Oral, Volume 3, Issue 2 (June 2023) – 10 articles

The exact knowledge of the mandibular canal position is fundamental in oral surgery and implantology. Clinicians have to be extremely cautious when operating in close proximity to this structure in order to avoid damaging the neurovascular bundle. Several anatomical variations of the mandibular canal have been described in the literature, such as bifid or trifid structures. The use of cone-beam computed tomography (CBCT) offers a detailed representation of the inferior alveolar nerve path, albeit with some difficulties of identification when dental implants or metal prosthesis are present. The aim of this study is to retrospectively evaluate the prevalence and location of bifid/trifid mandibular canals (BMC/TMC) by CBCT in Italian patients. The screening phase involved 584 patients, only 238 enrolled (97 men; 141 women), with an average age of 51 ± 17.20. A total of 36 patients (15.25%) showed at least one bifid mandibular canal; only 2 patients (0.84%) showed a trifid mandibular canal. Overall, 12 patients (5.04%) presented this variation bilaterally. There was no association with the sex of the enrolled sample. In conclusion, the presence of BMCs and TMCs may be considered as a risk factor for the onset of neurovascular complications. Being aware of changes in the mandibular canal helps clinicians to prevent inferior alveolar nerve impairments that may occur during oral surgery and implantology. Full article

The objective of this study is the development of an in vitro cell culture model of pigmented gingival keratinocytes to provide a unique tool to assess oral care products such as toothpaste and evaluate whether pigmented gingival cells might be less susceptible than unpigmented cells to cytotoxicity by any toothpaste. Sepia melanin at various concentrations was added to primary human gingival keratinocyte (HGK) monolayers to identify the concentration at which melanin is sufficiently phagocytosed in the absence of cytotoxicity; this concentration was subsequently used to generate pigmented HGK model. Extracts from three commercial adult toothpastes (Crest 3D White, Sensodyne, and Colgate Optic) at different dilutions were evaluated in pigmented and unpigmented HGKs for cytotoxicity over a 24 h duration by MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay. Results demonstrated that HGKs showed a concentration-dependent uptake of sepia melanin with a significant linear correlation of pigment uptake. Moreover, the melanin was distributed perinuclearly in the cells, that was similar to the distribution of physiological gingiva in vivo. Further experiments were conducted with 25 µg/mL sepia melanin as higher concentrations induced cytotoxicity. Evaluation of three commercial toothpastes on unpigmented and pigmented HGKs showed no differential effects at any dilution. In summary, a model of pigmented HGKs with the ability to create a controlled level of pigmentation was demonstrated. Examination of extracts from three commercial toothpastes revealed similar cytotoxicity to both pigmented and unpigmented HGKs. In conclusion, this study shows that the artificially pigmented HGK model is an easy and low-cost tool that mimics the in vivo gingival pigmentation. Moreover, the evaluated toothpastes showed similar cytotoxicity to pigmented and unpigmented HGKs, suggesting that the presence of melanin did not impart any protective effects. Further studies to employ this pigmented HGK model to evaluate a large number of oral care products and include repeated exposures and longer duration are warranted. Full article

Mandibular condylar fractures can be approached with invasive techniques, such as surgical repositioning and fixation of the fractured condyle, or with conservative techniques using myofunctional appliances. Recent publications recommend non-invasive or conservative approaches when treating mandibular condylar fractures, as they may produce more stable results and fewer consequences. However, to the knowledge of the authors, there is no long-term follow up publications of clinical cases treated with a conservative approach. This report presents a ten-year follow-up of a case report published two years ago by the same authors. In the previous report, the authors showed an eleven year-old girl treated with a myofunctional appliance due to a bilateral mandibular condylar fracture. The treatment produced a stable result over the following ten years with the patient not using any appliance after the myofunctional treatment was completed. The benefits of a conservative treatment, as well as the consequences of mandibular condylar fracture, such as a heart shaped mandibular condyle, are discussed here by the authors. Full article

