100 million adults and 15 million adolescents currently use e-cigarettes, a type of Electronic Nicotine Delivery System (ENDS) or Electronic Non-Nicotine Delivery System (ENNDS). While they were introduced as smoking cessation aids, they are currently marketed as consumer products rather than prescription-based cessation tools. According to the WHO, as of 2025, 88 countries do not have minimum age restrictions, and 74 countries have no regulations. The growing popularity of ENDS and ENNDS has introduced a new and complex set of behaviours and exposures that might impact oral and overall health. E-cigarette aerosols are reported to impact cardiovascular health, heighten airway inflammation and increase risk of upper respiratory infections. In the oral cavity, a high caries risk, greater staining of teeth and restorations, higher incidence of xerostomia, gingival inflammation and a greater prevalence periodontal and peri-implant diseases when compared to non-users. Oral mucosal lesions such are nicotine stomatitis, hairy tongue, and angular cheilitis are more prevalent when compared to former smokers. Thus, evidence is emerging to indicate that ENDS and ENNDS impact both oral and systemic health, albeit in ways different from conventional cigarettes. However, high-certainty evidence also supports e-cigarettes as effective smoking cessation tools, with four additional quitters per 100 individuals. Therefore, it behooves oral health professionals to play a crucial role in counselling and support patients with evidence-based data. More evidence is needed to understand the long-term health impacts of e-cigarettes.

Systemic diseases often have oral manifestations that can significantly impact oral health. These manifestations can stem from hematological, gastrointestinal, and viral infections, resulting in various alterations within the oral cavity. Recognizing the crucial link between general and oral health, this research aims to evaluate the awareness of dental students and interns regarding the oral manifestations of systemic diseases. A cross-sectional study involving 244 dental students, including clinical stage dental students from the Faculty of Dentistry at the University of Damascus and intern dentists, was conducted. Participants completed a survey assessing their knowledge and sources of information about oral manifestations of systemic diseases. Additionally, they answered questions pertaining to oral manifestations of gastrointestinal diseases, viral infections, and hematological disorders, alongside inquiries about investigations warranted when observing oral lesions. The participants' awareness levels were categorized as excellent, good, intermediate, or poor. Awareness levels were assessed based on the percentage of correct responses. The study demonstrated that awareness of the oral manifestations of gastrointestinal diseases ranged between intermediate and good, knowledge levels of 71.3% for inflammatory bowel diseases and 55.7% for Crohn's disease. Conversely, awareness regarding the oral manifestations of viral infections was notably lower, with poor knowledge observed for hepatitis viruses (11.5%) and COVID-19 (28.85%), while intermediate awareness was recorded for viruses associated with nasopharyngeal carcinoma (39.55%). Regarding hematological disorders, awareness was good for conditions associated with gingival bleeding (62.3%) and glossitis (70.5%). However, intermediate levels of knowledge were noted for disorders presented with aphthous ulcers (56.84%), submucosal bleeding and hemorrhagic ulcers (43.9%), and angular cheilitis (57.97%). Overall the knowledge of Syrian dental students regarding the oral manifestations of systemic diseases was classified as intermediate, with relatively strong awareness in areas such as inflammatory bowel diseases and glossitis but significant gaps in understanding viral infections and hepatitis-related symptoms. Additionally, only 11.1% of students reported having diagnosed a systemic disease based on oral manifestations, indicating a limited application of this knowledge in clinical practice. There is a need to enhance and elevate the knowledge of dental students and practitioners regarding oral lesions in general, and the oral lesions of systemic background in particular.

Vitamins are essential biocatalysts that have wide-ranging functions in supporting cellular metabolism. Vitamin deficiencies can significantly impact oral health, manifesting in oral mucosal and periodontal conditions. Deficiencies in the vitamin B complex are associated with glossitis, angular cheilitis, and recurrent aphthous stomatitis. Vitamin C deficiency leads to scurvy-related periodontal issues, whereas vitamin A insufficiency predisposes to oral epithelial keratinization abnormalities such as dry mouth and susceptibility to Candida. A reduction in vitamin D levels is linked to the risk of periodontal disease, reduced oral immunity, and oral neoplasia. Low vitamin E does not induce oral disease, but vitamin K deficiency causes gingival hemorrhage. Oral mucosal diseases have a huge impact on morbidity. We discuss the diagnostic challenges in identifying vitamin-related oral manifestations and the associated systemic features that may accompany the mucosal changes. This review provides clinicians with insight into the mechanisms that govern oral mucosal pathology and the risk factors related to specific vitamin deficiencies. The role of vitamin supplementation in treating and preventing oral conditions is also addressed.

