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Objectives: Growing evidence exists about post‐COVID condition/syndrome as sequelae of Sars‐CoV‐2 infection in healed patients, possibly involving the lungs, brain, kidney, cardiovascular and neuromuscular system, as well the persistency of taste dysfunction. Such symptoms develop during or after infection and continue for more than 12 weeks with pathogenesis related to virus persistency but variable by organs or systems. Materials and Methods: We recently observed six patients recovered from COVID‐19 and with negative RT‐PCR testing, showing oral mucosa lesions (mainly ulcers) overlapping those occurring in the acute phase, persisting up to 20 days and thus needing a biopsy with histological investigation and spike protein evaluation by immunohistochemistry. Results: We found epithelial ulceration, inflammatory infiltrate, vessels with increased diameter and flattened endothelium but no thrombi formation; also, we found a weak epithelial SARS‐CoV‐2 positivity limited to the basal/spinosum layers, progressively decreasing toward the periphery, and the intraepithelial lymphomonocytes, endothelium, and perivascular pericytes too. Conclusions: Our findings provide evidence that SARS‐CoV‐2 can persist, as for other organs/systems, also in the oral epithelium/mucosa after the acute phase and can be responsible for lesions, although by a pathogenetic mechanism that should be better defined but certainly referable as the oral mucosa counterpart of post‐COVID syndrome. [ABSTRACT FROM AUTHOR]

Objective: Oral lesions received increased attention as likely new signs or secondary manifestations of COVID‐19. Therefore, we clinically examined oral cavity of patients with COVID‐19 and investigated oral lesions and patient comorbidities as possible risk factors of COVID‐19 disease outcome. Methods: From January to March 2022, a prospective study was conducted by recruiting all COVID‐19 patients admitted to the Intensive Care Unit and Respiratory Intensive Care Unit of Maxi‐Emergencies Hospital in Bari, Italy. Results: From the enrolled 103 COVID‐19 patients, 46.6% were females and 53.4% were males. Findings show that risk of presenting with severe COVID‐19 disease was higher in patients who developed oral lesions related to COVID‐19 than those with no oral lesions (RR = 7.998, p =.002). Next, patients with concomitant autoimmune diseases were at higher risk of a negative COVID‐19 disease outcome than those without comorbidities (OR = 8.838, p =.026). Conclusions: COVID‐19‐related lesions of oral mucosa should not be ignored as they can be early and easily detectable signs of severe COVID‐19 disease condition, thus, serving as a prevention measure for any potential unfortunate event. Findings of this study, without implying causation, offer a direction for future investigations that aim to confirm the presence of specific oral lesions in COVID‐19 patients as signs of severe disease progression. [ABSTRACT FROM AUTHOR]

Objectives: To describe the association between endodontic treatment failure and medication‐related osteonecrosis of the jaw (MRONJ) in a cohort of oncologic patients in therapy with antiresorptive and antiangiogenic drugs. Materials and Methods: Patients were selected as affected by MRONJ in absence of the common local risk factors (oral surgical procedures or ill‐fitting dentures) but showing failure of previous endodontic treatment performed at least 6 months before the starting of antiresorptive/antiangiogenic therapies. Jaw lesions were all surgically treated and patients underwent a strict clinical and radiological follow‐up. Results: Among 18 patients, who developed 18 MRONJ, the only detectable local risk factor was the presence of teeth with failed endodontic treatment (more precisely, root canal underfilling in eight cases, root canal overfilling in two cases, root perforation in three cases, root fracture in five cases). All patients completely healed after surgical procedure and no recurrence was observed. Conclusions: Endodontic treatment failure should be considered a local risk factor for MRONJ development in oncologic patients. For such reason, it is mandatory to carefully evaluate them prior than the beginning of antiresorptive and antiangiogenic drugs administration. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The perioperative control of ammonia, reduction of stress, and administration of drugs tolerated in type 1 citrullinemia and Brugada pattern allowed the successful and uneventful management of general anesthesia in the study patient. The aim of this study was to report the targeted perioperative management of general anesthesia (GA) adopted for dental extractions in a rare patient with type 1 citrullinemia and Brugada pattern. A male, Caucasian, adult type 1 citrullinemia patient needed dental extractions under GA. The medical history showed neurodevelopmental impairment, growth retardation, epilepsy, and a Type 2 Brugada electrocardiographic pattern in the second precordial lead. The authors focused the anesthesiologic protocol on the prevention of hyperammonemia and fatal arrhythmias. Changes in diet and 10% glucose solution administration prevented protein catabolism due to the fasting period (ammonia was 44 μmol/L preoperatively and 46 μmol/L postoperatively; glycemia was 120 g/dL preoperatively and 153 g/dL postoperatively). The patient received a continuous electrocardiogram, noninvasive blood pressure, pulse oximeter, entropy monitoring, train‐of‐four monitoring, and external biphasic defibrillator pads. Midazolam, remifentanil, and dexamethasone were administered for pre‐anesthesia; thiopental and rocuronium for induction; remifentanil and desflurane for maintenance; sugammadex for decurarization. After the intraligamentary injection of lidocaine 2% with epinephrine 1:100,000 for local anesthesia, the patient developed a transient Type 1 Brugada pattern that lasted a few minutes. The whole procedure lasted 30 min. The patient's discharge to ward occurred 3 h after the end of GA. The perioperative management of ammonia, reduction of stress, and administration of drugs tolerated in Type 1 citrullinemia and Brugada pattern allowed the successful and uneventful administration of GA in the study patient. [ABSTRACT FROM AUTHOR]

