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Hypersensitivity reactions affecting the oral mucosa present a significant clinical challenge due to their diverse manifestations and the wide range of potential allergens involved. This article explores the types of allergic reactions commonly observed in the oral cavity, including contact allergies and systemic allergic reactions, emphasising their clinical presentations and diagnostic approaches. Common allergens such as metals and resin-based dental materials are highlighted, discussing their impact on oral health. Diagnostic strategies, including clinical examination, history taking, cutaneous patch testing and histopathological evaluation, are assessed for their efficacy in establishing the diagnosis of an allergic reaction and in identifying specific allergens. Management and treatment options are also reviewed, focusing on allergen avoidance, pharmacological interventions, and the selection of hypoallergenic dental materials. This article underscores the importance of a multidisciplinary approach in improving diagnostic accuracy and therapeutic outcomes for patients with oral mucosal allergies.

The study aimed to present the characteristics of the three most prevalent oral potentially malignant disorders, leukoplakia, oral lichen planus (OLP), and actinic cheilitis, using data from 62 patients collected at the “Sfântul Spiridon” Emergency Clinical Hospital in Iași, Romania, between January 2015 and January 2023. The results revealed a higher prevalence of these lesions among older adults, particularly those over 50 years old, and a significant gender disparity in the incidence of actinic cheilitis, which was more common in males (68%). Leukoplakia was frequently observed on the tongue and lower lip, whereas OLP commonly affected the buccal mucosa. Actinic cheilitis was primarily noted on the lower lip, attributed to chronic sun exposure. The study highlighted the importance of early detection and regular monitoring of these conditions to prevent malignant transformation.

Oral lichen planus (OLP) is a chronic inflammatory condition that poses significant therapeutic challenges. Emerging evidence suggests that topical Janus Kinase (JAK) inhibitors could represent a novel treatment paradigm for OLP. This review explores the pathophysiology of OLP, highlighting the role of the JAK-STAT pathway in its pathogenesis. We discuss the current landscape of topical JAK inhibitors, including their mechanism of action, efficacy, and safety profile. The review also examines recent clinical trials and observational studies that shed light on the potential of these agents in managing OLP. Finally, we provide a perspective on the future of JAK inhibitors in the context of OLP treatment, considering both their therapeutic potential and the need for further research.

The medical and dental fields are experiencing a significant shift in approach thanks to the integration of artificial intelligence (AI). With a vast influx of patient data, there is a pressing need for sophisticated software capable of organizing and preserving this information effectively. The emergence of AI-driven models and computer vision techniques for identifying patterns in clinical and histopathological images related to oral pathology lesions holds promise for enhancing diagnostic accuracy and prognostic predictions. While microscopic morphology remains the gold standard in diagnostic pathology, its reliance on individual pathologists introduces variability. Consequently, AI presents a potential solution for achieving consistent and more precise diagnoses. Moreover, by analyzing extensive data from the patients’ medical chart the artificial neural network could provide a presumptive diagnosis and an invaluable screening tool in predicting individual risk for oral pathology based on information regarding their risk factors, systemic diseases and conditions and clinical pathological data. Within oral and maxillofacial pathology, AI stands poised to elevate diagnostic accuracy, tailor treatment, and ultimately enhance patient outcomes. Nevertheless, the integration of AI in healthcare demands meticulous attention to ethical, legal, and regulatory complexities. Moreover, given the nascent nature of AI technology, prudence is paramount when deploying it in this specialized domain.

This narrative review highlights the emerging role of salivary markers in the detection of oral cancer. Saliva contains diverse biomolecules that can provide valuable information on physiological and pathological processes in the body, including specific biomarkers that indicate the presence and progression of oral squamous cell carcinoma (OSCC). Salivary markers have the potential to transform the diagnosis and management of malignant oral lesions by offering a non-invasive approach to screening and monitoring the disease. This review examines the current state of knowledge regarding salivary markers in oral cancer, including their advantages over traditional biopsy-based techniques, limitations, and the need for further research. It concludes by outlining the future prospects of salivary biomarkers in oral cancer detection and management.

In general terms, neoplastic conditions are characterized by increasing in cell proliferation and decreasing in cell apoptosis. The multiplication of atypical neoplastic cells, through their invasive capacity, leads to the infiltration of tissues or organs through the bloodstream or the lymphatic system. In this context, chemotherapy remains one of the most used treatment modalities, contrary to the progress made in recent years regarding the management of cancer in the Oro-Maxillo-Facial (OMF) sphere. This is applied either alone or associated with other therapeutic methods to block abnormal cell proliferation. The great inconvenience of chemotherapy is the lack of selectivity because it acts both on tumor cells and normal cells in the body. The oral cavity is very vulnerable to the direct and indirect toxic effects of chemotherapy. This fact is primarily due to local peculiarities that include: a high rate of mucosal cell turnover, the presence of a complex and diverse microflora in the oral cavity as well as the small traumatic injuries present as a result of the exercise of normal oral functions (mastication, swallowing, phonation).

Menopause is a non-pathological change which involve the permanent cessation of menstruation for at least 12 months and occurs in women with an average age of 51 years in the context of non-pathological estrogen deficiency. The effects of menopause are closely related to the lack of ovarian hormones, a fact that induces a physical and emotional instability of the woman with a direct impact on the health of the oral cavity. This paper reviews the changes in the oral mucosa in the peri- and post-menopause phases. The most frequently reported changes are: dryness of the oral cavity, sensation of decreased amount of saliva, burning sensation, dysgeusia, altered tolerance to pain and the possibility of neurological manifestations. The dentist and general practitioner must recognize the variety of signs and symptoms that occur in the context of this physiological stage and, at the same time, must focus on the symptomatic management of oral health changes.

