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Objective: To evaluate the in vivo antimicrobial activity of different forms of application of chlorhexidine digluconate (CHX). Method and Materials: A group of 10 volunteers performed mouth rinsings with a 0.2% and 0.12% solution of CHX and applied CHX in the form of a 0.2% gel, a 0.2% and a 0.12% spray and a swab impregnated with a 0.2% solution. Samples of saliva were taken at baseline; 30 seconds; and 1, 3, 5, and 7 hours after each application. An epifluorescence microscopy technique (BacLight Live/Dead stain) was used to evaluate bacterial vitality. Results: Bacterial vitality under basal conditions was 92%. At 30 seconds after CHX application, the lowest levels of viable bacteria were detected with the 0.2% and 0.12% solutions (1% and 8%, respectively). After 3 hours, the percentage of live bacteria achieved with the gel and sprays was similar to the basal figures (80% to 91%). At 7 hours, bacterial vitality recovered basal percentages, except with the 0.2% solution (77%). Conclusion: The 0.2% solution of CHX had the greatest sustained antimicrobial effect on the salivary flora, confirming the influence of the concentration and form of application on CHX substantivity. (Quintessence Int 2009;40:141-144). [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of a new toothbrush (Balene) for the mechanical removal of dental plaque in patients with acquired brain injury., Material and Methods: The study group consisted of 25 adults with acquired brain injury. The participants underwent 2 sessions of toothbrushing lasting 1 min, one with a conventional toothbrush and the other with the Balene toothbrush. This new double-headed toothbrush has 6 active sides, which allows for the simultaneous toothbrushing of both alveolar arches, with elastomer bristles angled at 45°, as well a handle that rotates up to 180°. Therefore, the user does not need to remove the toothbrush from the oral cavity during the toothbrushing process. Dental plaque accumulation was assessed using the simplified oral hygiene index of Greene and Vermillion., Results: The plaque index was significantly reduced both with the Balene toothbrush (p < 0.001) and with the conventional toothbrush (p < 0.001). The dental plaque removal efficacy was similar with the two toothbrushes. There were also no statistically significant differences in the removal of plaque with the Balene toothbrush between the autonomous and assisted toothbrushing modalities (p = 0.345)., Conclusions: For patients with acquired brain injury, the Balene toothbrush was as effective as a conventional toothbrush, regardless of whether the toothbrushing modality was autonomous or assisted., Clinical Relevance: The Balene® toothbrush's efficacy in removing dental plaque is similar to that of conventional toothbrushes, both with the autonomous and assisted toothbrushing modality. Given its particular ergonomics, this toothbrush could be indicated for certain select patients with acquired brain injury (i.e., those whose degree of cooperation allows for toothbrushing, with a sufficient mouth opening, with no substantial abnormalities in the intermaxillary relationship, and with no significant edentulous sections)., (© 2023. The Author(s).)

Objectives: The objective of this study was to determine bleeding control interventions (BCIs) that were reported to be effective in controlling postoperative bleeding in patients with inherited functional platelet disorders (IFPDs) undergoing invasive dental procedures., Study Design: We searched MEDLINE/PubMed, Embase, Cochrane Library (Wiley), and Scopus from 1960 through April 2020 for studies on patients with IFPD undergoing invasive dental procedures. Two reviewers conducted assessments independently., Results: We found a total of 620 nonduplicate published articles, of which 32 studies met our inclusion criteria. Management with BCI in patients with IFPD included in this systematic review was effective in 80.7% of treatment sessions. Local measures used intraoperatively were found to be effective. Three different protocols of BCI were noted; the most effective protocol consisted of antifibrinolytics, scaffold/matrix agents, and sutures (P < .01). An adjunct protocol consisting of a tissue sealant was also effective (P < .01). A third protocol of platelet transfusion and antifibrinolytics was ineffective in controlling postoperative bleeding in 4 of 6 dental sessions., Conclusions: This systematic review supports the use of local measures intraoperatively and antifibrinolytics postoperatively. It also supports making decision regarding platelet transfusion based on the clinician's clinical judgment and medical history of the individual patient., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy., Materials and Methods: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL., Results: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014)., Conclusions: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Pain may be the initial symptom in oral cancer, and is a common complaint both in patients awaiting treatment and in those already in treatment. However, little has been published in the literature on the management of oral cancer pain. Effective pain control requires a multimodal approach in which pharmacological management based on the World Health Organization (WHO) analgesic ladder continues to play an essential role. Although different routes are available for the administration of analgesics, oral delivery continues to be the principal route for pain control in the first instance. Interventional approaches include blockade of a peripheral nerve or of the relevant ganglion, and the use of central neuraxial blockade. The intraventricular or intrathecal administration of opioids, with or without local anaesthetics, has been indicated for severe intractable pain. The development of new treatment modalities provides additional options, though further clinical research is required. There is no evidence of the efficacy of non-pharmacological methods such as acupuncture or transcutaneous nerve stimulation in the management of oral cancer pain. Surgery, radiation therapy, and chemotherapy have also been suggested, but their results have not been quantified., (Copyright 2010 Elsevier Ltd. All rights reserved.)

