A tissue-engineered model of T-cell mediated oral mucosal inflammatory disease.

T-cell-mediated oral mucocutaneous inflammatory conditions including oral lichen planus (OLP) are common but development of new treatments aimed at relieving symptoms and controlling OLP progression are hampered by the lack of experimental models. Here, we developed a tissue-engineered oral mucosal equivalent (OME) containing polarised T-cells to replicate OLP pathogenesis. Peripheral blood CD4+ and CD8+ T-cells were isolated, activated and polarised into Th1 and cytotoxic T-cells (Tc). OME were constructed by culturing oral keratinocytes on an oral fibroblast-populated hydrogel to produce a stratified squamous epithelium. OME stimulated with IFN-γ and TNF-α or medium from Th1 cells caused increased secretion of inflammatory cytokines/chemokines. A model of T-cell-mediated inflammatory disease was developed by combining OME on top of a Th1/Tc-containing hydrogel, followed by epithelial stimulation with IFN-γ/TNF-α. T-cell recruitment towards the epithelium was associated with increased secretion of T-cell chemoattractants CCL5, CXCL9 and CXCL10. Histological assessment showed tissue damage associated with cleaved-caspase-3 and altered laminin-5 expression. Treatment with inhibitors directed against JAK, KCa3.1 channels or clobetasol in solution and/or via a mucoadhesive patch prevented cytokine/chemokine release and tissue damage. This disease model has potential to probe for mechanisms of pathogenesis or as a test platform for novel therapeutics or treatment modalities.

Involvement of the Oral Mucosa by Ingestion of Caustic Substances due to a Suicide Attempt and Its Treatment with the Use of Photobiomodulation: Report of Two Cases.

Suicide is a major public health challenge worldwide, affecting both classes, sex and ages. The WHO estimates that 700,000 people die from this condition worldwide. With the onset of the pandemic, they believe that these numbers have increased, affecting mainly the most vulnerable. The ingestion of caustic substances is one of the most used means in suicides with significant damage to the oral cavity and gastrointestinal tract, in which the dental surgeon is the professional who must provide care for the treatment and oral rehabilitation in these cases. Thus, due to the scarcity of studies, we aim to report two cases of attempted self-extermination with the ingestion of caustic substances that caused great damage to the oral cavity and the care carried out in the intensive care unit, using oral care protocols associated with photobiomodulation with expressive results. We carried out the treatment in the intensive care unit with photobiomodulation, using low-power laser therapy, obtaining significant responses with an average time of four sessions of application of the protocol. We believe that because these are cases of high complexity and high mortality and morbidity rates, the presence of well-defined and applied protocols provides benefits to these patients.

Controlled dual drug release from adhesive electrospun patches for prevention and treatment of alveolar osteitis.

Approximately one in five individuals experience alveolar osteitis (AO) following wisdom tooth extraction. AO is characterised by loss of the blood clot from the tooth extraction socket leading to infection and pain, resulting in repeated hospital visits that impose a substantial burden on healthcare systems. Current treatments are sub-optimal; to address this we developed a novel drug-loaded mucoadhesive patch composed of dual electrospun polyvinyl pyrrolidone/Eudragit RS100 (PVP/RS100) and poly(N-isopropylacrylamide) (PNIPAM) fibres protected by a poly(ε-caprolactone) (PCL) backing layer. These patches demonstrated controlled release of the long-acting analgesic bupivacaine HCl and the anti-inflammatory drug prednisolone. Topical application of patches to tissue-engineered gingival mucosa showed that patch-released bupivacaine and prednisolone achieved sustained tissue permeation with 54.8 ±â€¯3.3 % bupivacaine HCl and 65.8 ±â€¯5.1 % prednisolone permeating the epithelium after 24 h. The drugs retained their functionality after release; bupivacaine HCl significantly (p < 0.05) inhibited veratridine-induced intracellular calcium flux in SH-SY5Y neuronal cells, while prednisolone significantly reduced gene expression of IL-6 (2-fold; p < 0.001), CXCL8 (5.1-fold; p < 0.01) and TNF-α (1.5-fold; p < 0.001) in stimulated THP-1 monocytes. Taken together, these data show that dual electrospun patches have the potential to provide a mucoadhesive covering to prevent blood clot loss while delivering pain relief and anti-inflammatory therapeutics at tooth extraction sites to prevent and treat AO. This study not only offers a future therapeutic pathway for AO but also contributes valuable insights into future advancements in drug delivery devices for periodontal or oral mucosal tissue.

