Oral, Volume 4, Issue 3 (September 2024) – 12 articles

(1) Objectives: The purpose of this review was to compare the effects of combining skeletal anchorage and Class II devices, both from an overall perspective and individually for each type of appliance, considering as main outcomes the vertical dimensions and the inclination of the mandibular and maxillary incisors. (2) Materials and Methods: A search without time restrictions was performed up to February 2024 in PubMed, PubMed Central, Scopus, and Medline for randomized controlled trials, as well as prospective and retrospective cohort studies, considering Class II patients treated with and without skeletal anchorage. The effect measure used for the meta-analytic evaluation was the standardized mean difference (SMD). The SMD calculation was obtained by subtracting the mean values of T1–T0 for each individual treatment and then calculating the SMD between the treatments involved. The meta-analysis was performed using the standardized mean difference of the mean difference of the T1–T0 change in the outcome between the different treatments evaluated as the effect size. (3) Results: A total of 1217 documents were initially retrieved. According to the PRISMA protocol, 18 studies comparing different skeletal anchorage protocols (upper/lower miniscrews and miniplates), combined with four appliances (Herbst, Forsus, Carriere Motion, and elastics), were included in the analysis. No significant difference in skeletal divergence was found between groups from an overall point of view (SMD: 0.19 (−0.48 to 0.83) according to the random-effects model). A statistically significant reduction in IMPA° was found in patients treated with temporary anchorage devices (TADs) (SMD of 5.58 (3.40 to 7.75)), except for the elastics group (SMD: 3.76 (−0.91 to 8.43)). The effect on the upper incisors’ inclination appeared to be strictly dependent on the type of anchorage (TADs in one or both of the arches). Some limitations must be considered when interpreting the results: the small number of studies included and the heterogeneity among them are among the limitations, and the temporal disparity among some studies; the ages of the patients were not always comparable; and, finally, the clinical relevance of the effects of TADs is sometimes questionable. (4) Conclusions: The vertical dimension seems not to be significantly affected by skeletal anchorage; instead, the proclination of mandibular incisors is generally reduced when TADs are used. Skeletal anchorage might be useful if lingual tipping of the upper incisors is required; however, it is influenced by the anchorage protocol. Full article

Adolescent carriers of the Aggregatibacter actinomycetemcomitans JP2 genotype have an increased risk of developing periodontitis, due to the bacterium’s high leukotoxin (LtxA) production. LtxA contributes to marginal bone loss by killing immunity cells, thus activating the proinflammatory interleukin-1β (IL-1β), which, in turn, activates the osteoclasts. A possible strategy to prevent periodontitis might be to neutralize LtxA in JP2-infected individuals. The aim of this study was to investigate whether extracts from Matcha or Guava leaves can prolong the viability of macrophages in cell cultures by neutralizing the highly leukotoxic JP2 genotype bacteria. The A. actinomycetemcomitans JP2 genotype was pretreated with extracts from either Matcha or Guava leaves. Later, the extracts were rinsed off, before JP2 bacteria were exposed to macrophage cell cultures. The experiment was repeated, where JP2 bacteria were persistently treated with the extracts instead, i.e., the extracts were not rinsed off. The macrophage viability after bacterial exposure was analyzed and compared with that of macrophages exposed to untreated JP2 bacteria. IL-1β secretion in the cell culture medium was quantified in all group samples. Pretreatment of the A. actinomycetemcomitans JP2 genotype with Matcha or Guava leaf extracts moderately neutralized LtxA activity, which resulted in prolonged macrophage viability and decreased IL-1β secretion. These effects of prolonged macrophage viability were enhanced when extracts were persistently present during the exposure period. The results indicate that Matcha and Guava leaf extracts have effects on the virulence of the A. actinomycetemcomitans JP2 genotype that may be useful in future treatment strategies to prevent periodontitis in JP2 bacterium carriers. Full article

