Oral, Volume 3, Issue 1 (March 2023) – 12 articles

The main objective of this systematic review was to evaluate the microbiology of maxillary sinus infections and to determine whether an odontogenic origin of the infection can be established. The PIE question posed was the following: In patients with sinus and dental symptomatology who come for ENT or dental assessment and who undergo a microbiological study of the maxillary sinus and are found to have infectious sinus pathology, is the infectious sinus pathology related to an odontogenic origin? The literature review was carried out in PubMed, Web of Science, and the Cochrane Library. A total of 2769 articles were identified in the three databases used. Inclusion and exclusion criteria were applied, and after eliminating duplicates, 55 full-text publications were identified as suitable for inclusion. After reading this series of publications, four articles were excluded due to lack of data in the article. Finally, 51 studies were included in the qualitative analysis. In this study, the microorganisms were classified into three groups: group 1 (microorganisms of the oral microbiome related in the literature to oral pathology, namely caries and periodontal disease), group 2 (microorganisms found in the oral microbiome but not related to oral disease), and group 3 (microorganisms not identified in the microbiome). This review included 51 articles and a total of 6415 patients who underwent surgery in 7051 sinuses. Most sinus infections were caused by group 2 (63.51%) or group 1 (24.21%) bacteria. Within group 1, the most frequent bacteriological agents in sinus infections were Peptostreptococcus spp. (35.22%) and St. Viridans spp. (39.89%). In group 2, the most frequent bacteriological agents in sinus infections were H. influenzae (29%) and Streptococcus spp. (23.63%). In group 3, the most frequent cause of sinusitis of dental origin was dental caries, followed by foreign bodies (implants) and sinus elevation. Different studies have shown that certain species of bacteria isolated from maxillary sinus cultures are more frequently associated with rhinosinusitis of odontogenic origin. The results of this systemic review show that, among the bacterial species most frequently found, anaerobic species predominate over aerobic species, especially Peptostreptococcus and Staphylococcus aureus, which are part of the oral microbiome, suggesting an odontogenic origin of maxillary sinus infection. Therefore, bacterial cultures of maxillary sinus aspirate can be of great use to clinicians in the differential diagnosis of odontogenic sinusitis. Full article

The oral problems of 24 cancer patients on immunotherapy between 2017–2022 and referred by their oncologists, were reported. The age range was 49–80 years, and the median was 64 years. Lung cancer was the most common disease. Three patients a had history of autoimmune disease prior to cancer diagnosis. Patients received immunotherapy for two to 48 months. Prior to immunotherapy, 17 patients received cytotoxic chemotherapy, five angiogenesis inhibitors and one1 radiotherapy to head/neck. During immunotherapy, four patients received chemotherapy, one received bevacizumab, and eight received bone targeting agents, either alone or in combination. Presenting symptoms were oral pain (18 patients, 75%), dental pain (five patients), xerostomia (five patients), burning/itching (seven patients), bleeding (three patients), swelling (three patients), and taste problems (dysgeusia) (three patients). One patient was asymptomatic. Immune-related lesions were observed in 15 patients (62.50%), of which three were exacerbations of prior autoimmune disease. Three patients reported severe deterioration and itching after using a mouthwash. We also observed six (25%) infections (four candidiasis and two herpes simplex), and six (25.00%) cases of medication-related osteonecrosis of the jaw (MRONJ). Five of those MRONJ cases developed among the eight patients with the administration of bone targeting agents and one in a patient with bevacizumab. Two patients presented with more than one lesion. In conclusion, immune-related lesions were most common; oral infections and MRONJ were also observed. Various oral complications might be related to the interplay between immunotherapy and other therapies prior or concurrent to immunotherapy. Full article

Purpose: To systematically review studies that investigated the consequences of various polishing protocols on the mechanical properties of zirconia. The effects on the roughness and crystalline phase transformation were also evaluated. Materials and methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed. The electronic searches were conducted via OVID MEDLINE (R) and Scopus for publications between 1996 and August 2022. The search strategy was limited to full texts in the English language and in vitro studies. The influences on flexural strength, hardness, fracture strength, fracture toughness, wear resistance, roughness and phase transformation were collected. Various methodologies to measure these properties were also outlined and compared. The risk of bias for included studies was evaluated according to a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Results: After removing duplicates, the systematic search identified a total of 419 studies. Nineteen studies satisfied the inclusion criteria and were selected for final analysis. Fifteen of the included studies observed the changes in surface roughness along with the mechanical properties and ten studies detected the tetragonal (T) to monoclinic (M) phase transformation. Eight studies also investigated the change in properties after polishing the ground surface. Testing parameters were not consistent among studies due to the varying methods. Conclusions: To a certain extent, polishing influences the strength, hardness, toughness and wear resistance. The damage in some mechanical properties, as well as the roughened surface, from grinding can be restored via an appropriate polishing treatment. The polishing process itself barely induces the transition from the tetragonal to monoclinic phase of zirconia, while this commonly occurs after grinding. If the subsequent polishing is adequate, the transformed monoclinic phase can be eliminated with the removal of the outermost surface layer. In dentistry, polishing is an imperative step to maintain the superior functions and service life of zirconia for patients. Full article

