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Introduction: Radiotherapy-Induced Xerostomia (RIX) is one of the most common adverse effects of Radiotherapy (RT) in the Head and Neck Cancer patients (HNC), and a major determinant of survivors' quality of life. The primary objective was to evaluate the reduction of patients’ xerostomia symptoms after the utilization of a sodium-hyaluronate mouthwash compared to a placebo solution. The secondary objectives were to evaluate the improvement of quality of life, and to evaluate the patients’ satisfaction. Methods: The protocol was approved by the ethical committee (Ref. 50053/19) and registered at ClinicalTrials.gov (ID: NCT05103124). The study was a double-blind randomized clinical trial (RCT) with a crossover design and was conducted the Fondazione Policlinico Universitario A. Gemelli, Rome Results: Thirty-two patients completed the study protocol. Lower values of the modified Xerostomia Questionnaire (XQ) were retrieved when comparing the baseline scores to the ones after treatment, when compared with placebo (Mann-Whitney U test = 0.01); higher values of patients’ satisfaction (Likert Scale) and modified XQ were retrieved for the sodium-hyaluronate mouthwash (Mann-Whitney U test = 0.001). Conclusions: This RCT highlight the advantages of treating RIX with the sodium-hyaluronate mouthwash, since it seems to be clinically effective in reducing its symptoms, without any reported adverse events.

Introduction: The aim of this case series was to evaluate the necrosis of teeth adjacent to the site of mandibulotomy or mandibulectomy in a cohort of patients suffering from head and neck cancers. Methods: Fourteen patients who underwent segmental mandibulectomy or paramedian mandibulotomy for oral, oropharynx or major salivary gland cancer and a total of 23 teeth were included in this case series. Twelve patients underwent adjuvant head and neck radiotherapy. Cold sensitivity pulp testing and/or electric pulp testing were performed on teeth at the margin of mandibulectomy and on teeth adjacent to mandibulotomy after surgery. A “positive” response was considered the healthy state, and “negative” was considered the diseased state of the tooth. Results: The 10 patients who underwent mandibulotomy had 12 teeth with a negative response. The 4 patients treated by mandibulectomy had two positive and three negative responses to cold and electric pulp tests. Fifteen out of 23 teeth (65.2%) showed a negative response to sensitivity testing. Conclusions: Tooth necrosis seems to be a common event after mandibulectomy and mandibulotomy. Clinical Relevance: To avoid post-surgery complications, performing root canal therapy before surgery on the teeth adjacent to the surgical site could be an appropriate strategy.

Abstract: Oral candidiasis is an opportunistic infection of the oral mucosa sustained by fungi of the genus Candida. Various Candida species, with a predominance of C. albicans, normally a saprophyte of the oral cavity, may become virulent and infect the oral mucosa with variegated clinical presentation, in case of imbalance of the oral microbiota, the presence of local predisposing factors and systemic conditions that weaken the immune system. Conventionally, oral candidiasis eradication is done with the help of antifungal drugs. However, the growing phenomena of drug resistance and the increase in infections sustained by non-albicans species being less responsive to common antifungals have orientied researches towards the experimentation of alternative therapies. The present review considered the most promising alternative therapeutic proposals. The use of plant derivatives with phytotherapy is a promising option, such as probiotics, to rebalance the oral microbiota in case of dysbiosis. Finally, antimicrobial photodynamic therapy (aPDT), with highly selective fungicidal activity and free of side effects, is also being studied as a powerful alternative to drug administration. All these therapies are alternatives or supportive to the conventional treatment of recurrent and non-drug-responsive forms of oral candidiasis. However, further studies are needed to define the most active compounds, the efficacy of the therapies compared with the conventional ones, and the planning of regulated and standardized protocols.

This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials.The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty-five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one-third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1-year follow-up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan-Meier survival curves were used to analyse PRCT and DRCT.Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty-two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003-0.27, p .05), whereas further bone loss (OR 10.63, 95% CI 2.08-54.36, p .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χComposite resin restorations resulted in tooth survival in50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow-up.

This study aims to find a correlation betweenThe protocol was registered on ClinicalTrials.gov (ID: NCT04009161) and approved by the ethical committee of the 'Fondazione Policlinico Universitario Gemelli IRCCS' (22858/18). An oral swab was obtained before RT to assess the presence ofNo patient developed G4 OM, and only 36/152 patients (23.7%) developed G3 OM. Tumour site and lymphocytopenia were risk factors for severe OM (OR for tumour site: 1.29, 95% CI: 1-1.67

Any oral potentially malignant disorders (OPMDs) must be regularly monitored through clinical examination to detect any possible malignant transformation. Conventional intraoral exams, however, can be difficult because these conditions may resemble benign lesions. For this reason, several non-invasive diagnostic technologies have been developed to help the clinician in detecting and distinguishing between cancerous and benign lesions. Epithelial dysplasia can be considered the most important predictor of malignant evolution. Therefore, in this study we aim to evaluate the ability of an optical filter for autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLESIn this retrospective study, medical records, photographs and videos of 25 patients with oral lesions were analyzed. Forty-two biopsy samples in 25 patients with OPMDs and at least one suspicious oral mucosa lesion that were evaluated in white light, autofluorescence with optical filter GOCCLESThe sensitivity and specificity for the autofluorescence evaluation with GOCCLESThe optical filter for autofluorescence (GOCCLES