The early detection and accurate diagnosis of potentially malignant oral lesions, such as actinic cheilitis, leukoplakia, and oral lichen planus, are crucial for improving patient outcomes. Dermatoscopy, a non-invasive diagnostic technique, offers enhanced visualisation of these lesions, enabling precise assessment of morphological features critical for early recognition and differential diagnosis. This article aims to present dermatoscopic findings from cases of these common conditions, highlighting their importance in refining clinical management. Dermatoscopy not only improves diagnostic accuracy by revealing detailed lesion characteristics but also assists in evaluating malignancy risk, monitoring progression, and guiding the decision-making process for biopsy and treatment. While biopsy remains definitive for diagnosis, dermatoscopy serves as a valuable preliminary tool. Future research should focus on establishing standardised dermatoscopic criteria for oral lesions and integrating dermatoscopy into regular oral health evaluations to advance patient care.

Geographic Tongue (GT), also known as benign migratory glossitis, is a benign inflammatory condition characterised by irregular, smooth, red patches on the tongue surface, often with a white or light-coloured border. Despite being a common oral condition, its pathophysiology remains poorly understood. This review aims to shed light on the latest insights into the pathophysiology of GT, exploring its etiological factors, immunological aspects, and potential genetic predispositions. We discuss the role of environmental factors, such as stress and dietary habits, and delve into the immunopathological mechanisms that may contribute to the manifestation of GT. The review also examines the possible genetic and epigenetic factors involved in GT and their interaction with environmental triggers. Recent advancements in molecular biology and genetics offer new perspectives in understanding the complex nature of GT, paving the way for improved diagnostic and therapeutic approaches. This review concludes with a discussion on the potential future directions in GT research, focusing on the need for larger epidemiological studies and the exploration of novel therapeutic targets.

Recurrent Aphthous Stomatitis (RAS) is a prevalent oral mucosal disorder characterized by recurring painful ulcers. The pathogenesis of RAS remains incompletely understood, but emerging evidence suggests a significant link between gut microbiota and the development of RAS. This review aims to explore the existing literature on the interplay between gut microbiota and RAS, focusing on how intestinal dysbiosis may influence the onset and severity of RAS. We discuss the role of gut microbiota in immune modulation, the breakdown of oral tolerance, and the possible pathways through which gut bacteria can affect oral health. Additionally, we examine the impact of diet, antibiotics, and probiotics on the gut microbiota and, subsequently, on RAS. The review concludes with potential therapeutic strategies targeting gut microbiota to manage and prevent RAS, paving the way for novel interventions in this field.

Immunodeficiencies induced by chemotherapy make cancer patients vulnerable to to reactivation of latent viruses and to primary viral infections caused by exposure to environmental factors, such as air, water, microbial flora and debris. Patients with hematological cancers are more prone than patients with solid tumors to develop viral infections that affect the oral cavity due to high-dose chemotherapy regimens and prolonged immunosuppression. Viruses of the Herpetoviridae family (herpes simplex, varicella, cytomegalovirus, Epstein-Barr) and human papillomavirus cause mouth pain with difficulties in eating and oral ulcerations that can spread, leading to life-threatening systemic infection. Therapeutic approaches for the more severe and atypical oral manifestations seen in cancer immunosuppressed patients include inhibitors of virus replication, antivirals, surgical excision and analgesics, but the painful oral lesions are associated with longer healing times. The differential diagnosis of a oral ulcers in cancer patients is broad, but it should include various viral infections.

In patients with haemophilia, any oral surgery carries the risk of prolonged and excessive bleeding. Close collaboration between haematologists and oral surgeons is necessary to prevent excessive bleeding. No procedure can be considered minor in a patient with haemophilia because of the serious potential consequences. Successful treatment protocols using systemic treatment, antifibrinolytic agents and local haemostatic measures are described in the current literature.

Angular Cheilitis (AC) represents a multifaceted oral pathology characterized by erythematous lesions at the labial commissures. Despite its prevalence, AC is often inadequately addressed due to its polymorphic etiology, which can encompass infectious agents, nutritional deficits, and systemic conditions. This article provides a systematic review of the pathophysiology, clinical presentation, and etiological factors of AC, including nutritional deficiencies, infectious agents, and systemic diseases. Emphasizing a multidisciplinary strategy, we discuss the collaborative roles of dental, medical, and dermatological expertise in the accurate diagnosis and effective management of AC. We outline diagnostic criteria, appropriate laboratory tests, and imaging techniques tailored to address the multifaceted nature of the condition. Management strategies encompass a range of options from topical treatments and medications to dietary modifications and preventative measures, with an emphasis on evidence-based practices. This review advocates for integrated care models to optimize treatment efficacy, patient compliance, and to mitigate the recurrence of AC. Our analysis aims to enhance the understanding of AC and to provide a framework for its management, contributing to better patient care and opening avenues for future research.