Life-threatening hemorrhage after orthognathic surgery is rare. However, when it occurs, immediate diagnosis of the source of bleeding is imperative for successful management. The current report is the first to describe a rare life-threatening bleed from the left lingual artery following a genioplasty in a young healthy patient. Such occurrence also emphasizes the diverse anatomical course of the lingual artery and focuses on raising awareness about its numerous variations, sites of origin. Surgeons are often unaware of the anatomic variations of the lingual artery and its relation to the surrounding structures, which often lead to unexpected hemorrhages. Moreover, depending on severity, they can become challenging to manage and may lead to life-threatening complications. Taking into consideration the variations and the classification of the anatomical course of the lingual artery will improve surgical outcome, reduce morbidity, and lead to appropriate healing and recovery. This previously unpublished case regarding complications of lingual artery hemorrhage after genioplasty can bring awareness for future surgical considerations. Full article

Musculoskeletal symptoms are common in both acute COVID-19 disease and post-acute sequelae (Post-Acute COVID Syndrome). The purpose of this study is to investigate whether there are reduced levels of masticatory function in patients with PACS (Post Acute COVID Syndrome) who suffer from sarcopenia, under the hypothesis that the latter may also involve the masticatory muscles. This study includes 23 patients hospitalized for COVID-19 between February 2020 and April 2021 and currently suffering from PACS. Among these PACS patients, 13/23 (56%) suffer from sarcopenia, 5/23 (22%) complain of asthenia but do not suffer from sarcopenia and the remaining 5/23 (22%) do not present muscle symptoms (non-asthenic non-sarcopenic). Oral health indices of all patients were collected. The masticatory strength was assessed with a gnathodynamometer based on piezoresistive sensors, and the masticatory effectiveness was measured by administering the “chewing gum mixing ability test” by having patients perform 20 masticatory cycles on a two-color chewing gum and analyzing the outcome through the ViewGum© software. Moreover, we gathered data with a hand grip test and gait speed test. The data collected in this study show that PACS sarcopenic patients have decreased masticatory effectiveness and strength compared to PACS asthenic non-sarcopenic patients and PACS non-asthenic non-sarcopenic patients. Full article

The aim of this study is to study the effect of aging in different media (deionized water and artificial saliva) on the force/torque generation by thermoplastic orthodontic aligners. Ten thermoformed aligners, made of Essix ACE^® thermoplastic sheets, were aged in deionized water and in artificial saliva over two weeks at 37 °C, five in each medium. The force/torque generated on upper second premolar (Tooth 25) of a resin model was measured at day 0 (before aging), 2, 4, 6, 10, and 14, using a biomechanical test set-up. The results showed that aging of aligners by storage in aging agent has no significant impact on their force/torque decay. No significant differences were also found in force/torque between the aligners stored in deionized water nor artificial saliva. The vertical extrusion-intrusion forces were measured in the range of 1.4 to 4.6 N, the horizontal oro-vestibular forces were 1.3 to 2.5 N, while the torques on mesio-distal rotation were 5.4 to 41.7 Nmm. It could be concluded that the influence of saliva only on the mechanical properties can be classified as insignificant, and no significant difference between artificial aging in deionized water or artificial saliva was observed. Full article

(1) Background: Psoriasis is a chronic and inflammatory systemic disease that has been associated with periodontal pathologies, specifically periodontitis. The aim of this research is to answer the following question: Could periodontitis aggravate psoriasis? (2) Methods: We carried out a systematic review following the PRISMA guide using PubMed, Embase, Scopus, and WOS; (3) Results: A total of 111 studies were identified in the databases and 11 were obtained after screening. The selection included nine case–control studies, one cross-sectional study, and one cohort study. Most of the publications report an increase in bleeding on probing and the presence of periodontal pockets in patients with psoriasis, confirming that inflammation caused by periodontitis can contribute to systemic inflammation worsening psoriasis. To summarize, the scientific literature indicates that local periodontal inflammation could aggravate psoriasis. Full article