Objectives: The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy and to identify possible risk factors. Material and Methods: PRISMA protocol was used to evaluate and present the results. PubMed, Scopus and Web of Science were used as search engines: English full-length papers of clinical studies, in peer-reviewed journals, were investigated. Cumulative meta-analysis was performed with a random effects model (PROSPERO registration code: CRD42018079986). Results: Among 2,020 records screened, 8 were included in this review. Sixteen of 494 patients who underwent tooth extraction before radiotherapy developed osteoradionecrosis, with an osteoradionecrosis incidence of 2.2% (95% Confidence of Interval=0.6–3.9, p&nbsp

Objectives: This review aimed to evaluate the correlation between viral infections (HPV, EBV, HSV-1, CMV) other than HCV and oral lichen planus to assess if there is sufficient evidence to establish if these viruses can play a role in the etiopathogenesis of the disease. Materials and methods: We reviewed the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library), employing MeSH terms such as “oral lichen planus” and “OLP” in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria. Results: A total of 43 articles of the 1219 results initially screened were included in the study. We allocated the 43 selected items into four groups, according to each related virus: HPV, EBV, HSV-1, and CMV. Conclusions: Heterogeneous results neither confirm nor exclude a direct correlation between the investigated viral infections and oral lichen planus etiopathogenesis and its feasible malignant transformation. Many viral agents can cause oral lesions and act as cancerizing agents. Future studies could be desirable to produce comparable statistical analyses and enhance the quantity and quality of the outcomes to promote the translation of research into clinical practice.

Objective The purpose of this study was to describe an unusual case of intraoral juvenile xanthogranuloma (JXG) and to perform a systematic review to investigate the available literature regarding oral JXGs. Study design We present a new case of oral JXG arising in a 36-year-old Italian woman and conducted a systematic literature review in PubMed, Web of Science and Scopus, according to the PRISMA guidelines. Results Our review of the English-language literature yielded 34 cases of oral JXG, which are included in our case report. Conclusions JXG is a non-Langerhans cell histiocytosis. Oral JXG has been reported, but it is a rare manifestation. Because of the rarity of oral lesions and possible variations in the clinical and histological presentation, the correct diagnosis can be challenging, requiring a careful clinical and histopathological evaluation with adjuvant immunohistochemical studies.

The present study investigated clinical and histomorphometric data after sinus lift procedures performed with and without mesenchymal stem cells (MSCs) added to a graft. Twenty-four patients underwent maxillary sinus lift for implant placement. Twelve patients each were assigned to control (Group 1) and test (Group 2) groups. An MSC suspension was added to the graft used in patients of Group 2. Five of 12 patients in both groups underwent crestal-approach sinus lift with immediate implant placement, while seven patients received a lateral-approach sinus lift. The MSC suspension was obtained using the Rigenera protocol. Samples from the grafted site were evaluated, processed, and stained using three staining techniques 90 days after surgery. Histomorphometric analysis was performed using an imaging software (ImageJ). Two types of tissues were defined: Type 1 'mature bone' and Type 2 'osteoid tissue'. The mean Type 1 tissue percentage was 27.24% in Group 1 and 44.45% in Group 2 (P0.05). The mean Type 2 tissue percentage was 10.86% and 7.04% in Groups 1 and 2, respectively. The mean Type 1 tissue percentages for the crestal approach were 24.52% for Group 1 and 50.78% for Group 2, while the mean Type 1 tissue percentages for the lateral approach were 29.18% for Group 1 and 39.92% for Group 2. Patients treated with grafts containing MSCs showed 63.18% increased bone formation compared to those treated with grafts not containing MSCs (P0.05). Although our data showed a positive trend in patients treated with MSCs, differences between subgroups were not significant (P0.05).

Background: This study aims to find a correlation between Candida spp. oral colonisation prior to radiotherapy (RT) and (i) the development of severe oral mucositis (OM) (grade 3/4) and (ii) early development of severe OM (EOM). Methods: The protocol was registered on ClinicalTrials.gov (ID: NCT04009161) and approved by the ethical committee of the ‘Fondazione Policlinico Universitario Gemelli IRCCS’ (22858/18). An oral swab was obtained before RT to assess the presence of Candida spp. Severe OM occurring before a dose of 40 Gy was defined as EOM. Results: No patient developed G4 OM, and only 36/152 patients (23.7%) developed G3 OM. Tumour site and lymphocytopenia were risk factors for severe OM (OR for tumour site: 1.29, 95% CI: 1–1.67, p = 0.05; OR for lymphocytopenia: 8.2, 95% CI: 1.2–55.8, p = 0.03). We found a correlation between Candida spp. and EOM (OR: 5.13; 95% CI: 1.23–21.4 p = 0.04). Patients with oral colonisation of Candida spp. developed severe OM at a mean dose of 38.3 Gy (range: 28–58; SD: 7.6), while negative patients did so at a mean dose of 45.6 Gy (range: 30–66; SD: 11.1). Conclusions: Candida spp. in the oral cavity appears to be a predictive factor of EOM.

