0 or T1N0M0). The 5-year survival rate, where applicable, has been 96.7%. Advanced stage oral cancers have been diagnosed in six patients, three of whom have died. We suggest that the application of strict and rigorous clinical criteria in dysplasia/neoplasia surveillance could help clinicians to detect and treat early OLP malignant transformation and therefore improve long-term survival rates. Nevertheless, a small subgroup of patients has been shown not to benefit from such surveillance and to be characterized by a rapid development of advanced-stage oral carcinomas, with consequent poor prognosis.

Immune activation and chronic inflammation as the cause of malignancy in oral lichen planus: is there any evidence ?

by Stefano Fedele and Lorenzo Lo Muzio

Oral Oncology, 2004

The association of chronic inflammation with a variety of epithelial malignancies has been recogn... more The association of chronic inflammation with a variety of epithelial malignancies has been recognised for centuries. Well established examples include, among many others, oesophageal adenocarcinoma associated with chronic oesophagitis and bowel cancer associated with chronic inflammatory bowel diseases. By now no data, other than clinical observation, have been available in understanding the pathogenesis of these inflammation-related tumours. However, recent molecular studies on the relationship between solid malignancies and the surrounding stroma have given new insights. There is now enough evidence to accept that the chronic inflammatory process per se is able to provide a cytokine-based microenvironment which is able to influence cell survival, growth, proliferation, differentiation and movement, hence contributing to cancer initiation, progression, invasion and metastasis. Here it is discussed whether also oral lichen planus (OLP), being a chronic inflammatory autoimmune disease which has been clinically associated with development of oral squamous cell carcinoma, might be categorised among these disorders. With this aim, we critically reviewed and detailed the presence, in OLP subepithelial infiltrate, of inflammatory cells and cytokine networks that might act to promote squamous tumorigenesis. #

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Treatment of Gorham’s disease with zoledronic acid

Oral Oncology, 2005

Gorham&amp;amp;#39;s disease (GD) is a rare disorder characterized by spontaneous and progres... more Gorham&amp;amp;#39;s disease (GD) is a rare disorder characterized by spontaneous and progressive osteolysis of one or more bones and thought to belong to lymphangiomatoses spectrum of diseases. Surgical, radiation and medical therapies have been performed with variable and often discouraging outcomes and currently there is no recognized effective treatment. In this paper we describe a 24-year-old girl with GD localized to mandible who was effectively managed with zoledronic acid, a nitrogen-containing high-potency bisphosphonate.

Electrostimulating device in the management of xerostomia

Oral Diseases, 2007

The present study was undertaken to evaluate the safety and effectiveness of a recently developed... more The present study was undertaken to evaluate the safety and effectiveness of a recently developed electrostimulating device mounted on an individualized intra-oral removable appliance. The device, containing electrodes, a wetness sensor, an electronic circuit and a power source, was tested on patients with xerostomia in a crossover, randomized, sham-controlled, double-blinded, multicenter study. Electrical stimulation and also sham were delivered during 10 min to the oral mucosa, in the mandibular third molar region. Oral dryness was measured by the sensor. As the primary outcome, sensor dryness and xerostomia symptom changes as a result of device wearing were assessed, and compared between active and sham modes. In addition, side-effects were recorded. Electrostimulation resulted in a significant decrease in sensor dryness, leading to a beneficial effect on patients&amp;amp;#39; subjective condition. No significant side-effects were observed.