Corticosteroids, including glucocorticoids, mineralocorticoids, and androgenic hormones, are hormonal mediators produced by the adrenal glands and are widely used in the treatment of various conditions, including dental diseases. While systemic corticosteroid therapy offers significant therapeutic benefits, it is crucial to understand the potential adverse effects on oral health. This paper aims to highlight the impact of systemic corticosteroid therapy on oral health, focusing particularly on the associated complications and management strategies. The paper emphasizes specific complications that may occur in the oral cavity as a result of corticosteroid use, the most important being an increased susceptibility to oral infections such as candidiasis and impaired bone metabolism, with a significant reduction in the mineral density of the mandibular bone (BMD), as well as delayed wound healing, the occurrence of oral ulcers, and changes in the oral microbiome. Furthermore, the importance of rigorous oral care and regular dental monitoring for patients undergoing systemic corticosteroid therapy is underlined. The role of oral health specialists in the early detection and efficient management of oral complications, as well as patient education regarding proper oral hygiene practices and possible side effects, is of crucial importance. In conclusion, it is essential for healthcare providers to be vigilant regarding the potential oral health complications associated with systemic corticosteroid therapy, and early detection, prevention, and the implementation of appropriate management strategies are fundamental for optimizing oral health outcomes in patients undergoing corticosteroid treatment.

Obstructive sleep apnea syndrome (OSAS) represents a major health problem associated with serious long-term consequences, affecting 2-5% of men and 2% of women from the general population. The most important risk-factors that lead to this condition are obesity, age, male sex, craniofacial abnormalities, malocclusions, personal habits such as smoking and alcohol consumption, the use of sedative medications, endocrine disorders. The purpose of this literature review is to evaluate the relationship between craniofacial morphologies, malloclussions and the use of sedative madication and the development of obstructive sleep apnea.

Aim of the study. Dental anxiety has an important role in the development of the periodontal disease. The aim of the current study is to investigate the relationship between dental anxiety and periodontal disease. Material and methods: Data was collected between 2022 and 2023 using a self-reporting questionnaire created with the Google Forms platform. Results: High dental anxiety is correlated both with poor periodontal health (p=2.11E-86) and with strong psychosocial impact that dental aesthetics has on the quality of life (p=4.46E-56). These directly influence the frequency of visits to the dentist (P values: 4.89E-07, 9.53E-17 and 5.29E-07), as well as the time elapsed since the last professional dental hygienization (P values: 0.0008, 1.57E-17 and 5.62E-10). These three are also interconnected with general health (P values: 0.015, 3.73E-09 and 1.95E-05) and stress (P values: 5.09E-10, 1.64E-08 and 9.87E-07). In addition, BMI shows a direct relationship with dental anxiety (p=0.020), as well as with periodontal health, along with the quality of eating habits (p=0.017 and p=0.001). Conclusion: the results indicated that the severity of the periodontal disease is a result of dental anxiety, and vice versa. Therapy should be personalized for each individual following a comprehensive evaluation and should be based on the experience and expertise of the dentist, the intellectual capacity of the patient, age, cooperation, and clinical situation of the patient.

Childhood viral and bacterial infections may cause oral symptoms that might help early diagnosis and treatment and support the prevention efforts of pediatricians and parents. Oral lesions can clinically mimic malignancy and genetic disorders. The inflammatory changes of oral mucosa during childhood infectious diseases pose some challenges during differential diagnosis, due to the wide range of etiologies. Global migration and gaps in vaccination coverage have allowed viral infections to expand and reemerge. This review highlights the clinical features and treatment recommendations of childhood infections that can be encountered in dental practice, with a short description of the underlying systemic illness. Thorough patient history and physical examination are essential for determining the infectious agent that affects oral cavity. Treatment strategies customized for the pediatric age group are guiding the management of oral and perioral lesions from infancy through adolescence. The clinical features, diagnosis criteria, and treatment algorithms of the most common pediatric infectious diseases are summarized based on their prevalence. Dentists can play an important role in early identification of various childhood infections through soft tissue lesion investigation. Due to the numerous oral complications, vaccination awareness is another important task assigned to dentists

Periodontitis patients are known to have increased circulating lipopolysaccharide activity and metabolic disturbances, which may be either the cause or effect of endotoxemia. This review approaches endotoxemia as a possible molecular mediator between periodontitis and increased risk of cardiometabolic disorders. Observations that bacteria disseminate into circulation after toothbrushing and periodontal procedures and assumptions that endotoxin may disseminate through inflamed periodontium and bleeding gums support the idea of endotoxemia in periodontitis. However, the evidence that periodontitis-associated dysbiosis contributes to endotoxemia is not as strong as in the case of gut microbiome dysbiosis. Although the causality is insufficiently demonstrated thus far, many studies have associated changes of the gut microbiome composition, function, and specific bacterial metabolites with cardiometabolic diseases, whereas research on the oral microbiome has severely fallen behind.

Periodontitis patients are known to have increased circulating lipopolysaccharide activity and metabolic disturbances, which may be either the cause or effect of endotoxemia. This review approaches endotoxemia as a possible molecular mediator between periodontitis and increased risk of cardiometabolic disorders. Observations that bacteria disseminate into circulation after toothbrushing and periodontal procedures and assumptions that endotoxin may disseminate through inflamed periodontium and bleeding gums support the idea of endotoxemia in periodontitis. However, the evidence that periodontitis-associated dysbiosis contributes to endotoxemia is not as strong as in the case of gut microbiome dysbiosis. We describe the structure-function relationship of lipopolysaccharide, the local and systemic inflammatory and immunological responses caused by lipopolysaccharide, current knowledge on endotoxemia in periodontitis, factors affecting the levels of endotoxemia, and its relation to cardiometabolic disorders. They are physically, microbiologically, and biochemically connected to each other, and only crumbs of information are known about this connection. Although the causality is insufficiently demonstrated thus far, many studies have associated changes of the gut microbiome composition, function, and specific bacterial metabolites with cardiometabolic diseases, whereas research on the oral microbiome has severely fallen behind.