(1) Background: The general hypothesis that HNC patients show compromised oral health (OH) is generally accepted, but it is not evidence-based. The objective of this baseline report of a prospective observational study was to describe the oral health of a cohort of patients with HNC at the time of dental evaluation prior to radiotherapy (RT). (2) Materials and Methods: Two hundred and thirteen patients affected by HNC who had received an indication for RT were examined with the support of orthopantomography (OPT). The DMFt of all included subjects, their periodontal status and the grade of mouth opening were recorded. (3) Results: A total of 195 patients were ultimately included: 146/195 patients (74.9%) showed poor OH (defined as having a DMFt score ≥ 13 and severe periodontitis). The following clinical characteristics were correlated with poor oral health in the univariate analysis: tumor site, smoking habit and age of the patients (in decades); χ2 test, p < 0.05. (4) Conclusions: This study confirms that the OH of HNC patients is often compromised even before the beginning of cancer treatment and, consequently, highlights how important it is to promptly schedule a dental evaluation at the moment of diagnosis of the cancer.

To assess (i) the prevalence of oral colonization by Candida spp. in patients with psoriasis and (ii) the prevalence of oral lesions associated with Candida spp. in patients with psoriasis and identify the risk factors for oral lesions. A systematic review was conducted in accordance with PRISMA criteria. The PROSPERO registration code is CRD42019127178. PubMed, Scopus and Web of Science were used as search engines. Meta-analyses and trial sequential analyses were performed. Among the 5805 retrieved records, nine articles were included. Among 530 psoriatic patients, 255 patients had an oral Candida spp. colonisation with an odds ratio (OR) = 3.44 (95% CI:2.38-5.00). Among 490 psoriatic patients, 43 patients developed oral Candida spp. lesions with an OR = 5.31 (95% CI:1.04-27.23). Among the patients without the main predisposing factors for infections, psoriatic patients had a higher OR (3.48, 95% CI: 2.0-6.0) for Candida spp. colonization, but not for Candida spp. infection, when compared with healthy controls (p-value > 0.05). Meta-analysis showed a higher risk of Candida spp. colonisation in patients with psoriasis. Patients who received immunosuppressive therapies were also at higher risk of developing oral lesions. Further studies are needed to understand these associations.

Background: White Sponge Nevus (WSN) is a rare benign disorder associated with mutations in genes coding for cytokeratin 4 (KRT4) and 13 (KRT13) characterized by dyskeratotic hyperplasia of mucous membranes. This study was aimed at examining different approaches (cytology, pathology and genetic analysis) to WSN diagnosis. Methods: A series of four patients with asymptomatic white diffuse oral lesions were evaluated and, before performing an incisional biopsy for pathology, an oral brush Thin Prep was collected for exfoliative liquid-based cytology (LBC). DNA for genetic analysis was also obtained from patients and both their parents, using buccal swabs. Results: Pathology and cytology showed similar results, leading to the same diagnosis of hyperkeratotic epithelium with acanthosis and spongiosis, without atypia, demonstrating the efficiency of LBC for the differential diagnosis. Sequencing analysis revealed at least 6 rare variants in the KRT4 and KRT13 genes in each patient, contributed in part by both unaffected parents. Conclusions: Thin Prep for oral exfoliative cytology and genetic analysis are sufficient for an accurate diagnosis of WSN. The combination of cytological and genetic analyses could substitute the histologic exam, providing a non-invasive alternative for incisional biopsy.

The aim of this study is to develop a prediction model for trismus (maximal interincisal distance equal to or less than 35 mm) based on a multivariable analysis of dosimetric and clinical factors.The maximum inter-incisal opening (MIO) of hean and neck cancer (HNC) patients who underwent radiotherapy (RT) ± concurrent chemotherapy with radical intent, was prospectively measured prior to RT (baseline) and 6 months post-RT. The outcome variable is trismus. The potential risk factors (clinical and dosimetric) were first screened by univariate analysis and then by multivariate analysis. At the end of this process, we used the features identified as relevant, to fit a logistic regression model and calculate the probability of observed trismus during the 6-month follow-up after RT.One hundred and four consecutive patients were included (mean age 63 years, range 25-87), 68 males, 36 females. In the univariate analysis, the MIO at baseline, as an independent variable, and several VA prediction nomogram was developed to assess trismus risk in planning process. An external validation of the model is required to apply it for current clinical use.

Diagnosis and management of sinonasal complications of dental diseases or treatment (SCDDT) may be challenging. We aimed to report our real-life experience in patients treated with endoscopic endonasal approach describing data about symptoms, etiology, extension of the disease and success rate. We evaluated retrospectively data about 262 patients diagnosed as SCDDT and managed from August 2015 to May 2022. In 44.65% cases, maxillary sinus complications were determined by a dental disorder; the remaining 55.34% of cases were iatrogenic. Patients were managed according to our multidisciplinary protocol including ENT, dental, and radiological evaluation. Treatments were planned with a personalized approach, based on the patient’s clinical characteristics; all patients were treated with an endonasal endoscopic mini-invasive conservative approach. Combined dental treatment was performed simultaneously in 152/262 (58%) of patients; in the remaining cases, it was postponed after surgery. The overall treatment success rate (symptom resolution and endoscopically observed maxillary sinus healing) was 96.5%. At 15 days after surgery, we observed a significant improvement in the quality of life. The mean post-operative Sinonasal outcome test-22 (SNOT-22) score was significantly lower compared to baseline (6 versus 43.4; p < 0.05). Our study showed that endoscopic sinus surgery can be a successful procedure for treatment of SCDDT, leading to fast resolution of sinonasal symptoms and improving the quality of life. Furthermore, the technique allows removal of migrated dental material or dental implants even in challenging cases.