Correlation of the treatment sensitivity of patient-derived organoids with treatment outcomes in patients with head and neck cancer (SOTO): protocol for a prospective observational study.

INTRODUCTION: Organoids have been successfully used in several areas of cancer research and large living biobanks of patient-derived organoids (PDOs) have been developed from various malignancies. The characteristics of the original tumour tissue such as mutation signatures, phenotype and genetic diversity are well preserved in organoids, thus showing promising results for the use of this model in translational research. In this study, we aim to assess whether we can generate PDOs from head and neck squamous cell carcinoma (HNSCC) samples and whether PDOs can be used to predict treatment sensitivity in HNSCC patients as well as to explore potential biomarkers. METHODS AND ANALYSIS: This is a prospective observational study at a single centre (Guy's and St Thomas' NHS Foundation Trust) to generate PDOs from patients' samples to assess treatment response and to correlate with patients' treatment outcomes. Patients will be included if they are diagnosed with HNSCC undergoing curative treatment (primary surgery or radiotherapy) or presenting with recurrent or metastatic cancers and they will be categorised into three groups (cohort 1: primary surgery, cohort 2: primary radiotherapy and cohort 3: recurrent/metastatic disease). Research tumour samples will be collected and processed into PDOs and chemosensitivity/radiosensitivity will be assessed using established methods. Moreover, blood and other biological samples (eg, saliva) will be collected at different time intervals during treatment and will be processed in the laboratory for plasma and peripheral blood mononuclear cell (PBMC) isolation. Plasma and saliva will be used for circulating tumour DNA analysis and PBMC will be stored for assessment of the peripheral immune characteristics of the patients as well as to perform co-culture experiments with PDOs. SOTO study (correlation of the treatment Sensitivity of patient-derived Organoids with Treatment Outcomes in patients with head and neck cancer) uses the collaboration of several specialties in head and neck cancer and has the potential to explore multiple areas of research with the aim of offering a valid and effective approach to personalised medicine for cancer patients. ETHICS AND DISSEMINATION: This study was approved by North West-Greater Manchester South Research Ethics Committee (REC Ref: 22/NW/0023) on 21 March 2022. An informed consent will be obtained from all participants prior to inclusion in the study. Results will be disseminated via peer-reviewed publications and presentations at international conferences. TRIAL REGISTRATION NUMBER: NCT05400239.

Botulinum toxin for the management of bruxism: an overview of reviews protocol.

INTRODUCTION: Bruxism is characterised by a repetitive activity in the masticatory muscles that involves teeth clenching or grinding and/or forceful mandibular movements. Its management is typically initiated when individuals start experiencing the adverse effects of the condition. One of the available intervention forms is the administration of botulinum toxin type A (BoNT-A). Numerous systematic reviews have addressed the use of BoNT-A to manage bruxism; however, the results are controversial. The current overview aims to determine BoNT-A's effectiveness for managing bruxism in relation to placebo, the absence of treatment or alternative interventions in the adult population. METHODS AND ANALYSIS: This study will include systematic reviews (SRs), with or without meta-analysis, aiming to evaluate the efficacy of BoNT-A for bruxism in adults. A broad literature search will be carried out on Cochrane Library, EMBASE, LILACS, Livivo, PubMed/MEDLINE, Scopus, Web of Science and the grey literature. Experts in the topic and reference lists of included SRs will also be consulted. The study selection will be conducted in two phases by two independent reviewers. Data collection will be performed by one author and cross-checked by another. The methodological quality of included SRs will be evaluated using AMSTAR-II. A narrative synthesis will be employed as the formal method to combine individual study data. The overlap across studies will be quantified by the corrected covered area and illustrated by the Graphical Representation of Overlap for Overviews. ETHICS AND DISSEMINATION: This overview does not require ethics approval, as it uses secondary data from previously published studies. The results will be disseminated through the publication in a high-impact journal. OSF OF REGISTRATION: DOI: 10.17605/OSF.IO/RB45T.

Myofibroma with Atypical Features can Mimic Low-Grade Myofibroblastic Sarcoma: Two Paediatric Cases.