Periodontal pathology and early clinical manifestations in the context of leukemia are influenced by the host organism, by immunological, microbiological and genetic factors, but also by environmental factors (physical agents (ionizing radiation, x-rays) and chemical agents (drugs such as cytostatics, exposure to organic solvents or to pesticides, herbicides, exposure to cigarette smoke). The purpose of this article is to emphasize both the importance of the health status of the marginal periodontium and the severity of gingival-periodontal manifestations in the context of haematological diseases. We also want to draw attention to the role of periodontal treatment: the elimination of periodontal inflammation, the reduction of periodontal pockets, the maintenance of rigorous oral hygiene and the periodic check-up in a dental practice in this category of patients. Clinical and radiological evidence-gathering is very important in the recognition and diagnosis of gingival-periodontal manifestations in haematological diseases, as when they are not treated in time, they become a source of infection of the oral cavity and in the entire body. Conclusions. It is essential to analyze this interaction in all aspects, from a clinical, microbiological, immunological and genetic point of view, in order to make a diagnosis and implement a correct and complete treatment plan.

The aim of this review is to provide an overview of the current evidence of some popular food supplements and superfoods that might be of interest in periodontology. Although the number of publications investigating the effect of these products on human health and their possible use in medicine is increasing, only little is known so far regarding their effects on periodontal tissues and their possible use in periodontal treatment or medicine. In summary, an increasing number of studies have revealed aspects and effects of these so-called lifestyle or fitness supplements and superfoods that may have an impact on periodontal health and healing after treatment. However, some the current evidence is of a very low quality, and more validated scientific data are required before their possible use in prevention or treatment of periodontal diseases can be made.

Introduction. As the area of nano-based platforms for antimicrobial treatment aimed at pathogenic oral biofilms continues to expand, this review serves to bring together researchers from several disciplines to foster more collaboration and discovery among dental practitioners.

Canine impactions are frequently encountered in the pediatric population. Impacted canines may pose a functional and esthetic problem for patients and can affect the neighboring teeth (incisors and premolars). Early detection and management of such pathology may help the pediatric dentist and orthodontist to prevent many unwanted local and regional complications. Various surgical and orthodontic techniques may be used to recover impacted maxillary canines. The decision to surgically correct these impacted teeth is usually made by the orthodontist. The treatment of impacted teeth requires a multidisciplinary team comprising orthodontist, pediatric dentist, dento-alveolar surgeon, and sometimes a periodontist.

Burning mouth syndrome (BMS) is a chronic disease characterized by the presence of persistent oral mucosa pain, mainly burning sensation without any detectable clinical cause or modified general investigations. Coronavirus infections, in some patients, caused sensations of oral burning, of a neuropathic nature, which mimicked the symptoms of BMS. In addition, the psychiatric manifestations associated with the COVID-19 pandemic have exacerbated the symptoms of patients already diagnosed with burning mouth syndrome. Based on these observations, we conducted a longitudinal study to assess the changes in depressive and anxiety symptoms in BMS patients during the pandemics. We recruited two groups of age and gender-matched BMS patients. The first group included patients with BMS diagnosed with coronavirus infection and the second one without coronavirus infection. The study concluded that in patients with coronavirus infection there was an intensification of anxiety-depressive symptoms more pronounced in the first 6 months after infection (duration being associated with the infection severity and long-COVID symptoms), followed by a recurrence or even decrease in symptoms compared to the initial examination. Oral symptomatology had a similar evolution, the intensity being determined by the severity of the COVID-19 infection episode and by the prolonged use of antivirals. The lack of a larger number of studies and patients with BMS and COVID-19 infection limited the possibility of comparative analyses.

Chronic actinic cheilitis (AC) is a morbid condition with the potential for malignant transformation, predominantly affecting the vermilion of the lower lip in patients with a history of prolonged exposure to ultraviolet radiation. Classically, the diagnosis of actinic cheilitis is based on the visual clinical examination and the detailed anamnesis of the patient. In selected cases, tissue biopsy and histopathological analysis represent the gold standard for the diagnosis of certainty. Currently, digital dermatoscopy is an innovative, non-invasive in vivo technique which uses magnification lenses and a light source, enabling the visualization of structures in the deep epithelium and superficial chorion (either using polarized light, or a contact fluid to minimize light reflection off stratum corneum) at a magnification of 10 fold or more, depending on the device. It is useful in the primary assessment of actinic cheilitis, but also for dynamic monitoring of disease progression, early detection of progression to squamous cell carcinoma and evaluation of treatment effectiveness. Detailed epithelial and subepithelial structural aspects visible through digital dermatoscopy allow a rigorous selection of patients who need exposure to an invasive maneuver such as tissue biopsy.