Rehabilitation of an edentulous posterior maxilla with dental implants is challenging, and sinus floor augmentation could be considered as an important surgical procedure for bone augmentation in this region before implant placement. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with simplified processing: its application in sinus floor augmentation has been widely investigated in literature. However, the biological properties and actual efficacy of this product remain controversial. This study assessed the effect of sinus floor augmentation with PRF versus freeze-dried bone allograft (FDBA) on stability of one-stage dental implants. This split-mouth randomized clinical trial evaluated 10 patients who required bilateral sinus floor augmentation. PRF and L-PRF membrane were used in one quadrant while FDBA and collagen membrane were used in the other quadrant. Implant stability was assessed by resonance frequency analysis (RFA) immediately, and 2, 4, and 6 months after implant placement. The implant stability quotient (ISQ) was compared over time and between the two groups using repeated measures ANOVA and independent sample t-test. The mean ISQ significantly increased over time in both groups (p < 0.001). The increase was greater in the PRF group (p < 0.05). Within the limitations of this study, PRF yielded superior results compared with FDBA regarding the stability of one-stage dental implants.

Simple Summary Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance. Abstract Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.

PURPOSE This study was conducted to compare the bone cutting performance of the piezoelectric device with traditional drills in terms of cut execution time, environmental noise produced, surface morphology characteristics, and residual cell vitality of the bone samples. MATERIALS AND METHODS Two fresh pig jaws were obtained from a local slaughterhouse, and nine bone samples with a standard size (1 cm3) were harvested from each jaw: three using piezosurgery, three with a multiblade bur mounted on a surgical handpiece, and three with a diamond bur mounted on a high-speed handpiece, for a total of 18 samples. Two samples for each harvesting method were examined by scanning electron microscope (SEM), observing four surfaces per sample. For each surface observed, a count of the intertrabecular spaces was performed, and each space was evaluated as completely, partially, or unfilled by debris. Four samples per sampling method were examined by cell culture to evaluate residual cell vitality after cutting. The execution time of each osteotomy was measured with a stopwatch. The environmental noise was measured, at two different distances, with a phonometer. RESULTS At SEM analysis, piezosurgery osteotomies showed 66% of totally free intertrabecular spaces on the cutting surface, statistically significantly higher than those on the multiblade bur (33%) and diamond bur (12%) cutting surfaces (P < .0005). Bone samples harvested with piezosurgery also demonstrated faster cell proliferation. Finally, piezosurgery generated less environmental noise, though it required longer cutting time. CONCLUSION Piezoelectric technology is a valid alternative to rotating burs for osteotomy, demonstrating higher bone cell viability and a precise and silent, though slower, cut.

Background: Any oral potentially malignant disorders (OPMDs) must be regularly monitored through clinical examination to detect any possible malignant transformation. Conventional intraoral exams, however, can be difficult because these conditions may resemble benign lesions. For this reason, several non-invasive diagnostic technologies have been developed to help the clinician in detecting and distinguishing between cancerous and benign lesions. Epithelial dysplasia can be considered the most important predictor of malignant evolution. Therefore, in this study we aim to evaluate the ability of an optical filter for autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLES®) and of toluidine blue staining in identifying dysplastic areas in patients with OPMDs. Methods: In this retrospective study, medical records, photographs and videos of 25 patients with oral lesions were analyzed. Forty-two biopsy samples in 25 patients with OPMDs and at least one suspicious oral mucosa lesion that were evaluated in white light, autofluorescence with optical filter GOCCLES®, toluidine blue staining and then biopsied with histopathological analysis were analyzed. Results: The sensitivity and specificity for the autofluorescence evaluation with GOCCLES® for identifying dysplasia or carcinoma were 66% and 48%, respectively. The positive and negative predictive values were 34% and 77%, respectively, and the accuracy was 53%. The sensitivity and specificity for toluidine blue staining were 91% and 68%, respectively. The positive and negative predictive values were 55% and 95%, respectively, and the accuracy was 75%. Conclusions: The optical filter for autofluorescence (GOCCLES®) and toluidine blue staining are simple, inexpensive, rapid and non-invasive procedures that can assist the clinician in distinguishing OPMDs from healthy mucosa but they are not able to distinguish benign and malignant lesions.

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

Objectives: To analyze psychological profiles, pain and oral symptoms in patients with oral lichen planus (OLP). Materials and methods: 300 patients with keratotic OLP (K-OLP; reticular, papular, plaque-like subtypes), 300 patients with predominant non-keratotic OLP (nK-OLP; erythematosus atrophic, erosive, ulcerative, bullous subtypes) and 300 controls were recruited in 15 universities. The number of oral sites involved and oral symptoms were recorded. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered. Results: The OLP patients, especially the nK-OLP, showed higher scores in the NRS, T-PRI, HAM-D, HAM-A and PSQI compared with the controls (p-value

Objective: The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient’s perception variables potentially correlated to poor healing. Subjects and methods: Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy. Results: Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson’s correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes. Conclusions: The clinical evaluation was correlated with the patient’s perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools. Clinical relevance: Patient perception can be a predictor of the healing of biopsied tissues.