Diabetic neuropathy may present with a wide spectrum of sensory manifestations in the oral cavity, ranging from increased sensitivity to pain to impaired nociception. Early detection is crucial, since the changes have significant effects on dental treatment, patient safety and quality of life. We describe two contrasting pictures of patients with diabetes mellitus with signs of oral sensory neuropathy. The first case was a 14-year-old female with poorly controlled type 1 diabetes mellitus (T1DM) presenting with chronic carious lesions, gingivitis, and angular cheilitis. She also had amplified pain reactions to dental procedures despite adequate local anaesthesia and quantitative sensory testing revealed hyperaesthesia related to early diabetic neuropathy. The second patient was a 55-year-old male with a long-term history of type 2 diabetes mellitus (T2DM) with chronic periodontitis and reduced oral sensitivity. He complained of hypoesthesia and reduced pain perception during dental procedures with evidence of established neuropathic involvement. These cases illustrate the broad spectrum of clinical manifestations of diabetic sensory neuropathy in stomatology from early hyperaesthesia in a child with T1DM to late hypoesthesia in an adult with T2DM and illustrate the importance of metabolic control, interdisciplinary collaboration and individualised diagnostic and therapeutic strategies in dentistry.

Angular cheilitis (AC) is a descriptive diagnosis for an inflammatory skin process of varied etiology occurring at the labial commissure – the angle of the mouth. "Angular," or commissural, refers to a localized lip inflammation (i.e., “cheilitis,” from the Greek chilos or “lips”) that is distinguishable from the more generalized cheilitides that have different causes. The angles of the mouth are points of interface for the squamous epithelium of the face and oral mucosa. They are also a mechanically dynamic hinge for the oral aperture that endures more motion and tensile forces than the rest of the lips. Thus, the commissures are especially susceptible to certain stresses. Diffuse cheilitides may be a function of environmental, chemical, or infectious exposures. They may also reflect an internal condition, deficiency, or derangement. They include eczematous cheilitis, contact cheilitis, drug-induced cheilitis, infective cheilitis, actinic cheilitis, glandular cheilitis, granulomatous cheilitis, exfoliative cheilitis, plasma cell cheilitis, and nutritional cheilitis. Diffuse cheilitides will not be discussed here. Angular cheilitis is also called angular cheilosis, angular stomatitis, commissural stomatitis, rhagades, or perleche (from the French for “through licking”). Rhagades is a general term for fissuring of the skin in areas of motion, especially the labial commissures and nose.

Candida spp. are common components of normal microbiota in the oral cavity. However, Candida albicans can be a primary cause of superficial infections in the oral cavity and esophagus, especially in immunocompromised individuals. While these infections are rarely life-threatening, they can significantly impair quality of life and, in severe cases, progress to hematogenous dissemination. Oral candidiasis often exhibits as pseudomembranous, erythematous (atrophic), chronic hyperplastic, denture stomatitis, or angular cheilitis. Esophageal candidiasis is typically diagnosed by upper endoscopy, which involves histological examination and brushing. Clinical guidelines recommend topical antifungal agents for mild oral candidiasis, and systemic agents for moderate-to-severe disease or when topical therapy fails. However, azole antifungals pose a substantial risk of drug-drug interactions, primarily due to the inhibition of cytochrome P450 enzymes and drug transporters, which dramatically alters the pharmacokinetics of co-administered drugs. Additionally, amphotericin B, a polyene macrolide antibiotic, may cause nephrotoxicity and electrolyte disturbances (e.g., hypokalemia and hypomagnesemia). Moreover, the co-administration of nephrotoxic drugs may augment the toxicity associated with amphotericin B. Therefore, this review aimed to provide a comprehensive overview of the management of oral and esophageal candidiasis from the viewpoint of clinical pharmacology, with a particular focus on drug-drug interactions and adverse effect profiles.

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care.

This case report describes the emergence of oral immune-related adverse events following the administration of pembrolizumab, an immune checkpoint inhibitor (ICI), for cutaneous melanoma. The affected patient developed drug-induced oral lichenoid hypersensitivity reactions, oral candidiasis, and angular cheilitis that were successfully managed with topical dexamethasone and nystatin rinses and systemic fluconazole. Patients undergoing prolonged ICI therapy should be informed about the potential for oral complications and the need for close monitoring by oral healthcare providers. Proper management of ICI-related oral sequelae is essential to preserve dental and soft tissue health and prevent potential delays or premature discontinuation of oncologic treatment resulting from oral manifestations.