The literature contains numerous observations on the significance of systemic disorders as contraindications to dental endosseous implant treatment, but the justification for these statements is often apparently allegorical. Although implants are increasingly used in healthy patients, their appropriateness in medically compromised patients is less equivocal. Perhaps surprisingly, the evidence of their efficacy in these groups of patients is quite sparse. Indeed, there are few if any randomized controlled trials (RCTs) in this field. Furthermore, any health risks from the placement of implants are unclear. We review the current evidence for the risks associated with endosseous implants in a range of systemic disorders. There is clearly a need for prospective systematic trials. The degree of disease-control may be far more important that the nature of the disorder itself, and individualized assessment, including the medical condition, quality of life and life expectancy is indicated. The benefits of implants to many of these patients may outweigh any risks. However, proper informed consent is mandatory.

The presence of HCV-RNA in saliva of patients with chronic hepatitis C provides a biological basis for the potential transmission of this virus. HCV viremia is particularly high in HCV-HIV-coinfected patients, which could favor the presence of HCV in their saliva. This study was designed to evaluate the prevalence of HCV in saliva of HCV-HIV-coinfected patients. Stimulated whole saliva was collected from 75 HCV-HIV-coinfected patients and 75 HCV controls. The presence of HCV-RNA in saliva was tested by a highly sensitive noncommercialized nested PCR, and analyzed in relation to demographic, clinical, and analytical variables. HCVRNA was detected in the saliva of 49 (65%) HCV-HIV-coinfected patients and 39 (52%) HCV controls. The presence of HCV in saliva was not related to any of the analyzed variables in HCV-HIV-coinfected patients. In the HCV control group a statistically significant relationship was demonstrated only between the detection of HCV-RNA in saliva and the viral load in peripheral blood (p < 0.001). Our results indicate that there is a trend toward a higher HCV-RNA prevalence in the saliva of HCV-HIV-coinfected patients.

Purpose: To determine Lactate Dehydrogenase Activity (LDHA) in whole saliva in individuals with periodontal disease and the effect of ultrasonic scaling on this enzyme activity., Methods: A study group of 50 patients with PD (Community Periodontal Index of Treatment Needs > or = 3) was selected at random. Half of the patients (n=25) received ultrasonic periodontal treatment (Group 1). In the other 25 patients with PD the ultrasonic scaling was not performed (Group 2). A control group was selected (Group 3) consisting of 25 adults without PD (Community Periodontal Index of Treatment Needs = 0), with age and gender distribution similar to the study group. LDHA determinations were carried out with a Cobas Mira Plus II autoanalyzer pursuant to the recommendations of the French Society of Clinical Biology. A baseline determination of LDHA was carried out on all the participants and a second determination was performed 3 months later., Results: Baseline determination of LDHA was higher in patients with PD than in the control group. These differences were statistically significant (P< 0.001). LDHA was significantly reduced in patients with PD after ultrasonic scaling with respect to baseline determination (P< 0.0001). LDHA differences between Groups 2 and 3 were statistically significant (P< 0.0001), but it was not so between Groups 1 and 3.

Background: Salivary gland disorders have been included among the extra-hepatic manifestations related to HCV infection., Methods: The whole stimulated salivary flow rate (spitting technique) was studied in 74 HCV infected patients to evaluate salivary gland dysfunction., Results: The salivary flow of the patients with chronic HCV infection was similar to that of the healthy controls. The association between subjective xerostomia salivary flow was seen to be very weak. No significant associations were found between salivary flow and age, sex, risk factor of acquired infection, ALT, AST, GGT, ALP values, time lapsed since the diagnosis or HCV-RNA detection in saliva., Conclusions: Although the functional repercussion of hepatitis C related lymphocytic sialoadenitis remains unclear, we did not find a significant reduction in the whole stimulated salivary flow in HCV infected patients.

An unusual case of synchronous squamous cell carcinoma and leiomyosarcoma of the oral cavity is reported in a patient without any identified environmental risk or predisposing factors. The invasive squamous cell carcinoma involved the tongue, whereas the leiomyosarcoma was located in the soft palate. No immunostaining was found for human papillomavirus or Epstein-Barr virus, and in situ hybridization showed negativity for human papillomavirus DNA within the tumor cells. Alterations of bcl -2, c-erb -b2 and Rb oncoproteins were not found immunohistochemically. Overexpression of p53 was detected by immunohistochemistry in both tumors, but p53 gene mutations were not found by polymerase chain reaction. Neither loss of heterozygosity of p53 nor microsatellite instability was detected in this patient. The smooth muscle nature of the leiomyosarcoma was confirmed by immunohistochemical methods. To our knowledge, synchronous smooth muscle and epithelial oral tumors have not previously been reported.

A prospective study to assess the efficacy of fluconazole in oropharyngeal candidiasis in patients with HIV was conducted. A cohort of 30 HIV-positive persons with clinical and microbiologic confirmed oropharyngeal candidiasis (Candida albicans > 1000 CFU/ml) received fluconazole 100 mg daily for 7 days. In vitro antifungal susceptibility tests demonstrated a lack of fluconazole resistances. Cultures of mouth swabs were performed at the end of therapy and 2 weeks later. There was a clinical and microbiologic cure in 26 patients (87%). In 10 of these 26, cultures remained negative after 2 weeks; most of them had CD4 lymphocyte count > 400/ml. In the other 16 patients (53%), cultures showed a microbiologic relapse 2 weeks after treatment. In spite of clinical improvement, treatment failure was observed in four patients, all of them with CD4 lymphocyte count < 50 ml.