Background: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. Methods: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. Results: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values5) in K-OLPs and nK-OLPs, respectively. The PSQI’s validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. Conclusions: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.

Nowadays, there is a considerable interest to study the biological and microbiological changes that accompany orthodontic treatment. Growing knowledge on oral microbiota allows, day after day, to identify and characterize the microbial arrangements specifically associated with oral and extra-oral conditions. The aim of the present work is to highlight any further correlations between orthodontic appliances and the qualitative and quantitative modifications of the oral microbiota, such as predisposing factors for the onset of caries, periodontal diseases, and other infections, which can impact the oral and systemic health of the orthodontic patients. When compared with subjects without orthodontic appliances, orthodontic patients reported significant qualitative and quantitative differences in supra- and subgingival plaque during the entire treatment period. Certain components of fixed appliances (mainly bonded molar brackets, ceramic brackets, and elastomeric ligatures) showed high risks of periodontal disease and tooth decay for patients. An unclear prevalence of Candida spp. and the paucity of studies on viruses and protozoas in the oral microbiota of orthodontic patients need to be further investigated. The evidence emerging from this study could guide clinicians in modulating the timing of controls and enhance patient motivation to prevent the formation of mature plaque, thus reducing the risks of oral-plaque-related diseases.

Background The introduction of photodynamic therapy (PDT) in various branches of the dental field such as endodontics, implantology, periodontology, and restorative dentistry and oral medicine has become useful in recent decades. This systematic review presents an overview of the literature to evaluate the usefulness of topical PDT for the treatment of benign oral soft tissue lesions and to identify limitations in prior studies to improve PDT applications. Methods We performed a review of the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library) employing MeSH terms such as "Photodynamic therapy" and "PDT" in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria. Results Initial results were 1513. Finally, there were only 21 studies that met our selection criteria. We divided the 21 selected items into two groups: inflammatory diseases and infective diseases. Conclusions Although topical PDT is an easy to perform and well-tolerated treatment and appears to be a valid method with promising results in the treatment of benign lesions of the oral cavity's soft tissues, further studies are needed to complete the current knowledge of this technique.

Cooperazione tra otorinolaringoiatra e odontostomatologo in oncologia cervico-cefalica.I pazienti affetti da tumori della testa e del collo (HNC) richiedono cure specialistiche lungo tutto l’iter diagnostico-terapeutico. La collaborazione tra otorinolaringoiatra e odontostomatologo risulta fondamentale, poiché le diverse sedi anatomiche coinvolte dalla patologia oncologica hanno caratteristiche peculiari, e i migliori risultati in termini di aspettativa e qualità di vita possono essere raggiunti solo attraverso un approccio multidisciplinare. La collaborazione sinergica di tutti gli operatori sanitari nella diagnosi precoce di tali tumori consente una prognosi migliore per questi pazienti; in quest’ottica, subito dopo la diagnosi di patologie odontostomatologiche potenzialmente maligne (PMD), i pazienti dovrebbero sottoporsi a uno screening ORL completo per l’individuazione di lesioni del tratto aero-digestivo superiore. È fondamentale che, dopo la diagnosi di carcinoma e prima di qualsiasi trattamento oncologico, questi pazienti ricevano una valutazione dentale e parodontale accurata e completa, per ottimizzare il trattamento e ridurre al minimo le complicanze o gli effetti collaterali. La pianificazione multidisciplinare ablativa, ricostruttiva e protesica nella chirurgia oncologica testa-collo è diventata indispensabile per offrire ai pazienti il miglior risultato funzionale ed estetico; un miglioramento della funzione orale e della relativa qualità di vita è infatti strettamente correlato a una corretta riabilitazione protesica. Infine, prima e dopo l’intervento chirurgico e/o la radioterapia, gli obiettivi principali del trattamento odontoiatrico in questi pazienti sono rappresentati dalla prevenzione e dal trattamento delle malattie dentali e degli effetti collaterali dei vari trattamenti oncologici a livello del cavo orale.Head and neck cancer (HNC) patients require specialized care throughout the continuum of cancer diagnosis, treatment, and survival. Cooperation between ENT and dentists is crucial, since all of the different anatomic areas affected by cancer have distinctive characteristics and the best results in terms of life expectancy and patients’ quality of life can only be achieved through a multidisciplinary approach. The synergic cooperation of all health care workers in the early diagnosis of HNC allows a better prognosis for such patients. As soon as dentists diagnose a Potentially Malignant Disorder (PMD), patients should undergo complete ENT screening for detection of lesions in any portion of the upper aerodigestive tract. Before and after cancer diagnosis and before any oncologic treatment, it is critical that these patients undergo an accurate and complete dental and periodontal assessment to optimize treatment and minimize complications or side effects. Multidisciplinary ablative, reconstructive and prosthetic programing in HeadNeck oncologic surgery has become imperative to offer patients the best functional and esthetic outcome. An improvement in oral function and associated quality of life is strictly related to correct prosthetic rehabilitation. Finally, after surgery and/or radiotherapy (RT), the main objectives of dental treatment in these patients are the prevention and therapy of dental diseases and the side effects of oncological therapies involving the oral cavity.

