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This document is a letter to the editor discussing a study conducted in Moscow, Russia, between September 2020 and December 2022. The study investigated the association between COVID-19 infection or vaccination and the development of pemphigus vulgaris (PV) and pemphigus foliaceus (PF). The study found that COVID-19-related antigenic challenges were associated with the development of PV and PF, suggesting a possible causal relationship. However, the authors note that this is the first observational study on the topic and further research is needed to confirm these findings. [Extracted from the article]

Purpose: The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.Methods: A class IIb medical preparation, packaged in appropriate syringes, was tested. Patients were instructed how to use the gel for 10 days: finger rub application (3 times daily) on the dried lesion after meals, without eating, drinking, or speaking for at least 30 min thereafter. The Wilcoxon signed-rank test was used to assess whether there were any differences in the distributions of reported pain and lesion dimension. A microbiological examination was also performed with oral swabs; chi-squared test was used to compare the difference in the presence of microorganisms before and after treatment.Results: Thirty patients were treated. A significant improvement in reported outcome and a significant reduction in the initially measured largest dimension of the lesion were observed after use of the clinical protocol. Additionally, a significant reduction in the pathogen count was found.Conclusion: Even if with limitations, data showed that this medical preparation facilitated prompt recovery from reported pain, without adverse reactions. Further work with a larger study population, and possibly a randomized control medication, will be needed. [ABSTRACT FROM AUTHOR]

A systematic review was carried out to identify if periprocedural administration of systemic antibiotics could decrease risk of medication-related osteonecrosis of the jaws (MRONJ) in patients under antiresorptive and/or biologic agents for teeth extraction. PubMed/MEDLINE and Scopus were systematically searched for case-series with more than 10 patients, retrospective/prospective studies, and trials concerning this issue. Manual searching of references from previous reviews was also carried out. Of 1,512 results, 17 studies were included, focusing on antibiotics for extraction in patients under intravenous bisphosphonates (8 studies), oral bisphosphonates (2 studies), oral and intravenous bisphosphonates (6 studies), and denosumab (1 study), of which 12 performed dental extraction with surgical flap. With no trials found, "quality in prognosis studies" (QUIPS) tool was used to evaluate risk of bias. First-line treatment was 2-3 grams of oral amoxicillin in 76.4% of studies; 300-600 mg of clindamycin was the alternative treatment in 23.5% of studies. Treatment ranged from 3 to 20 days, consisting of 6-7 days in 47% of studies. No microbiologic insight was provided. A significantly higher risk of MRONJ for patients unexposed to antibiotics was provided in one retrospective study. QUIPS tool revealed moderate-high risk of bias. With empirical data from bias-carrying, heterogeneous observational studies, the validity of antibiotics is yet to be established. [ABSTRACT FROM AUTHOR]

Oral biopsy is a common surgical practice. To date, few authors have described the healing of mucosal wounds following oral biopsy. The aim of the present single-center, prospective, randomized, controlled study is to evaluate the differences between two chlorhexidine (CHX) mouthrinses and a treatment-free approach in the immediate postoperative period following oral mucosal biopsy. 354 patients were included in this study and were randomly allocated to three groups: A) CHX 0.12% mouthrinse (twice daily, 10 mL rinse for 30 s), B) CHX 0.20% mouthrinse (twice daily, 10 mL rinse for 30 s), and C) no topical treatment. 118 patients were treated in group A and 115 in group B; 121 received no therapy in group C, reporting the greatest improvement in related symptoms. Outcome variables included the age, gender, site and size of lesions, visual analog score (VAS), Oral Health Impact Profile questionnaire (OHIP-14), and number of painkillers taken during the first week post-surgery. Use of a CHX 0.12% mouthrinse exhibited the poorest outcome. On the other hand, best clinical healing was found for patients treated with CHX 0.20%. These findings suggest that regardless of its concentration, CHX was found to be ineffective in reducing related symptoms, whereas CHX 0.20% can be recommended to facilitate enhanced healing. [ABSTRACT FROM AUTHOR]