Purpose: The purpose of this study is to assess the effectiveness of the best performing interpretable machine learning models in the diagnoses of leukoplakia and oral squamous cell carcinoma (OSCC). Methods: A total of 237 patient cases were analysed that included information about patient demographics, lesion characteristics, and lifestyle factors, such as age, gender, tobacco use, and lesion size. The dataset was preprocessed and normalised, and then separated into training and testing sets. The following models were tested: K-Nearest Neighbours (KNN), Logistic Regression, Naive Bayes, Support Vector Machine (SVM), and Random Forest. The overall accuracy, Kappa score, class-specific precision, recall, and F1 score were used to assess performance. SHAP (SHapley Additive ExPlanations) was used to interpret the Random Forest model and determine the contribution of each feature to the predictions. Results: The Random Forest model had the best overall accuracy (93%) and Kappa score (0.90). For OSCC, it had a precision of 0.91, a recall of 1.00, and an F1 score of 0.95. The model had a precision of 1.00, recall of 0.78, and F1 score of 0.88 for leukoplakia without dysplasia. The precision for leukoplakia with dysplasia was 0.91, the recall was 1.00, and the F1 score was 0.95. The top three features influencing the prediction of leukoplakia with dysplasia are buccal mucosa localisation, ages greater than 60 years, and larger lesions. For leukoplakia without dysplasia, the key features are gingival localisation, larger lesions, and tongue localisation. In the case of OSCC, gingival localisation, floor-of-mouth localisation, and buccal mucosa localisation are the most influential features. Conclusions: The Random Forest model outperformed the other machine learning models in diagnosing oral cancer and potentially malignant oral lesions with higher accuracy and interpretability. The machine learning models struggled to identify dysplastic changes. Using SHAP improves the understanding of the importance of features, facilitating early diagnosis and possibly reducing mortality rates. The model notably indicated that lesions on the floor of the mouth were highly unlikely to be dysplastic, instead showing one of the highest probabilities for being OSCC. Full article

Background: Burning mouth syndrome (BMS) is a chronic condition characterized by an intractable burning sensation in the oral cavity without visible mucosal lesions. Current treatment options are diverse but often limited by variable efficacy and patient tolerance. This study aimed to evaluate the efficacy of turmeric combined with vitamin B₆ (pyridoxine HCl) in treating BMS. Methods: In this retrospective, single-arm study, 28 non-smoking female patients with BMS were treated with a daily regimen of turmeric and vitamin B₆ for 60 days. The pain intensity was assessed using the visual analog scale (VAS) before treatment initiation (baseline VAS, BVAS) and after the treatment period (final VAS, FVAS). The Wilcoxon signed-rank test was utilized to analyze changes in the VAS scores. Results: The mean BVAS score was 5.61 (SD = 1.87), indicating moderate pain at baseline. Post-treatment, the mean FVAS score significantly decreased to 2.14 (SD = 1.35). The median delta in the VAS scores demonstrated a substantial reduction in pain intensity (median delta = 4.0; mean delta = 3.46; SD = 2.05). Statistical analyses revealed a significant reduction in the VAS scores (W = 0.0, p < 0.0001). Conclusions: The combination of turmeric and vitamin B₆ was found to significantly reduce pain scores in patients with BMS, indicating this therapeutic approach may be a promising alternative for BMS management. Larger-scale clinical trials are warranted to further validate these findings. Full article

Conventional complete dentures remain to be an important treatment for edentulous patients, especially those of low socioeconomic status. This study is a retrospective analysis that aims to elucidate influencing factors of post-insertion complications and patient satisfaction. Clinical records of 164 patients who received both maxillary and mandibular complete dentures at an Australian university teaching clinic were assessed and analysed. The parameters considered include reason for attendance, presenting clinical status, experience of operator, numbers of appointments for fabrication and adjustment, post-insertion complications and events, and patient satisfaction. The differences among selected attributes were analysed using a Mann–Whitney test, Chi-square test, or Kruskal–Wallis test where applicable, while the relationships between discrete variables were assessed by Kendall’s correlation. First, the number of appointments for fabrication differed significantly between female (6.8 ± 1.8) and male patients (6.2 ± 1.3; p = 0.025) and between student (6.7 ± 1.7) and professional operators (6.0 ± 1.1; p = 0.015). The number of appointments for adjustment was significantly associated with patient age (τ_b = 0.167, p = 0.003) and sharply declined after the first three months. Second, post-insertion pain was the most frequent complication, and it was significantly more associated with the mandible than the maxilla (χ² = 21.670, p = 0.000). Similarly, mandibular complete dentures were also significantly more associated with post-insertion reline than the maxillary (χ² = 8.804, p = 0.003). Lastly, patient satisfaction was significantly associated with patient attendance with old/worn dentures (χ² = 9.468, p = 0.002), as well as the absence of retention/stability issues (χ² = 41.712, p = 0.000), post-insertion reline (χ² = 29.300, p = 0.000), or denture replacement (χ² = 13.968, p = 0.000). Dissatisfied patients had a significantly higher age (70.9 ± 11.0 vs. 66.2 ± 12.6; p = 0.023) and number of appointments for adjustment (4.9 ± 3.5 vs. 3.1 ± 2.1; p = 0.001) than satisfied patients. In summary, these findings revealed the above factors that influence the fabrication process, post-insertion complication, and patient satisfaction of conventional complete dentures. Future research may include analysis of cases completed at private practices and consideration of other potentially relevant factors such as denture usage and mental status. Full article