Metastases to orofacial tissues are infrequent, their incidence being 1&ndash, 8% of malignant oral tumors, sometimes manifesting as the first clinical sign of an occult cancer. Renal cell carcinoma (RCC) is the second most common metastatic carcinoma to the oro-facial tissues, involving the jawbones, gingiva, oral mucosa, tongue or salivary glands. Also, RCC frequently displays a prominent clear cell component, which may predominate in the clear cell renal cell carcinoma subtype (CCRCC) and histologically mimic many other clear cell tumors, both benign and malignant, which can be epithelial (from keratinizing epithelia, cutaneous adnexa, salivary glands and odontogenic epithelium), melanocytic or mesenchymal in origin. In view of the necessity for prompt and accurate diagnosis of such unusual neoplasms, we report on the salient clinico-pathological features of 7 CCRCC metastatic to the oro-facial tissues, and highlight their immunohistochemical profile, to more accurately discriminate this neoplasm from other tumors of the oral cavity with a prominent clear cell component.

Osteoporosis (OP) is a bone disease consisting of a progressive loss of bone mineral density (BMD) and therefore resulting in greater susceptibility to fractures. OP shares a number of risk factors and demographic characteristics with periodontitis (PD), a bacteria-induced chronic inflammation of periodontal structures that leads to loss of alveolar bone and teeth. In the last decade, with the advent of gut and oral microbiome studies and profiling, a growing diagnostic and prognostic significance has been attributed to dysbiosis associated with various systemic and organ-specific pathologies. This evidence has inspired research on modulating the microbiota to restore health by the use of prebiotics and probiotics. The aim of this work is to overview the bidirectional interrelationships between OP and PD, reporting the most recent evidence on triggering factors and, mainly, the role of gut and oral dysbiosis in the onset and progression of both OP and PD, with the perspective in their therapy.

Objective: Aims of this study were to test the efficacy of anti-BP180-NC160 ELISA in the diagnosis of oral pemphigoid compared to the gold standard, represented by direct immunofluorescence and pathological examination, to correlate the antibody titers with the severity of the disease and the demographical data. Materials and Methods: Patients with a suspect of oral pemphigoid were enrolled and underwent biopsy and sera collection both, in order to perform histopathological examination, direct immunofluorescence and ELISA. The test outcomes were compared, and ELISA sensitivity, specificity, accuracy, and negative and positive predictive values were calculated. Results: ELISA showed good specificity (83.3%), while sensitivity was only 50%. A moderate correlation between antibody titers and disease severity was recorded. Conclusions: Mucomembranous Pemphigoid is an autoimmune autoantibody-mediated blistering disease, often affecting exclusively the oral mucosa. Currently, the biopsy is required to diagnose this disease, but serological tests are also commonly employed during clinical practice as adjunctive tools. BP180-NC160 ELISA should be considered an ancillary diagnostic test in course of oral pemphigoid; direct immunofluorescence+histologic examination remains the diagnostic gold standard.

Osteoradionecrosis (ORN) of the jaw is considered the most severe long-term adverse effect that can occur in radiation therapy patients. Teeth extractions and dental diseases are the main risk factors for ORN in irradiated patients. The aim of this case series was to evaluate the outcome of primary root canal treatments performed on patients who underwent head and neck radiotherapy and to evaluate any ORN related to the endodontic treatment. In this case series, primary root canal therapies (absence of radiolucency) were performed on 10 teeth of 8 patients who underwent radiotherapy for head and neck cancers. Radiation doses to the periapical area were calculated using the radiotherapy planning computed tomographic scan. After a 277-day mean follow-up, all patients were asymptomatic, no teeth showed periapical radiolucency, and no ORN was observed. Even if a limitation of buccal opening occurred after radiotherapy and complicated the endodontic procedures, root canal therapy seemed to be safe and a valid alternative to tooth extraction.

Objective. The aim of this study was to obtain data from a review of cases of brown tumors (BT), which are benign lesions of bone characterized by giant cells that arise during hyperparathyroidism (HPTH). BTs may affect the maxillofacial area and manifest as a brownish, slow-growing swelling causing difficulty in the differential diagnosis. Study Design. We present data from 4 new cases of oral BTs based on a systematic literature review conducted by searching EMBASE, Medline, and CENTRAL databases, according to the PRISMA guidelines. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for multiple or extraoral maxillofacial BTs. Results. In total, 167 cases (163 from 136 articles and 4 new cases; mean age 36.6 years; male-to-female ratio 1:2) were retrieved. The onset of extraoral maxillofacial BTs (odds ratio [OR] 176.3; 95% confidence interval [CI] 18.7