Oral cavity is the first site to encounter e-cigarette (EC) or tobacco smoke. Increased gingival pigmentation can lead to aesthetic concerns and hinder successful outcomes of gingival depigmentation procedures as well as lead to color alterations in patients with dental restorations. While the effects of tobacco smoke and nicotine in increasing pigmentation in the gingiva of the smoker have been well-documented, the effects of EC on pigmentation have not been explored. Due to large variations in e-liquids from different sources, this study focused on the effects of EC liquid base constituents, propylene glycol (PG) and vegetable glycerin (VG), which are a universal constituent of all e-liquids. Effects of PG and VG solutions mixed at different ratios (0/100, 20/80, 55/45, 80/20, and 100/0 % v/v) were examined using primary human melanocytes obtained from neonatal foreskin; this cell model is representative of the physiological model of gingival melanocytes and has been used in our previous study. Results showed significant concentration-dependent cytotoxicity for all groups, although mixtures with higher PG content showed higher cytotoxicity to cells as compared to those with VG. Melanogenesis was robustly activated by PG-containing mixtures with the greatest effect obtained for 80/20 PG/VG mixture as compared to other ratios, while VG by itself did not activate melanogenesis. The activation of melanin synthesis within cells was not correlated to intracellular tyrosinase activity as that was suppressed by PG at higher ratios. Morphological changes of a multidendritic phenotype were observed in cells exposed to all PG/VG mixtures, with markedly greater effects for groups with higher PG content. Taken together, the results of this pilot study demonstrate for the first time that EC base constituents possess the capacity to significantly activate melanogenesis in human melanocytes at nontoxic concentrations, with the dominant effect obtained at a PG/VG ratio of 80/20, indicative of a nonlinear response with increasing concentrations of PG. Moreover, further studies to address the impact of PG/VG with the addition of nicotine and the effects of different EC flavors are underway. Future studies to elucidate mechanisms of increased pigmentation as well as further investigate effects in melanocytes with the presence of other oral cell types and other components of the oral microenvironment such as saliva and bacterial flora are warranted. This research emphasizes the need to reconsider the regulation of EC base constituents PG and VG as different ratios of these compounds can cause differential effects. Full article

Background: This pilot study aimed to verify the efficacy of two orthodontic appliances in relation to changes in the lower intercanine distance in growing patients. Methods: Twenty patients aged 10–16 years were enrolled in the study and separated into test and control groups. The test group included 10 patients (5 males, 5 females; mean age, 10.4 ± 1.57 years) who were treated with an elastodontic device. The control group included 10 patients (5 males, 5 females; mean age 10.8 ± 1.53 years) who were treated with clear aligners. The two groups exhibited the same orthodontic features. The orthodontic criteria were: skeletal class I relationship, molar class I relationship, and presence of lower crowding. Patients were evaluated as having mild or moderate crowding according to the Daniels and Richmond index. The lower intercanine distance was evaluated at three timepoints via intraoral scans: T0 (before starting therapy), T1 (after six months), and T2 (after 1 year). Data were analyzed using a nonparametric approach via the Wilcoxon signed-rank test. Results: There was no statistically significant difference between the two groups at T0, T1, or T2 (p < 0.05). Conclusions: elastodontic devices and clear aligners can successfully help the orthodontist conduct lower arch expansion treatment. These appliances are comfortable to wear, simple to clean every day, and reduce the number of dentist appointments. Finally, but not of least importance, these devices have allowed dentists to continue orthodontic treatments during the lockdowns of the COVID-19 pandemic. Full article

About half of the world’s population requires the services of a dentist. However, the in-depth understanding of the concerns and priorities of the global public and scientific communities concerning dentists is essential for the planning and development of sustainable strategies, interventions, and policies that will cater for the current global oral health needs. Therefore, this study investigated the global search and research interests on dentists using a hybrid research design—a combination of infoveillance and bibliometric research designs. The data analysed in this study were obtained from Google Trends and SCOPUS. The findings show that, over the years, there has been a significant growth in the volume of information search and research outputs on dentists with huge inequalities existing between the Global South and North. It is also notable that the COVID-19 pandemic played a significantly influential role in the global information search and dissemination trends on dentists. The knowledge and funding for dentist-related research flow significantly from the countries of the Global North. The review of the network visualisation of keyword co-occurrence revealed a misplaced priority in the global research interest areas on dentists and oral health. The obtained findings could help to shape the future of dental healthcare and policy. Full article

This study aimed to evaluate the effectiveness of different Passive Ultrasonic Irrigation (PUI) protocols on debris removal and exposure of dentinal tubules in simulated complex root canal cavities. Twenty single-rooted human mandibular premolars with simulated root canal cavities were filled with the debris and randomly divided into ten groups based on the final irrigation protocol: 1—positive control; 2—negative control; 3—conventional irrigation (CI) with 2.5% sodium hypochlorite (NaOCl); 4—CI with 17% ethylenediaminetetraacetic acid (EDTA) followed by NaOCl; 5—three cycles of PUI for 20 s (NaOCl-NaOCl-NaOCl); 6—three cycles of PUI for 20 s (NaOCl-EDTA-NaOCl); 7—one 60 s PUI cycle (NaOCl); 8—one PUI 180 s cycle (NaOCl); 9—two cycles of PUI for 60 s (EDTA-NaOCl); and 10—two cycles of PUI for 60 s (NaOCl-EDTA). The groups were analyzed by SEM. The Kruskal-Wallis test was used at a 5% level. PUI showed a higher reduction of debris, similar to the positive control group (p > 0.05) and higher than the CI and negative control groups (p < 0.05). Regarding the exposure tubules, the CI groups were similar to the negative control group in all cavities (p > 0.05). The PUI groups were similar to the positive control group (p > 0.05). However, only groups 6, 7, and 10 were statistically different from the CI and negative control (p < 0.05). The protocols using PUI, comprising groups with three cycles of 20 s (NaOCl-EDTA-NaOCl), two cycles of 60 s (EDTA-NaOCl), or one cycle of 60 s (NaOCl), were more effective at removing debris and increasing the exposure of dentinal tubules. Full article