Objective: In the recent years, an increasing number of peri‐implant medication‐related osteonecrosis of the jaw (PI‐MRONJ) have been reported in literature, both in oncologic and osteoporotic patients. The aim of this study is to describe 19 cases of patients previously diagnosed as affected by peri‐implantitis, who were treated for PI‐MRONJ, with consideration on clinical and histopathological features. Materials and Methods: Patients included were affected by postmenopausal osteoporosis and were administered with different antiresorptive drugs. Due to the presence of clinical and radiological signs of peri‐implantitis not healed after non‐surgical periodontal treatment, they were referred to the Complex Operating Unit of Odontostomatology of the University of Bari. Then, after a drug holiday of at least 3 months and cycles of antibiotics, and after other cycles of periodontal treatment, patients underwent the surgical removal of implant fixtures and surrounding bone. Results: Although the previous diagnosis of peri‐implantitis, the histopathological analysis with both conventional and confocal laser scanner microscopy confirmed the diagnosis of peri‐implantitis‐like MRONJ. Conclusion: Peri‐implantitis not healed after conventional treatment in patients at risk on MRONJ occurrence should be considered as peri‐implantitis‐like PI‐MRONJ and treated as required in order to get complete healing of the pathological condition, thus avoiding delay in the diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The frequency of oral squamous cell carcinoma in young adults has increased in the last decades, and there are conflicting results in literature about its prognosis in young subjects. The aim of this study was to analyse the clinical and pathological features of oral squamous cell carcinoma in a cohort of young adults in order to investigate the presence of new independent prognostic markers. Materials and Methods: Only HPV‐negative young patients (under 40‐year‐old) affected by oral squamous cell carcinoma were considered in this study. Clinical and pathological data were collected. Patients were re‐staged according to the 8th edition of AJCC. Results: Overall, 66 patients were considered in this study. Perineural invasion significant correlated with both 7th and 8th edition of AJCC, and lymphovascular invasion (p‐value <.05). The multivariate survival analysis showed that patients with perineural invasion had a significant worse prognosis (HR = 6.384 95% C.I. 1.304–31.252; p‐value =.022). Conclusions: Perineural invasion emerged as an independent prognostic factor for disease‐specific survival in young patients with oral squamous cell carcinoma. Furthermore, the evaluation of this parameter is simple, inexpensive and can be used to augment the risk stratification of oral cancer based on the 8th edition of AJCC. [ABSTRACT FROM AUTHOR]

Re‐absorbable dermal fillers of poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid are considered overall safe and well tolerable because of biocompatibility; nevertheless, rarely, late, or early adverse reactions may occur. [ABSTRACT FROM AUTHOR]

From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) underwent elective neurofibroma resection at our institution (Departments of Plastic Surgery and of Odontostomatology). Specimens were photographed under optical microscope and confocal laser scanning microscopy (CLSM) with ultra-high accuracy of detail, including depth of field. Patients were followed up for a minimum of 4 years and up to a maximum of 12 years, postsurgery. While all nonrecurring lesions showed intense fluorescence, six of the seven lesions with absence of fluorescence under CLSM recurred at a mean of 5.5 years after surgical excision. Among the re-excised lesions, 3 were diagnosed as malignant at the subsequent removal. Despite the limitation of a small cohort, CLSM appears to be a simple and low-cost technique to differentiate forms of neurofibromas with low and high risk of recurrence and malignant degeneration. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate. [ABSTRACT FROM AUTHOR]

Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases. [ABSTRACT FROM AUTHOR]

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The newdimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The proper performing of the fine‐needle aspiration cytology of head and neck neoplasms leads to an accurate preoperative diagnosis by an inexpensive and relatively simple technique. The proper performing of the fine‐needle aspiration cytology of head and neck neoplasms leads to an accurate preoperative diagnosis by an inexpensive and relatively simple technique. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Oral manifestations of Crohn's disease include gingivitis, deep ulcerations, pseudopolyps, and labial or buccal swelling; these are uncommon in children and can precede or coincide intestinal inflammation lesions, leading frequently to a delayed diagnosis. Oral manifestations of Crohn's disease include gingivitis, deep ulcerations, pseudopolyps, and labial or buccal swelling; these are uncommon in children and can precede or coincide intestinal inflammation lesions, leading frequently to a delayed diagnosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Oral maxillary exostoses are proliferating bone lesions with an unknown etiology occurring on the cortical plates both in the maxilla and in the mandible of young individuals, showing a typical slow but continuous enlargement. No treatment is usually required unless they create esthetic or functional limitations during follow‐up; the biopsy is needed only for doubtful lesions. Furthermore, it is mandatory to collect an accurate familiar history of patients affected by exostosis, especially when occurring with atypical clinical presentation, in order to exclude or prevent potentially associated systemic diseases. Oral maxillary exostoses are proliferating bone lesions with an unknown etiology occurring on the cortical plates both in the maxilla and in the mandible of young individuals, showing a typical slow but continuous enlargement. No treatment is usually required unless they create esthetic or functional limitations during follow‐up; the biopsy is needed only for doubtful lesions. Furthermore, it is mandatory to collect an accurate familiar history of patients affected by exostosis, especially when occurring with atypical clinical presentation, in order to exclude or prevent potentially associated systemic diseases. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The diode laser promotes regression of the small venous lake of the lip by forced dehydration with induced photocoagulation of the lesions, with an uneventful postoperative course and anesthetic sequelae. [ABSTRACT FROM AUTHOR]