Background: Oral squamous cell carcinoma (OSCC) accounts for more than 90% of oral epithelial malignancies and often arises from precursor lesions, whose diagnosis is based on biopsy and histopathology. In vivo reflectance confocal microscopy (RCM) images the vital tissues at microscopic resolution, well correlating with conventional histopathology, but it is poorly investigated in oral oncology. The present work aims to describe RCM cytoarchitectural findings in oral mucosae affected by OSCC and its precursors. Materials and Methods: A series of clinically suspected oral lesions underwent RCM imaging before conventional biopsy and histopathological assessment in order to identify features suggestive of tumoral changes. Sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of RCM compared to histopathology were calculated. Results: Totally, 30 sites in 20 patients were considered and clinically classified into 16 “leukoplakia”/“ traumatism”, nine erosive-ulcerative lesions, three verrucous lesions, and two healthy mucosae, as control. The histopathological “positivity,” due to the presence of various degrees of dysplasia and/or neoplasia, was found in 11 lesions; the RCM “positivity” was referred to nine lesions reporting the RCM detection of polymorphism, multinucleated cells, irregular cellular maturation, altered nuclear/cytoplasm ratio, and abnormal blood vessels. After excluding three verrucous lesions from the RCM analysis, due to the low laser penetration through the hyperkeratotic layers, the results well correlated with histopathology, reporting 1.000 (SE), 0.933 (SP), 0.909 (PPV), and 1.000 (NPV). Conclusion: RCM can reveal dysplastic/neoplastic signs occurring in oral lesions, thus supporting their diagnostic pathway. Background: Oral squamous cell carcinoma (OSCC) accounts for more than 90% of oral epithelial malignancies and often arises from precursor lesions, whose diagnosis is based on biopsy and histopathology. In vivo reflectance confocal microscopy (RCM) images the vital tissues at microscopic resolution, well correlating with conventional histopathology, but it is poorly investigated in oral oncology. The present work aims to describe RCM cytoarchitectural findings in oral mucosae affected by OSCC and its precursors. Materials and Methods: A series of clinically suspected oral lesions underwent RCM imaging before conventional biopsy and histopathological assessment in order to identify features suggestive of tumoral changes. Sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of RCM compared to histopathology were calculated. Results: Totally, 30 sites in 20 patients were considered and clinically classified into 16 “leukoplakia”/“ traumatism”, nine erosive-ulcerative lesions, three verrucous lesions, and two healthy mucosae, as control. The histopathological “positivity,” due to the presence of various degrees of dysplasia and/or neoplasia, was found in 11 lesions; the RCM “positivity” was referred to nine lesions reporting the RCM detection of polymorphism, multinucleated cells, irregular cellular maturation, altered nuclear/cytoplasm ratio, and abnormal blood vessels. After excluding three verrucous lesions from the RCM analysis, due to the low laser penetration through the hyperkeratotic layers, the results well correlated with histopathology, reporting 1.000 (SE), 0.933 (SP), 0.909 (PPV), and 1.000 (NPV). Conclusion: RCM can reveal dysplastic/neoplastic signs occurring in oral lesions, thus supporting their diagnostic pathway.

High-dose radiotherapy (RT) for head and neck cancer has significant adverse effects on maxillofacial tissues, among which osteoradionecrosis (ORN) is the most severe and potentially life-threatening. [...]

Osteoradionecrosis (ORN) of the jaws is the most severe side effect, in some case life-threatening, [...]

Objective The aim of this study was to systematically review the literature to determine: (a) the malignant transformation rate (TR) of oral lichen planus (OLP) and its risk factors; (b) whether or not oral lichenoid lesions (OLL) have a different malignant TR. Materials and methods PubMed, Scopus, and Web of Science were used as search engines: only observational, full-length, English language studies were investigated. PRISMA protocol was used to evaluate and present results. PROSPERO registration code is CRD42016048529. Results Among 7,429 records screened, only 21 were included in this review. Ninety-two of 6,559 patients developed oral squamous cell carcinoma, with an overall TR of 1.40% (1.37% for OLP and 2.43% for OLL), an annual TR of 0.20%. Female gender, red clinical forms, and tongue site seem to slightly increase the transformation risk. Conclusions This systematic review confirms that both OLP and OLL, the latter with a slightly higher TR, may be considered potentially malignant disorders and suggest that erosive type, female gender and tongue site should be considered as risk factors for OLP transformation. Major efforts should be done to establish strict clinical and histological criteria to diagnose OLP and to perform sounder methodological observational studies.

Simple Summary Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. The results highlight how post-RT teeth extractions are a major risk factor for ORN onset (ORN incidence of 5.8%), especially in the mandible, with a diminishing trend in the last years. Abstract Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. Methods: This systematic review was conducted according to PRISMA protocol, and the PROSPERO registration number was CRD42018079986. An electronic search was performed on the following search engines: PubMed, Scopus, and Web of Science. A cumulative meta-analysis was performed. Results: Two thousand two hundred and eighty-one records were screened, and nine were finally included. This systematic review revealed an ORN incidence of 5.8% (41 patients out of 462, 95% CI = 2.3–9.4); 3 ORN developed in the maxilla. No other clinical risk factors were detected. Conclusion: Post-RT teeth extractions represent a major risk factor for ORN development, especially in the mandible, with a diminishing trend in the last years. Further research on other possible risk factors might improve this evidence.