Squamous cell carcinoma is the most common epithelial neoplasm of the head and neck, and it is estimated to represent over 90% of oral neoplasms. Despite therapeutic advances, morbidity and mortality from oral squamous cell carcinoma have not improved significantly in the last 30 years, mainly due to the detection of cases in advanced stages. While tobacco and alcohol use are major risk factors for oral cancer, other known causes are: genetic mutations, dietary deficiencies, prolonged exposure to UV radiation, immunosuppressive conditions, oral or systemic infections. Poor oral hygiene, gingival or periodontal chronic inflammatory conditions, as well as chronic oral erosive lesions favor the appearance of oral infections. Bacterial colonization and adjacent pro-inflammatory status induce the initiation and progression of oncogenic processes by stimulating cell proliferation, angiogenesis, and mutagenic processes. Studies investigating the salivary microbiome, performed on people with precancerous or neoplastic lesions, have shown a decrease in microbial diversity and abundance, especially of the species Firmicutes and Actinobacteria together with the increase in the representation of Lactobacillus. Two theories are formulated to clarify the relationship between the salivary microbiome and oral squamous cell carcinoma. The first discusses bacterial colonization as a direct pathogenic cause of carcinoma, the second describes microbiome abnormalities after tumor onset. In both concepts, metagenomic and transcriptomic changes occur in the salivary microbiome and influence oral cellularity and the immune response. In addition, a combination of both theories is very likely to occur during the progression of oral carcinoma. The analysis of the salivary microbiome as a biomarker for the detection of potentially malignant oral lesions and early oral carcinoma is an innovative and non-invasive method that offers promising prospects. To standardize it, there are numerous molecular and genomic biology studies in progress, extensive studies, including new therapeutic approaches to oral carcinoma by correcting salivary microbiome dysfunctions.

This article focuses on herpesviruses and major periodontopathic bacteria in the etiology of localized juvenile periodontitis. The joint association of herpesvirus with severe periodontitis and systemic diseases argues for a possible systemic involvement of periodontal herpesviruses in medical disorders and for periodontal therapy that targets both herpesviruses and bacterial pathogens. The etiopathogenesis of severe periodontitis includes active herpesviruses, specific bacterial pathogens, and pro-inflammatory cytokines. The inflamed periodontium constitutes an important reservoir of herpesviruses outside of the hematopoietic compartment. Several rationales prompted studies on periodontal herpesviruses. Severe periodontitis lesions can contain hundreds of millions of active herpesviruses and bacterial pathogens that may. Systemic and topical anti-herpesvirus therapy can neutralize active herpesviruses, and effective patient self-care can help prevent inflammatory cells containing latent herpesviruses from entering the periodontium.

Worldwide the rate of edentulism due to an increasingly aging population is as high as 70%, according to region, country, socio-ecconomic status, etc. The habit of using a removable prosthesis, can alter the delicate ecological balance of the oral cavity can cause denture candidiasis. Chronic atrophic candidiasis, or denture candidiasis, is a common infection of the oral cavity caused by overgrowth of mainly Candida species and it affects mostly patients with an affected immune system. Risk factors for the development of this pathology can be divided in two, systemic or local. Drugs like steroids, broad spectrum antibiotics, immunosuppressives can increase the risk of oral candidiasis by suppressing cellular immunity and phagocytosis. Timely diagnosis of the ethiopathogenic pathogenic fungal microorganisms and the susceptibility to antifungal medication are crucial to the correct treatment of the infection and to implement preventive healthcare-associated strategies. Mirroring bacterial resistance, fungal infections, both non-Candida albicans but also antifungal resistant isolates have up-surged; thus, reliable diagnostic methods and new treatment modalities (utilizing novel antifungal agents or alternative therapies such as photodisinfection) are much sought-after in the management of candidiasis.

Maxillary sinusitis is a frequent pathology encountered in both otolaryngology but also in oro-maxillo-facial and dento-alveolar surgery. When it is of odontogen origin it can originate in a maxillary tooth infection, and/or endodontic treatment, periodontal bone loss and dental implants. Odontogenic maxillary sinusitis accounts for approximately 10%–41% cases of maxillary sinusitis and a routine radiologic examination can reveal its dental origin. The purpose of this review was to assess the association and influence between the various odontogenic conditions (endodontic periapical pathology, periodontal disease, bone loss, dental trauma, missing teeth, etc.) and the presence of maxillary sinus mucosal thickening reported in the literature. The thickness of the alveolar cortical plate and the roots of maxillary molars affect the spread of odontogenic infection, which, in turn, is the basis of treatment planning. Conclusion: Otolaryngologists are frequently involved in the treatment of patients with maxilary sinusitis. However, during treatment the odontogenic cause is often overlooked, leading to persistent symptoms in patients and an incomplete and a failure of sinusitis treatment. A collaborative approach to the diagnosis and treatment of suspected odontogenic maxillary sinusitis between otolaryngologists and dental practitioners may be an effective patient-centered strategy. The interdisciplinary management of sinusitis and the dental origin of the condition is essential in these cases.

From a clinical perspective doctors rely on auspicious wound healing on a daily basis. Without a thorough understanding of this process success in treatment cannot be obtained. Thus it is of utmost importance that clinicians know and understand both the local, but more importantly, the systemic factors, which most of the time are not so apparent, which can affect and delay wound healing. The oral cavity hosts a plethora of tissues that serve various functions, and in this complex environment cells, bacteria, viruses, and fungi live in a subtly balanced ecosystem. It is this complexity of factors, both systemic and local, that offer the healing particularities and challenges of the oral cavity.

The modifications that occur during chemotherapy can affect the patient systemically and orally with various degrees of severity. Some cases can become so severe that they can lead to the discontinuation of the recommended chemotherapy treatment, risking a less then optimal result of success, can decrease the level of quality of life and may even place the patient’s life at risk. Establishing a detailed and complete plan of oral treatment and care for the oncology patient that is to commence chemotherapy is essential for the minimization of chemotherapy-related side effects that may develop starting from the first administration of anti-tumor treatment. The aim of this study was to evaluate the protocols and conduits of oral and periodontal treatment for the oncology patient before starting chemotherapy.