Myofibroma is a rare benign mesenchymal tumor that frequently affects the pediatric population with a predilection for the head and neck region. About 10% of myofibroma cases, presenting atypical features, can be misinterpreted as low-grade myofibroblastic sarcoma (LGMS), with therapeutic and prognostic impact. Here, we report two pediatric cases of benign myofibroblastic tumors, one of them showing typical characteristics of myofibroma, the other was an atypical myofibroma, which initially mimicked low-grade myofibroblastic sarcoma. Atypical myofibromas, despite its distinctive characteristics, follow a benign course, similar with typical myofibroma. It is necessary to distinguish atypical myofibroma from low-grade myofibroblastic sarcoma and avoid unnecessary invasive therapy.

Comparative Analysis of Heavy Metal Content in Impacted Third Molars from Industrial and Non-Industrial Areas and Its Effect on the Isolation, Culture, and Proliferation of Dental Stem Cells (DSCs).

Background: This study investigates the impact of environmental pollution on the quality and viability of dental stem cells (DSCs) from impacted third molars. By comparing DSCs from patients in industrial areas with high air pollution and those from non-industrial regions, the research assesses the adverse effects of heavy metals on stem cell proliferation. Methods: Impacted lower third molars were collected from 28 patients-10 from industrial and 18 from non-industrial areas. Patients were divided into two age groups: 18-27 years and 28-38 years old. Dental pulp was extracted under sterile conditions, and DSCs were isolated and cultured. Heavy metal concentrations in dental tissues were measured using atomic absorption/emission spectrometry. Results: The study found significantly higher concentrations of copper and lead in the dental tissues of patients in industrial areas. Cell viability was lower in samples from these areas, with a statistically significant difference in average doubling time and the number of cells obtained after the first passage. There was no significant impact of gender on heavy metal content, except for higher iron levels in men. Conclusions: Exposure to industrial pollutants negatively affects the viability and proliferation of DSCs, but there are no differences in differentiation in the osteogenic medium regarding cell mineralization. These studies highlight the importance of environmental factors for oral health, suggesting that residents of polluted areas may face greater difficulties in dental and regenerative treatments. Further research is needed to develop strategies to mitigate the effects and improve clinical outcomes for affected populations.

Children and adolescents assisted in a referral oral medicine diagnostic service: 20 years of experience in Brazil.

BACKGROUND: Several lesions can affect the oral and maxillofacial region, with trends influenced by lifestyle and age. AIM: To investigate the occurrence of oral and maxillofacial lesions in paediatric patients assisted in an oral medicine diagnostic service in Brazil over 20 years. DESIGN: A retrospective cross-sectional study was performed in an oral medicine diagnostic service (1999-2019). Data included sex, age, anatomic site, and diagnosis from clinical records of children (0-9 years) and adolescents (10-19 years). Lesions were diagnosed through clinical examination. Biopsy and histopathologic examination were performed when necessary. RESULTS: Among 10 530 records, 702 (6.67%) were from patients aged 0-19 years diagnosed with oral or maxillofacial lesions. A high frequency of females was observed (58.1%). Reactive/inflammatory lesions were the most common group of lesions (45.2%), followed by abnormalities of teeth/developmental defects (17.8%) and pulpal and periapical diseases (8.5%). Mucocele/ranula was the most common lesion in children (29.3%) and adolescents (25.3%). Lips were the most affected anatomic sites. CONCLUSION: Most lesions were benign, and mucocele/ranula was the most frequent. Our results did not differ from those of histopathological-based studies, but they provided information on the occurrence of oral and maxillofacial lesions to dentists and paediatricians.

Cavernous haemangioma of the masseter muscle: transoral approach.

Intramuscular haemangiomas (IH) are rare lesions, accounting for less than 1% of all haemangiomas. This article presents the case of a woman in her 40s with a swelling in her left cheek. CT revealed an intramuscular lesion within the masseter, suggestive of a venous malformation. Surgical treatment was carried out with intraoral access to the lesion, allowing for complete removal, resulting in temporary swelling and trismus. There was no facial paralysis. We discuss information on IH in the head and neck and their surgical approaches.

Importance of 3D imaging in the evaluation of root formation following regenerative endodontic procedures: a case series.

The follow-up of teeth that have undergone regenerative endodontic procedures through radiographic imaging is crucial for evaluating their success and determining their future prognosis. The periapical radiographs stand out as the primary tool for this task and are also recommended by the existing guidelines. However, two-dimensional (2D) imaging may not reveal the findings accurately, mimicking the root formation success which may not be true otherwise when assessed using cone beam CT (CBCT) imaging. This case series featuring two instances underscores the significance of CBCT in identifying such signs of failure, particularly when they might be obscured in 2D imaging.