Aim To compare the effectiveness and safety of three activated irrigation techniques when removing pulp tissue from the isthmus of a transparent tooth model. The three techniques assessed were: the EndoVac (EV), passive ultrasonic irrigation (PUI) and ultrasonic wave aspiration (TUWA). Conventional syringe irrigation (CSI) was used as a control. Methodology A transparent tooth model was created using the mesial root of an extracted mandibular first molar that had an isthmus and two independent mesial canals. An artificial 0.3 ml cylindrical chamber was created below the apical foramen. The tooth was then cleared. After preparation, the root canals were filled with fuchsine-stained bovine pulp tissue. The irrigation protocols were compared in respect of their effectiveness at removing pulp tissue from the isthmus and their safety with regards to irrigant extrusion. For all four groups, 5.25% sodium hypochlorite solution was used as the irrigant. Photographs were taken and analyzed using an imaging software. A Kruskal-Wallis test was used to detect the differences between groups (statistical significance was set at p

Background and Objectives: Previous literature has disclosed that facial attractiveness affects the esthetic evaluation of nose and lip deformity on frontal and lateral photographs. However, it has never been debated if the removal of the external facial features on three-dimensional (3D) models (&ldquo, cropped assessment bias&rdquo, ) could provide a considerable usefulness in the interpretation and comparison of the results. Additionally, it has been assumed on two-dimensional (2D) studies that esthetic assessment biases with respect to observer gender, and it is not acknowledged if and to the extent that &ldquo, gender assessment bias&rdquo, may be influenced by a three-dimensional layout. The aim of this study is to investigate if facial traits and observers&rsquo, gender may affect the esthetic ratings of unilateral cleft lip and palate (UCLP) patients after soft tissue reconstruction. Materials and Methods: Three-dimensional images of ten UCLP patients&rsquo, images were acquired before the intervention (T0), one-month (T1) and six-months (T2) postoperative. Geomagic&reg, software (version 2014, 3D Systems, Rock Hill, SC, USA) was used to remove the external facial features of 3D surface models. Five-point scale developed by Asher-McDade et al. was used to rate both nasolabial attractiveness and impairment for full-face (FF) and cropped-face (CF) 3D images. Forty-three judges (21 males, 22 females) were enrolled for the esthetic evaluation. Intraclass correlation coefficient (ICC) was used to test intra- and inter-examiner reliability, a value of 0.7 was set as the minimum acceptable level of reliability. Results: When comparing the 2 sets of observations (FF and CF), the ICC ranged from 0.654 to 0.823. Concerning gender assessment bias, the ICC ranged from 0.438 to 0.686 and from 0.722 to 0.788 for males and females, respectively. Concerning inter-examiner reliability, ICC for questions 2&ndash, 7 ranged from 0.448 to 0.644 and from 0.659 to 0.817 at T0 and T2, respectively. Conclusions: The removal of external facial features provides subtle differences on the esthetic assessment of UCLP patients. Moreover, based on our data, examiners&rsquo, gender differences may affect esthetic assessment of UCLP patients. Despite the subjectivity of esthetic judgments, a reliable, validated and reproducible scoring protocol should consider the influence of gender differences on 3D esthetic assessment of UCLP patients.

Pseudolesions are defined as physiological or paraphysiological changes of the oral normal anatomy that can easily be misdiagnosed for pathological conditions such as potentially malignant lesions, infective and immune diseases, or neoplasms. Pseudolesions do not require treatment and a surgical or pharmacological approach can constitute an overtreatment indeed. This review aims to describe the most common pseudolesions of oral soft tissues, their possible differential diagnosis and eventual related systemic diseases or syndromes. The pseudolesions frequently observed in clinical practice and reported in literature include Fordyce granules, leukoedema, geographic tongue, fissured tongue, sublingual varices, lingual fimbriae, vallate papillae, white and black hairy tongue, Steno's duct hypertrophy, lingual tonsil, white sponge nevus, racial gingival pigmentation, lingual thyroid, and eruptive cyst. They could be misdiagnosed as oral potential malignant disorders, candidiasis, Human Papilloma Virus (HPV)-related affections, oral autoimmune diseases, or benign and malignant tumors. In some cases, pseudolesions feature in a syndromic panel, for example, fissured tongue in Melkersson-Rosenthal syndrome. It is strictly fundamental for dentists to know and to distinguish oral pseudolesions from pathological conditions, in order to avoid overtreatment. Pseudolesions are defined as physiological or paraphysiological changes of the oral normal anatomy that can easily be misdiagnosed for pathological conditions such as potentially malignant lesions, infective and immune diseases, or neoplasms. Pseudolesions do not require treatment and a surgical or pharmacological approach can constitute an overtreatment indeed. This review aims to describe the most common pseudolesions of oral soft tissues, their possible differential diagnosis and eventual related systemic diseases or syndromes. The pseudolesions frequently observed in clinical practice and reported in literature include Fordyce granules, leukoedema, geographic tongue, fissured tongue, sublingual varices, lingual fimbriae, vallate papillae, white and black hairy tongue, Steno's duct hypertrophy, lingual tonsil, white sponge nevus, racial gingival pigmentation, lingual thyroid, and eruptive cyst. They could be misdiagnosed as oral potential malignant disorders, candidiasis, Human Papilloma Virus (HPV)-related affections, oral autoimmune diseases, or benign and malignant tumors. In some cases, pseudolesions feature in a syndromic panel, for example, fissured tongue in Melkersson-Rosenthal syndrome. It is strictly fundamental for dentists to know and to distinguish oral pseudolesions from pathological conditions, in order to avoid overtreatment.