Objective: To perform a randomized, placebo‐controlled, double‐blind study, with a follow‐up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP). Subjects and Methods: Thirty‐two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow‐up. Results: Symptoms improved in all clobetasol‐treated patients during the first 2 months of therapy, while only 50% of placebo control group (p = .005) displayed similar results; of the remaining half, 12.5% did experienced a worsening while 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol‐treated patients improved, while only 62.5% of the placebo‐treated patients had a positive response (p = .229). Conclusions: It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic‐erosive oral lesions. [ABSTRACT FROM AUTHOR]

Background: Presence of epithelial desquamation, erythema, and erosions on gingival tissue is usually described in the literature as desquamative gingivitis (DG). A wide range of autoimmune/dermatologic disorders can manifest as DG, although the two more common are oral lichen planus and mucous membrane pemphigoid. The aim of this study is to investigate prevalence of 11 periodontopathogenic microorganisms in patients with DG and to compare it with the microbiologic status of individuals affected by plaque-induced gingivitis (pGI).Methods: Cross-sectional clinical and microbiologic data were obtained from 66 patients (33 in each group). Subgingival plaque samples were analyzed using semiquantitative polymerase chain reaction analysis.Results: Statistically significant difference, but with little clinical significance, was observed in gingival conditions between the two groups, probably due to the worse home control hygiene of patients with DG. Prevalence and levels of Aggregatibacter actinomycetemcomitans, Eikenella corrodens, and Fusobacterium nucleatum/periodonticum were statistically higher in samples from patients with DG than in those with pGI. In multivariate regression models, subgingival colonization of A. actinomycetemcomitans and F. nucleatum/periodonticum was not statistically associated with DG, whereas, high levels of E. corrodens were associated with 13-fold increased odds for DG.Conclusions: Microbiologic differences were found in subgingival plaque for patients with DG and pGI. This may suggest possible association between periodontal pathogens and DG. [ABSTRACT FROM AUTHOR]

• Oral ulcers is a common clinical entity in oral medicine. • Trauma and oral cancer might cause oral breaching. • Optical coherence tomography was tested on traumatic and cancer lesions. • Differential patterns emerged both reciprocally, and against healthy counterparts. • Optical coherence tomography might define timing of biopsy of oral ulcers. Ulcers in the oral mucosa is a relatively common, although challenging, entity in oral medicine, as it can arise due to a wide range of traumatic, infective, autoimmune, and neoplastic disorders. Although histopathology of lesional and peri‑lesional tissues remains the gold standard for persistent oral breaching, optical coherence tomography (OCT) has been recently suggested as a potential ally to enhance the early or non-invasive diagnosis of likely causation. The aim of the present study was to provide an in-vivo OCT analysis and description from a sample of 70 patients affected by traumatic or neoplastic-related ulcers, located on the buccal mucosa, tongue or gingiva, and compare the OCT data with those of 20 patients with healthy oral mucosa. OCT dynamic scans revealed clear distinction of epithelial layer (EP), lamina propria (LP) of healthy buccal mucosa, gingiva, and tongue as well as allowing observation of the keratin layer in gingiva, and the subepithelial vascularization of each site. Traumatic lesions had an EP of reduced in thickness, with an irregular, if not disrupted surface. Interestingly, LP seemed to preserve its reflectiveness and vascularization only in the traumatic lesions. Among neoplastic lesions, regardless their site of onset, both EP integrity/homogeneity, and LP reflectiveness/vascularization were lost and unrecognizable when compared to their healthy counterparts. OCT scanning allowed some differentiation between traumatic and malignant ulcers and thus may a useful and non-invasive means of determining the need and/or urgency of histopathological examination of oral lesions. [ABSTRACT FROM AUTHOR]