Aim of the study This review focuses on Computer-Controlled Local Anaesthetic Delivery systems (CCLAD) versus conventional carpule anaesthesia in its efficiency to reduce pain and anxiety. Material and methods For this purpose, we have searched for relevant studies in Science Direct, Thomson ISI – Web of Science, Scopus, PubMed, Google Scholar covering the period up to December 2018. We have included only the studies investigating oral surgery maneuvers that compared clinically CCLAD to conventional techniques. The authors looked mainly for data on pain, anxiety and effectiveness related to anaesthesia. Results The review provides a critical overview of 6 studies (n=325 subjects). Conclusions The review enabled the authors to draw the conclusion that CCLAD results in significantly lower level of pain perception compared to conventional injections, and it is a promising device for helping patients deal with pain perception. The literature needs to be expanded, mostly regarding anxiety and efficiency in oral surgery.

Concrescence is a dental anomaly of morphology in which two teeth are fused together at the cementum level. We report an exceptionaly rare case of an impacted mandibulary third molar in concrescence with a supernumerary tooth in a 31-year-old male. The panoramic radiograph showed a radiopaque and tooth-like mass located in the posterior region of the third quadrant. After the surgery it was revealed that the tooth-like structure was a union of the impacted mandibulary third molar with a supernumerary fourth molar, creating a dental concrescence. To our knowledge, only two more cases of inversely fusion of a maxillary third molar with a supernumerary tooth have been reported.

Migratory stomatitis is a rare recurring condition of unknown etiology that mainly involves lingual mucosa, with a typical appearance of geographic tongue. Factors such as heredity, nutritional deficiencies or stress may be the contributing factors to the appearance of lesions. Clinically, they appear as circular, multiple, erythematous lesions with red spots surrounded by a white, narrow, hyperkeratotic aspect with irregular, slightly elevated appearance modifying its form in 24 hours.The condition may have spectacular clinical signs when the lesions are localised on the tongue, and may involve other areas of oral mucosa, such as labial or floor of mouth mucosa. The aim of this study is to present a clinical case of a patient with two localisations of lesions corresponding clinically to migratory stomatitis. The anatomopathological examination confirmed the migratory stomatitis diagnosis, so we could begin the specific treatment, to which the patient responded positively.

Maxillary incisors usually erupt in the early mixed dentition stage but eruption anomalies can arise and are frequently caused by local factors. A failure of eruption affects the developing occlusion and has the potential to influence the psychological development of the child. Furthermore, impaction of frontal teeth can result in esthetic, functional and phonetic problems in addition to causing root resorption and chronic or acute infections. As general guidelines of managing the delayed eruption or impaction of these teeth, it is recommended for the clinician to ensure the existence of enough space in the dental arch and remove any impediment in the path of eruption. In addition to this, the eruption should further be aided through surgical exposure, with or without subsequent orthodontic traction. In order to appoint the appropriate treatment plan, various factors – such as patient age, medical history, associated systemic diseases or conditions, compliance, etiology and position of the un-erupted tooth, can influence the decision-making process,. Thorough clinical appraisal associated to appropriate paraclinical investigation is a prerequisite, but also an interdisciplinary approach is advised, in order to enhance the treatment outcome.

The purpose of the study. This study proposes an analysis of local inflammatory status by evaluating Quigley Hein indices, papillary bleeding indices (PBI) and gingival Lõe and Silness indices, accompanied by a detailed assessment of systemic status (VSH, CRP) in patients with rheumatoid arthritis and synthetic and biological DMARDs therapy. Results and discussions. DMARDs determine the level of CRP and FR markers, the rate of erythrocyte sedimentation, and cartilage and bone damage. In the present study, serum levels of VSH and CRP recorded individual values higher than the maximum reference limit for 48.2% and respectively 46.3% of the patients, the mean level being significantly higher in the advanced stages of the disease. Measurement of oral markers revealed the the lowest average level of Quigley Hein score in patients treated with Sulfasalazine + Rituximab, while the highest values were recorded for Leflunomide + Etanercept therapy. The lowest average level for GI score was seen in patients treated with Methotrexate + Adalimumab and Leflunomide + Adalimumab, and the largest was found in patients treated with Leflunomide + Rituximab and Methotrexate + Rituximab. Regarding the treatment of RA, we could not establish a clear effect on oral health ratios of conventional and synthetic DMARDs combined therapy. However, it is important to note that, in contrast, in patients receiving biological DMARDs treatment, the average level of oral health indices was significantly lower. Thus, we can note the positive influence that this class of drugs, especially those that act on TNF-α, generates it on local status. Conclusions. To maintain oral health, patients with AR are encouraged to achieve proper oral hygiene. Consultation of the periodontist is necessary to determine the course of treatment.

The aim of this study was to compare the prevalence of oral lesions and conditions in young and elderly population. The authors analyzed a number of 1324 patiens, treated in our clinic, between 2011-2017, divided into 4 subgroups. Prevalence of one or several oral lesions was of 51,29% patients. We identified a wide range of oral heterogeneous lesions, the first place being held by burning mouth syndrome and chronic candidiasis in the elderly, and by aphtous stomatitis and acute candidiasis in the young. The results of our study may provide important information on the types and incidence of oral mucosal lesions in the northern region of Romania and seems to be similar to the level predicted for young and elderly patients in our country.