Giant peripheral ossifying fibroma of gingiva: a diagnostic workup.

Reactive lesions of the oral cavity are non-neoplastic proliferations occurring due to chronic irritation. Peripheral ossifying fibroma (POF) is a reactive lesion usually occurring on the interdental papilla. POF is predominantly found in the second decade of life with a definitive female predilection. This is a case report of a middle-aged male patient with gingival overgrowth in left lower back tooth region. Clinically, the lesion was asymptomatic, firm, pale pink and sessile but unusually large in size. Surgical excision of the lesion was done followed by histopathological confirmation with emphasis on the diagnosis. The case in question is interesting because of its large size and location.

Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study.

INTRODUCTION: The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are at a higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individual's experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. METHODS AND ANALYSIS: We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12-18 FGDs with 5-8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, interpersonal and structural health equity factors that serve as barriers or facilitators to oral health status and care; (2) to explore knowledge and perceptions about causes, risk factors, prevention and screening for oral or OPC and (3) to elicit recommendations for improving access to regular and appropriate oral healthcare and suggestions on engaging PLWH from diverse identity groups in prevention interventions. ETHICS AND DISSEMINATION: All methods and procedures were approved by the University of California, San Francisco, Institutional Review Board (approval number: 23-39307) and are in accordance with the Declaration of Helsinki of 1975, as revised in 2000. Participants are required to provide informed consent. The results of this study will be presented at scholarly meetings and published in peer-reviewed journals. In addition, a lay summary of results will be created and distributed to our participants and community through our website and social media. TRIAL REGISTRATION NUMBER: NCT06055868.

Simple Bone Cyst Within Florid Cemento-Osseous Dysplasia: A Report of Two Cases.

Florid cemento-osseous dysplasia (FCOD) can rarely be associated with bone lesions, including simple bone cysts (SBCs). Only a few cases showing the co-occurrence of these two distinct entities have been reported in the literature. This article reports two new cases of SBCs within FCOD. The first case involves a 37-year-old Black female with a large radiolucent lesion around the apex of the right third mandibular molar, accompanied by multiple cemento-osseous lesions around the mandibular teeth. Surgical exploration revealed an empty bone cavity, confirming the diagnosis of an SBC. Curettage of the bone walls was performed to stimulate healing, with promising results observed at the nine-month follow-up. The second case concerns a 44-year-old Black female presenting with a radiolucent lesion at the site of extraction of the left third mandibular molar and a slightly painful radiolucent/radio-opaque lesion in the apical region of the right first mandibular molar. Surgical exploration confirmed an SBC in the region of the left third mandibular molar and a bone biopsy was made. Histopathological analysis confirmed FCOD. Curettage of the bone wall was again used to promote healing through increased bleeding. At the 30-month follow-up, new dysplastic lesions had appeared, the initial SBC had healed completely, and a new SBC seemed to have developed in the apical region of the left second mandibular premolar. These cases highlight the importance of considering SBCs in the differential diagnosis of well-defined radiolucent lesions and demonstrate that surgical intervention for SBC-associated FCOD can yield favorable outcomes. From these cases, we learn the critical need for accurate diagnosis to avoid unnecessary treatments and the value of regular follow-up to monitor for recurrence or new lesions.

Horizontal Platelet-Rich Fibrin in Vestibuloplasty: A Case Report.

Vestibuloplasty (VP) is a surgical technique that allows the deepening of the vestibule of the mouth. The gold standard, especially if an increase in keratinized tissue (KT) is required, is represented by the free gingival graft (FGG). The need for a donor site, however, is a source of discomfort and possible complications. To overcome these aspects, numerous techniques and materials have been used. Horizontal platelet-rich fibrin (H-PRF) has been very successful in recent years in various oral surgery procedures due to its ability to promote tissue healing and regeneration. The reported case presents a new technique of VP using H-PRF, which allows avoiding the second surgical site. A 25-year-old patient with post-surgical reduction of vestibule depth and poor KT was treated with VP. The patient refused an FGG procedure. Therefore, VP was performed using an H-PRF membrane as a graft material to lengthen the vestibule and promote KT regeneration. After nine weeks, an increase in vestibule depth and KT width was evident. The use of H-PRF in VP has allowed predictable surgery without significant complications. It therefore represents an alternative to the traditional FGG to be seriously taken into consideration.