Objectives Current recommendations for safe and effective dental management are less than optimal for some medical conditions because of limited evidence, conflicting conclusions, or both. This review (1) compiled and evaluated dental management recommendations for select medical conditions; (2) summarized recommendations and their assigned levels of evidence; (3) identified areas of conflict, ambiguity, or both; and (4) identified issues that warrant future research, enhanced consensus statements, or both. Study Design Systematic literature searches were performed for guideline publications, systematic and narrative reviews, and opinion documents containing recommendations for (1) medication-related osteonecrosis of the jaw (MRONJ); (2) cardiovascular diseases (CVDs); (3) prosthetic joints (PJs); and (4) systemic steroid therapy (SST). Results The search yielded the following numbers of publications that met the inclusion criteria: MRONJ – 116; CVDs – 54; prosthetic joints – 39; and systemic steroids – 12. Conclusions Very few of the compiled recommendations were assigned or linked to levels of evidence by their authors. Key conclusions include the following: MRONJ–expert recommendations trend toward proceeding with dental treatment with little to no modification in osteoporotic patients on bisphosphonates; CVDs–current recommendations are primarily directed to general surgery and applied to dentistry; PJs–routine antibiotic prophylaxis is not indicated for dental treatment; and SST–steroid supplementation is not indicated for most patients undergoing dental procedures under local anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extractions in patients with a history of intravenous use of a potent bisphosphonate by modifying a previously reported protocol to produce a significantly shortened operating time. Patients and Methods: Prospective patients with a follow-up of at least 4 months were included. Tooth extractions were performed without a vestibular split-thickness flap; healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection control was obtained with dental hygiene and antibiotic therapy. Results: Sixty-three patients participated in the study. Two hundred two tooth extractions were performed. Differences between the present and previous protocols (the previous protocol used a vestibular flap) were analyzed and the surgical time proved significantly shorter for the present approach (P = .00). Conclusions: The proposed surgical protocol appears to be a better choice for patients treated with intravenous bisphosphonates who need tooth extraction, because it seems to be faster and simpler than the previously reported successful protocol. [ABSTRACT FROM AUTHOR]

Background: Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG. Methods: All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain). Results: A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P= 0.003) and clinical gingival involvement (P= 0.003). Conclusion: Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG. [ABSTRACT FROM AUTHOR]

Purpose: More cases of osteonecrosis of the jaws in patients treated with intravenous bisphosphonates have been reported. The aim of this prospective hospital-based study was to detail a surgical protocol for teeth extraction in such patients. Patients and Methods: Prospective patients with a follow-up of at least 4 months were included. A surgical procedure using an ultrasonic surgical apparatus (Mectron Piezosurgery Device, Mectron Medical Technology, Carasco, Italy) was undertaken. Healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection controls were also obtained with antibiotic therapy. Results: Sixty-four patients took part in the study. Two hundred twenty teeth extractions were performed in a surgical setting. Bisphosphonate-related osteonecrosis of the jaw occurred in 5 postextraction sites (2.27%); no statistical differences could be reported regarding age, gender, duration of bisphosphonate treatment, concomitant corticosteroid therapy, mean surgical time, and patients'' underlying diseases. In contrast, the mandible appeared to be at greater risk than the maxilla to develop bisphosphonate-related osteonecrosis of the jaw (P = .0342). Conclusions: Even with many limitations, the proposed surgical protocol appears to be a possible choice for patients treated with intravenous bisphosphonates who need teeth extraction. Further prospective, possibly randomized studies are necessary to determine if this statement would be the same with larger patient samples in different clinical settings. [Copyright &y& Elsevier]

Objectives: The aim of this study was to evaluate the 2-year success rate of management of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ). Study design: A prospective study was performed. Positive outcome variables were the resolution of symptoms and the status of the mucosa. Results: A total of 37 patients are described. The precipitating event was a dental extraction in 22 cases (59.5%). Thirteen patients (35.1%) underwent surgery, and 24 (64.9%) underwent antimicrobial therapy alone. After 2 years, 20 patients (54.1%) presented with soft tissue closure over previously exposed bone, and there were no statistical differences in gender, age, bisphosphonate treatment, or treatment modalities. Spontaneous lesions seemed to have a worse prognosis (P = .001). Conclusions: Initial antimicrobial treatment, and later surgery for unresponsive patients, might be a feasible treatment modality for BRONJ. Because these results are not conclusive, it would be very interesting to know if this statement would be the same with a greater number of patients. [Copyright &y& Elsevier]