Odontogenic cysts are frequently encountered in clinical practice. However, residual cysts, a specific type of inflammatory odontogenic cyst, are relatively rare. These cysts may slowly expand over time, damaging surrounding soft tissues and bone, typically without posing a threat to life. We report the case of a 67-year-old man with liver failure and a cystic tumor in his right maxilla that had invaded his oral cavity and cheek, causing nasal obstruction and severe bleeding following an incisional biopsy. A computed tomography (CT) scan of the mass was nonspecific, and an initial histopathological analysis of the tissues was inconclusive due to chronic inflammation and hemorrhagic alterations, complicating the diagnostic pathway. The suspicion of a potentially aggressive malignant neoplasm and the need for immediate intervention due to bleeding necessitated a tracheotomy, tumor removal, percutaneous endoscopic gastrostomy, and transfusions of red blood cells. A subsequent histopathological examination revealed features indicative of a residual cyst. The entire lesion was excised through functional endoscopic sinus surgery. The surgical treatment was performed safely and effectively. Follow-up CT confirmed complete removal of the lesion. This case highlights a rare yet possible complication of odontogenic cysts and underscores the necessity of early diagnosis and comprehensive prophylaxis to prevent severe complications. Full article

Background: The provision of dental care in Pakistan is limited, with less than 5% of the population having access to qualified dental practitioners. The lack of contextually relevant local dental guidelines further adds to the problem. We developed clinical practice guidelines (CPGs) and referral pathways to improve primary care for common oral diseases. Methods: Using the GRADE-ADOLOPMENT approach, recommendations from source guidelines (developed in Europe and the United States) were adopted (retained as is or with minor changes), adapted (modified according to the local context), or excluded (omitted due to lack of local relevance). The guidelines included diseases such as periodontitis, dental pain, intraoral swelling, and oral cavity malignancies. The end result was a set of locally relevant CPGs, which were then used to formulate referral pathways, with the incorporated suggestions being based on a thorough evidence review process. Results: We included four recommendations, three of which were adopted with minor modifications to the referral pathway. These changes focused on assessing potentially malignant oral conditions and counseling for risk factors. No content changes were needed for the CPGs of the other two disorders. We developed referral pathways for three specific oral conditions, detailing primary care physicians’ roles in diagnosis, initial treatment, and timely referral. Conclusion: Contextually relevant dental CPGs and referral pathways can improve patient outcomes in Pakistan. Our study produced four additional recommendations focused on risk factor counselling and mitigation, which could potentially reduce the burden of oral malignancies in our local population. Full article

There are a series of protocols regarding the placement of dental implants after tooth extraction. The advantages and disadvantages that determine the procedure and timing of each dental implant placement process are key to achieving success. The main objective of this study was to elucidate/establish/determine whether there are differences in the survival and marginal bone loss between implants placed immediately after placement and those placed following a delayed protocol. A search was conducted in Pubmed, BVS, and Cochrane. Eleven randomized clinical trials that fulfilled the inclusion criteria were selected, and a meta-analysis was carried out to compare the implant failures and marginal bone loss between study groups. The analysis showed that delayed implant placement had fewer failures (odds ratio, fixed effects: 3.47 [CI: 95% (1.17, 10.48)]). As regards marginal bone loss, there was a tendency towards less tissue loss in the delayed placement group (mean difference, random effects: 0.11 [CI: 95% (−0.10, 0.33)]); however, further research is needed to evaluate this variable. Full article

Chelating gels may initially assist in root canal preparations to help establish a glide path. While irrigation surveys have investigated liquid chelators and gels to a minor extent, no endodontic survey has focused on EDTA gels and why clinicians use them. All 395 members of the Australian Society of Endodontology (ASE) were emailed an 11-question survey concerning chelation gel usage via Qualtrics. Paper copies were also distributed at ASE events. Descriptive statistics were performed for practitioner and chelating gel data. Cross-tabulations of the practitioner type with the case percentage usage of gels were analyzed with the chi square test (adjusted p value < 0.0083). The overall response rate was 181/395 (46%). For 174 eligible responses, those who never/rarely used a gel were as follows: endodontic residents 12/14 (86%), endodontists 53/71 (75%), general dentists 39/86 (45%), and other members 0% (0/3). Most gel users said that gels helped establish a glide path. Those who never/rarely used chelating gels commented that they held no benefits over liquid EDTA. Endodontists were less likely to use a chelation gel than general dentists (p < 0.0083). Older clinicians had higher gel usage than younger ASE members (p < 0.0083), indicating a possible trend to diminished gel usage over time amongst ASE members. In conclusion, most ASE members find no need for a chelating gel, raising questions about their clinical effectiveness. Studies would therefore be warranted to investigate gel efficacy and improved clinical outcomes. Full article