Gingival overgrowth is one of the most frequent side effect of immunosuppressive therapy with cyclosporine A in renal transplant patients. The exact pathogenesis of this pathology is uncertain but several influencing factors have been hypothesized such as age, gender, genetic predisposition, oral hygiene status, pharmacokinetic variables, immunological changes and concomitant use of other medications. Current treatment options for this pathology include conservative measures (plaque control, oral hygiene improvement, drug replacement) associated or not with surgical therapy. The oral specialist plays an integral role on the transplant team in establishing a clinical protocol that assists the organ transplant recipient in maintaining optimal oral health.

Epidermolysis bullosa is a group of genetically transmitted rare conditions characterized by tegumentary fragility, lesions on oral mucosa and dental caries. This autosomal disease includes three types of manifestations depending on the histopathological location of the lesions: simplex type-intraepidermic, jonctional – at the epidermis limit and distrophic – going beyond the structure of the dermis. Epidermolysis bullosa also includes the autosomal recessive subtype or Hallopeau-Siemens disease (RDEB-HS) characterized by severe oral mucosal lesions, such as blisters, ulcerations, scars, triggered by minor trauma (mastication of solid food). Oral cavity lesions vary in severity and frequency, ranging from small vesicles and up to eroding bullas, leaving large ulcerative areas in mucosa. The consequence is the appearance of sclero-atrophic scars in oral mucosa, resulting in a size reduction of the oral vestibule, ankyloglossy, microstomia, the occurrence of esophageal, pharyngeal or even malignant degeneration of residual lesions. In the dental tissues, the disease is manifested by the predisposition to the appearance of carious lesions, or enamel mineralization defects – imperfect amelogenesis. Material and method: This study analyzes, using clinical and histopathological criteria, the case of an 11-year-old patient diagnosed with Hallopeau-Siemens dystrophic epidermolysis bullosa. In this context, the authors investigated both tegumentary and oral cavity lesions. Results: The extraoral clinical examination reveals the presence of multiple vesicular-bullous lesions located all over the tegumentary surface, including the cephalic extremity, followed by the occurrence of synechiae scars, accompanied in the upper limbs by pseudo-syndactilia. Intraoral clinical examination reveals mucosal lesions with variable fluid contents located on the keratinized areas (the attached gum, the dorsal face of the tongue), as well as on the non-keratinized mucosa (jugal, floor of the mouth). The patient also has multiple coronary odontal lesions affecting both temporary and definitive dentition and poor oral hygiene. Conclusions: Understanding the lesion formation and manifestation mechanism, its evolution and method of healing is a priority in the treatment of patients with dystrophic epidermolysis bullosa, both for the dentist and the dento-alveolar surgeon. The tissue fragility of the oral mucosa, as well as the predisposition to the appearance of carious lesions and dental dystrophies require a specific approach to the patient in establishing the correct therapy management.

Lichen planus is a mucosal-cutaneous genodermatosis with a high involvement of oral mucosa. Oral lichenoid reactions are viewed as lichen planus-like lesions described in the literature in the field as pathological entities as such, or as forms of exacerbation of a pre-existent lichen planus. Drugs and dental materials are triggering factors for these lesions. If the diagnosis for lichen planus can be established based on a clinical examination or a clinical examination confirmed histopathologically, in case of lichenoid reactions, the diagnosis is difficult to establish due to their common features with lichen planus. This study is a retrospective review of histopathological features of lichen planus compared to oral lichenoid reactions conducted on patients from the Outpatient Unit within the Oral and Maxillofacial Clinic of „Sf. Spiridon” Emergency Clinical Hospital in Iasi. Although the histopathological and clinical features of idiopathic lichen planus and lichenoid reactions are quite similar, the study discovered a few features that differentiate them and also revealed the need for running additional examinations confirming the features of each condition.

The distomolars are supernumerary teeth that forms behind of maxillary and mandibular third molars. The etiology of this numerary anomaly has multiple theories but none of them is fully accepted. Most of the time, supernumerary teeth are associated with genetics syndromes like labio-palatal cleft, cleidocranial dysostosis, Gardner syndrome, but at healthy patients the prevalence is very low. This study presents three cases diagnosticated at Hospital “Sf. Spiridon” Iasi, Oral and MaxilloFacial department, with maxillary distomolars at patients without any associated syndromes. The anomaly did not had local complications, it was diagnosticated following paraclinic exams like panoramic radiographs and cone-beam computer tomography.

Even the minor surgery, anesthesia, by interrupting the normal course of life, bringing the patient into a state of dependence on the attending physician, the medical staff, the drugs, the preoccupation with the type of anesthesia, the duration and the course of the intervention, its success or complications, logically inspires a sense of fear. So, it is normal for the patient to be concerned about the method, technique and quality of anesthesia and surgery, the possibility of deficiency in the installation or the duration of anesthesia that could cause pain during the intervention or immediately afterwards. The problem of dento-alveolar surgery interventions in a dental practice ward presents multiple aspects and needs, in the context of increasing dental care both in private or state practice. Loco-regional anesthesia is the method by which chemical, physical or electric current are used to temporarily insensify the anatomical region on which it is intervening, while keeping the consciousness intact; in this kind of anesthesia only painful sensitivity is abolished, the thermal, tactile, and pressure sensitivities being retained, referred to by the American authors as “loco-regional analgesia”. In recent years new intraosseous anesthesia techniques have been developed and introduced on the market: the Stabident system; X-type; Quicksleeper; Intraflow; Hypo. With regard to injection methods of anesthetics, computerized electronic systems for the administration of anesthetics have appeared on the market. Intraoral application sites influence the time of installation and the duration of anesthesia after application of the local anesthetic.

