Search

The introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life. We provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology. The discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies. [ABSTRACT FROM AUTHOR]

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

Simple Summary: Immunosuppression is a medical condition in which a person's immune system is unable to function properly, or it does not function at all. It is a well-known fact that an ill-functioning immune system can favor the generation and development of potentially malignant lesions, autoimmune and allergic diseases, and even neoplasms. At present, the amount of risk for the development of oral cancer in immunosuppressed patients has not been quantitatively reported. Such a topic has been investigated, revealing that immunosuppression increases the risk of developing cancer from 0.2% to 1% (95% CI: 0.2% to 1.4%), giving further importance to the accurate follow-up of this category of patients. Even if the relationship between immunosuppression and increased incidence of systemic cancers is well known, there is less awareness about the risk of developing oral cancer in immunosuppressed patients. The aim of this review was to evaluate the association between immunosuppression and the development of oral cancer. Two authors independently and, in duplicate, conducted a systematic literature review of international journals and electronic databases (MEDLINE via OVID, Scopus, and Web of Science) from their inception to 28 April 2023. The assessment of risk of bias and overall quality of evidence was performed using the Newcastle–Ottawa Scale and GRADE system. A total of 2843 articles was identified, of which 44 met the inclusion criteria and were included in either the qualitative or quantitative analysis. The methodological quality of the included studies was generally high or moderate. The quantitative analysis of the studies revealed that immunosuppression should be considered a risk factor for the development of oral cancer, with a percentage of increased risk ranging from 0.2% to 1% (95% CI: 0.2% to 1.4%). In conclusion, the results suggest that a constant and accurate follow-up should be reserved for all immunosuppressed patients as a crucial strategy to intercept lesions that have an increased potential to evolve into oral cancer. [ABSTRACT FROM AUTHOR]

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

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