This study aimed to conduct a mixed-methods SR of the literature investigating the experiences (knowledge, attitudes, practices, and effects of use) concerning dental dam and cling film use. The SR methodology was informed by the Preferred Reporting Items for SRs and Meta-analysis framework, the Cochrane Handbook for SR of Interventions, the Joanna Briggs Institute guideline for conducting mixed-methods SRs, and the PICO (population, intervention (or exposure), comparison, and outcome) framework. Using a set of inclusion criteria, relevant studies in the literature were obtained for the review from 11 electronic databases, Teesside University Library, websites of multilateral health organisations, and reference lists of eligible literature. The included literature was appraised for quality using the Mixed Methods Appraisal Tool version 2018 and the AAOCDS Tool. Only those studies in the literature with sufficient quality were finally included for data extraction (using an adapted version of the JBI Quality Assessment and Review Instruments) and synthesis. Best evidence synthesis was performed for the quantitative data, while meta-aggregation was performed for the qualitative data. The synthesised data were then configured using the segregated approach. A total of 529 studies from the literature were obtained from the searched databases, while only four were obtained from the other sources. After de-duplication, screening, and quality appraisal, a total of 17 studies were found eligible and included in this review. Sixteen studies were non-grey literature while, one was grey literature, and only a few reported a finding on cling film and heterosexual populations. A total of 5516 adolescents and adults were investigated in the analysed literature. Overall, the reported knowledge of dental dams was generally poor, while no study reported knowledge of cling film. The attitudes towards dental dams/cling film were complex and predominantly negative, with very few participants using dental dams/cling film for oral sex. No study reported any finding on the effect(s) of dental dam/cling film use. In conclusion, there is a need for robust and strategic public health interventions for sexual health and safer oral sex practices. Full article

Poor oral hygiene and excessive consumption of soda are among the main drivers of systemic health issues in adolescents in the United States. This non-randomized pilot clinical trial focused on the effects of a health text message system and smartphone-based intervention on adolescent tooth-brushing behavior and dietary choices, with a convenience sample of 94 participants aged 12 to 14 years old. A group of 75 participants agreed to use a tooth-brushing app and received a health text message; the other group of 15 agreed to use the tooth-brushing app, but did not receive a health text message. Saliva specimens were collected directly before and at the end of each experiment; changes in the salivary presence of cariogenic bacteria over the duration of the study were evaluated and compared with the demographics and behavioral variables. Within the text message group, 5% of participants increased the frequency of daily tooth brushing. Within the non-intervention group, 29% of participants increased the frequency of their daily tooth brushing. There were reductions in the total salivary bacteria and total streptococci in both groups (p < 0.001), but no change in the presence of cariogenic Mutans streptococci. Raising adolescents’ consciousness of oral health behavior resulted in marginal to moderate improvements to oral hygiene and dietary choices, as well as reductions in total salivary bacteria. Full article

Background: Temporomandibular joint (TMJ) arthroscopy has become popular due to its satisfactory long-term results and few surgical complications. However, patients’ postoperative recovery is poorly studied. This study evaluates the postoperative evolution of the masticatory function and the daily activities of patients who have undergone TMJ arthroscopy. Methods: A prospective study was conducted in a Portuguese orofacial pain center with patients fulfilling the criteria for TMJ arthroscopy. For the first 30 days (D) after surgery, every 3 days, patients scored: (1) discomfort in the mastication of different food textures (soft, medium, hard); (2) time for a return to normal lifestyle (work, physical activities); and (3) TMJ pain during essential functions (mastication, speech, deglutition, deep breaths). The data were compared with preoperative results using descriptive statistics, one-way ANOVA, and the Friedman test. The level of significance was set at p < 0.05. Results: Forty-two patients were assessed for eligibility; fifteen did not meet the inclusion criteria, and five declined participation. Twenty-two patients initially started the study, but two canceled on days 6–18, and eleven patients tested positive for SARS-CoV-2. Nine female patients with sixteen operated joints completed the study. A progressive tolerance for scaling food textures was observed. Soft and medium textures were tolerated after D15 and D21, respectively. The hard texture was not well tolerated in the 30 days after surgery. Discomfort returning to work and practicing physical exercise was significantly reduced on D15 and D21, respectively. In addition, significant improvements in TMJ pain during mastication and speech were observed over time. Conclusions: Despite the study’s limitations, namely the small sample size, the non-validated questionnaire, and the non-biomechanical analysis of food texture, it was possible to observe after TMJ arthroscopy an early return to masticatory capacity with the progressive introduction of different food textures. The authors expect these results will help in future postoperative guidelines regarding postoperative recovery from TMJ arthroscopy. Full article