The congenital absence of teeth represents one of the most common anomalies of the craniofacial skeleton and it was observed back in the Palaeolithic age. The anthropological studies showed that with human evolution and diet changes, jaw bones change their size (decrease) in the anteroposterior direction. Upper lateral incisors agenesis causes aesthetic disorders that may be treated by: orthodontic space closure through mesialization of the canines and their reshaping, orthodontic space opening and implant-retained prosthesis and autotransplant of extracted premolars.The aim of this study is to present a clinical case of bilateral upper lateral incisors agenesis and its multidisciplinary treatment.The multidisciplinary treatment approach includes these stages: orthodontic, surgical and prosthetic treatment. After a clinical examination and in conjunction with complementary examinations and a discussion with the patient’s parents, the following treatment stages were set: orthodontic space opening, prosthetic surgical treatment (bone grafting and resorbable collagen membrane), insertion of dental implants with fixed prosthesis on implants and orthodontic treatment with recalibration of spaces for occlusal balancing. In conclusion, treatment decisions of this anomaly should consider the final physiognomic aspect, age, sagittal occlusal relationships and finally the patient’s profile

Rampant caries is the most aggressive and rapidly progressing type of carious disease. The management of these patients represents one of the most challenging experiences in any dental office because of the gravity and high risk of recurrence. The early diagnosis of this condition and identification of the risk factors allows the control of the disease and avoid repetitive, inefficient and aggressive operative procedures. Besides the traditional preventive methods, the effort of the dental team should focus on making the patient aware of the individual risk factors, and change his behavior and attitude towards systemic and oral health. This is a presentation of the case of a young patient with rampant caries, which illustrates the complexity of the pathology and the multitude factors involved in the etiology of the disease

Severe prognosis of oral cancer lies in the absence of manifest clinical symptoms at onset of this pathology. Early signs of malignant oral lesions are not easy to discover. Therefore, chances for cure of these patients are greatly diminished also by the late intervention of the specialist doctor. On the other hand, the preventive oncological examination aims to identify any clinical and histopathological modifications of the oral mucosa raising suspicion, especially of the lesions localized in high risk areas for the appearance of malignant lesions. In this context, the epithelial dysplasia is seen as the most important indicator for malignant transformation of oral mucosa. The study aims is to assess the efficiency of the complementary examination using the device ViziLite Plus. It is an additional method used in standard examination with incandescent light. The method based on the principle of chemiluminescence is a non-invasive procedure able to underline the asymptomatic dysplastic lesions in oral cavity. Even if it is not a screening and a perfect diagnosis technology, this device has an accuracy of 100% in discovering any pathological oral lesion. The method is easy to use and many studies showed that it is the best procedure in discovering suspicious oral lesions (with the improvement of visualization of over 60%). Considering all described advantages, ViziLite Plus remains today the most predictive complementary test in the diagnosis of high risk oral lesions

Oral candidiasis is the most frequent lesion encountered in HIV infected patients and is detected before any other clinic symptoms of oral pathology. Its growth is a complex process of changes in the oral cavity, and sometimes disorders involving the entire body. Its risk is increased by serious factors as follows: autoimmune deficiencies (illness of the primary cells which acts as modulators of the immune response), xerostomia, malignant neoplasm, different therapies (chemotherapy, antibiotic therapy, therapy with steroids) or iron deficiency anaemia.

Wounds remaining after dental extraction are not large in extent, not tension high and important sacrifices of tissues and however they may be accompanied with various pathological events with a rapid onset – a few hours after surgery, clinical manifestations being dominated by local phenomena. Oedema, pain, infection, hematoma, bruising and lockjaw are most frequently encountered. Their high incidence would recommend them as a major participant in the panel deviated from the normal of postoperative course, requiring the establishment of a therapeutic arsenal to reduce complex clinical phenomena. Paradoxically, however, with one located at the opposite effect, at least, after extraction alveolar alveolitis is one that should attract the attention of prevention measures across practitioner. If unfortunately this has occurred, it needs a complex therapy – surgery and drug-consuming time and money with a slow evolution (healing may take up to 30 days of treatment and monitoring) and a negative impact on patient comfort after dental extraction.

Burning mouth syndrome has never been associated with a specific medical conditions, although associations were reported with a wide variety of health and chronic pain conditions. The painful mouth syndrome revealed the lack of specific criteria for diagnosis. Stomatodynia is characterized by the existence or coexistence of local, general and psychological etiologic factors. Local factors, the most frequently involved was candidiasis, incorrectly adjusted dentures, contact allergies and oral parafunctions. Among the general factors that recordered a higher frequency, we mention : menopause, diabetes, previous medications and iron deficiency anemia. Regarding the psychological factors, there were identified: stress, anxiety, depression, mental lability and mental disorders.

Oral candidiasis is the most frequent lesion encountered in HIV infected patients and is detected before any other clinic symptoms of oral pathology. Its growth is a complex process of changes in the oral cavity, and sometimes disorders involving the entire body. Its risk is increased by serious factors as follows: autoimmune deficiencies (illness of the primary cells which acts as modulators of the immune response), xerostomia, malignant neoplasm, different therapies (chemotherapy, antibiotic therapy, therapy with steroids) or iron deficiency anaemia.