Background: Teeth are the anatomical tissue with the highest resistance to the action of chemical and physical agents. This is one of the reasons that make teeth particularly useful in the identification process of skeletonized and carbonized human remains. The aim of this research is to analyze the colorimetric changes in the enamel of teeth subjected to high temperatures to develop a reproducible colorimetric cataloging method. Methods: Six groups of 21 human teeth extracted from private clinics and from a Dental School for therapeutic reasons were used and subjected to three temperature ranges in a laboratory furnace: 400 °C, 700 °C, and 1000 °C. For each temperature, two time periods of 20 min and 60 min were chosen. Each group of dental elements was analyzed using a dental spectrophotometer to extract the colorimetric data of the crown. The obtained color coordinates were subsequently converted into Red–Green–Blue (RGB) values. The two predominant colors were also selected to create average colorimetric values, which demonstrate the change in color hue according to temperature. The groups of teeth subjected to 20 min at 400 °C exhibited a dark gray coloration, while the teeth subjected to 20 min at 700 °C showed a general increase in color brightness with beige–blueish hues. Results: The teeth subjected to 20 min at 1000 °C displayed progressively lighter shades with pinkish reflections. The teeth subjected to 60 min at the same temperatures demonstrated a general increase in brightness, making differentiation more challenging, except for the group of teeth burned at 400 °C, which showed light gray–blueish tones. Conclusions: This study further supports the existing literature on the correlation between colorimetric shifts in carbonized teeth and the maximum temperature reached, providing valuable assistance to forensic pathology and the forensic dental identification of burnt human remains. Additionally, this research has led to the development of a standardized colorimetric patented scale for the observation and examination of burnt human teeth. Full article

(1) Background: Head and neck cancer (HNC) is a major public health challenge worldwide, with oral squamous cell carcinoma (OSCC) being the predominant form. Despite advances in treatment, OSCC remains a major cause of morbidity and mortality due to delayed diagnosis and limited therapeutic efficacy. This study reviews omics technologies to assess new salivary biomarkers for the early detection of OSCC. (2) Methods: A comprehensive literature search in the last 20 years identified four relevant studies focusing on salivary biomarkers in OSCC. (3) Results: Proteomic and genomic analyses revealed significant changes in salivary composition between OSCC patients and healthy controls, suggesting promising diagnostic and prognostic biomarkers. However, studies showed varying degrees of bias, indicating the need for further research and improved standardization. (4) Conclusions: Saliva, with its advantages of ease of collection, minimal invasiveness, and potential for large-scale screening, is an emerging promising substrate for non-invasive biomarker research. Nonetheless, there is a need for improved biomarker sensitivity and specificity; currently, histological examination remains the golden standard. Full article

Background: The objectives of this pilot study are to compare the oral health status of institutionalised and non-institutionalised elderly people in Xiamen, China, and investigate oral health-related factors among this population. Methods: One elderly residential centre and one community centre in the same district were invited to join this study. Elderly people who were aged 65 years or older and able to participate in the oral health examination and questionnaire survey were recruited. Their demographic information, oral health-related behaviours, and oral health-related quality of life were collected through a questionnaire survey. The Decayed, Missing, and Filled Teeth (DMFT) index and the Community Periodontal Index were adopted to assess caries experience and periodontal status, respectively. A chi-square test, a t-test, and a correlation analysis were conducted for data processing. Results: Forty-nine elderly people participated in this study. There is no significant difference in the demographic background between non-institutionalised and institutionalised people. The mean DMFT index in the institutionalised group is significantly higher than that in the non-institutionalised group (p = 0.004). In contrast, the non-institutionalised group showed a significantly higher prevalence of gingival bleeding (p = 0.013) and a higher prevalence of periodontal pockets (p = 0.006) than the institutionalised group. Monthly income is also associated with the caries experience in this population. Conclusions: Institutionalised elderly people showed a higher severity of dental caries but a lower prevalence of periodontal symptoms than the non-institutionalised group. It is noteworthy that the generalisation of this pilot study is limited. Future research should be conducted to comprehensively investigate the oral health status of this population. Full article