The current study aimed to implement and validate an automation system to detect carious lesions from smartphone images using different one-stage deep learning techniques. 233 images of carious lesions were captured using a smartphone camera system at 1432 × 1375 pixels, then classified and screened according to a visual caries classification index. Following data augmentation, the YOLO v5 model for object detection was used. After training the model with 1452 images at 640 × 588 pixel resolution, which included the ones that were created via image augmentation, a discrimination experiment was performed. Diagnostic indicators such as true positive, true negative, false positive, false negative, and mean average precision were used to analyze object detection performance and segmentation of systems. YOLO v5X and YOLO v5M models achieved superior performance over the other models on the same dataset. YOLO v5X’s mAP was 0.727, precision was 0.731, and recall was 0.729, which was higher than other models of YOLO v5, which generated 64% accuracy, with YOLO v5M producing slightly inferior results. Overall mAPs of 0.70, precision of 0.712, and recall of 0.708 were achieved. Object detection through the current YOLO models was able to successfully extract and classify regions of carious lesions from smartphone photographs of in vitro tooth specimens with reasonable accuracy. YOLO v5M was better fit to detect carious microcavitations while YOLO v5X was able to detect carious changes without cavitation. No single model was capable of adequately diagnosing all classifications of carious lesions. Full article

Light-curing units (LCUs) are often subject to clinician-determined factors such as infection control barriers (ICBs) and different positionings of the light tip that may reduce their radiant exposure. The objective of this study was to investigate the individual and cumulative effects of ICBs and LCU positioning on light output. One LCU was used, in combination with five different ICBs and five different distances and angles. ICBs were also tested when placed correctly to manufacturers’ guidelines, and with creases or seams obstructing the light tip. All variables were tested in isolation and in combination with other variables. Measurements were taken from a laboratory-grade spectrometer, giving values of radiant exposure, irradiance and spectral emission. All ICBs, angles and distances showed significant reductions in light output compared to the control (p < 0.001). With increasing angle and distance, the light output was decreased further, with the greatest reduction of 80.6% from the control seen at 40° and 8 mm with an incorrectly placed ICB. When used with an ICB, an increasing angle also showed a protective relationship on the light output. When ICBs are used or when an increase in distance/angle is unavoidable, clinicians should consider compensating for the loss in radiant exposure by increasing curing times. Full article

The use of digital health technologies, including telemedicine and teledentistry, has become a necessity in healthcare due to the SARS-CoV-19 pandemic. These technologies allow for the reduction of the workload of healthcare providers and the improvement of patient outcomes in cases of remote monitoring, diagnosis, and communication. While there are no doubtful benefits, there are some counterparts, such as concerns about clinical risks, data security, and privacy protection. This paper aims to review the regulations regarding the use of digital health apps and software in healthcare. This scoping review followed the PRISMA-ScR guidelines and the five-step framework of Arksey and O’Malley. Study selection was based on eligibility criteria that were defined using the population-exposure framework. The review of the articles selected (n = 24) found that the majority focused on data security policies in the healthcare industry, highlighting the need for comprehensive regulations and app control systems to protect patient data. The articles also emphasized the requirement for more appropriate research and policy initiatives to improve data security practices and better address privacy and safety challenges related to health-related apps. The review recognized that papers did not report consistent standards in professional obligation and informed consent in online medical consultations, with potential risks for data privacy, medical liabilities, and ethical issues. Digital health has already revolutionized medical service delivery through technology but faces some challenges, including the lack of standardized protocols for handling sensitive patient data and the absence of common legislative provisions, raising concerns about confidentiality and security. To address these issues and deficiencies, regulatory compliance is crucial to clarify and harmonize regulations and provide guidelines for doctors and the health system. In conclusion, regulating patient data, clarifying provisions, and addressing informed patients are critical and urgent steps in maximizing usage and successful implementation of telemedicine. Full article

The application of surgical navigation in oral and maxillo-facial surgery has been increasing over time. In fact, computer-assisted surgery provides real-time, precise, and accurate position and guidance during surgery. The purpose of our work is to introduce the evolution of surgical navigation in recent decades, describe some technical aspects of this technology, explore new possibilities of application of surgical navigation in oral surgery, and validate the accuracy of computer-assisted surgery. We included four patients in our sample who underwent virtual planning on the cone beam CT data set and surgical navigation using non-invasive fiducial markers. The first patient presented a dislocated orthodontic arch in the soft tissues of the cheek, while the other patients presented supernumerary and impacted dental elements. Among them, two patients were affected by craniofacial synostosis. We evaluated the accuracy of computer-assisted surgery, calculating the discrepancy between the real and virtual target. In all cases, the target registration error was less than or equal to 1 mm. We can affirm that surgical navigation is a valid tool to enhance oral surgery, guaranteeing an undoubted advantage in terms of the reliability and predictability of the results, especially in complex cases. Full article