A case of obstructive chronic bacterial sialadenitis of submandibular salivary gland.

A young man in his early 20s presented with extraoral swelling on left side of his face, which had been present for a period of 1 month. Intraoral examination revealed an erythematous swelling on the left side of floor of the mouth at the ductal opening of left submandibular salivary gland. On palpation, multiple firm masses were noted, and pus mixed with blood was discharged from the ductal opening. He reported a history of swelling occurring in the same region, which was associated with mild fever and subsided after taking antibiotics. Keeping the history in mind, multiple radiographical investigations were carried out, focusing on the submandibular salivary gland. These investigations revealed the presence of salivary calculi, also known as salivary stones or sialolith, in the ductal pathway, causing obstruction to the glandular parenchyma. Hence, a final diagnosis of obstructive chronic bacterial sialadenitis was made. The case was treated surgically due to the size of the salivary stones, in combination with a preoperative antibiotic course. Multiple stones were retrieved and the incision was sutured. Complete healing was noted in a span of 2 weeks. This case report highlights the effectiveness of conventional imaging modalities in early diagnosis compared with advanced imaging techniques. By using conventional imaging, the case was managed with a simple surgical procedure rather than the more invasive option of removing the entire gland, thereby preserving the patient's quality of life. This case report underscores the importance of clinical examination and selecting appropriate investigative tools for early diagnosis, supported by a comprehensive literature review.

Gingivitis espongiótica. Manejo clínico no quirúrgico. Reporte de un caso / Spongiotic gingivitis. Non-surgical clinical management. Report of a case

Objetivo: La gingivitis espongiótica es una patología benigna poco común y una entidad clínica patológica poco frecuente que los odontólogos pueden observar durante la atención odontológica. Es importante conocer la misma para poder diagnosticarla adecuadamente, describir sus características clínicas y elaborar un plan para su tratamiento. El objetivo de este artículo es presentar un caso clínico de esta patología poco conocida, describir sus características y su manejo clínico. Caso clínico: Un niño de 7 años que ingresó derivado por su odontólogo a la cátedra de Estomatología de la Facultad de Odontología de la Universidad Nacional de Córdoba, Argentina, presentaba en la encía libre e insertada del maxilar superior una lesión con ausencia de sintomatología y evolución crónica, benigna y con cambios estéticos notorios. Se deriva a la cátedra de Periodoncia para realizar un tratamiento interdisciplinario. Tuvo una respuesta favorable al tratamiento de la lesión, y se realizó un seguimiento periódico de la misma evitando la técnica quirúrgica convencional para su tratamiento.(AU)

Aim: Spongiotic gingivitis is a rare benign pathology and a rare clinical pathological entity that dentists can observe during dental care. It is important to know it to be able to properly diagnose it, describe its clinical characteristics and develop a plan for its treatment. The aim of this article is to present a clinical case of this little-known pathology and describe its characteristics as well as its clinical management. Clinical case: A 7-yeard-old child who was referred by his dentist to the Department of Stomatology of the Faculty of Dentistry of the National University of Córdoba, Argentina, presented a lesion in the free and inserted gingiva of the upper jaw, with absence of symptoms and chronic, benign evolution with notable aesthetic changes. He is referred to the Periodontics department to perform interdisciplinary treatment. He had a favorable response to the treatment of the lesion, and a periodic follow-up was carried out, avoiding the conventional surgical technique for its treatment.(AU)

Factors Impacting Quality of Life in a Group of Iranian Patients in Chronic Oral Mucosal Disease Following Treatment?

OBJECTIVE: The objective of this study was to investigate the impact of treatment on the quality of life of patients with chronic oral mucosal diseases. Specifically, the study aimed to determine how treatment affects the changes in the quality of life of these patients. METHODS: This descriptive study involved 220 patients diagnosed with chronic oral mucosal lesions. Data were collected using the Chronic Oral Mucosal Disease Questionnaire, validated for use in Persian/Farsi. The study population was selected through convenience sampling. Data analysis employed descriptive statistical methods, including frequency and percentage distribution tables, graphs, measures of central tendency, and dispersion. Additionally, confidence intervals were utilized for the studied ratios and indices. RESULTS: Among the study population, 129 (58.6%) were male and 91 (41.4%) were female. The mean quality of life, as assessed by the utilized questionnaire, was 61.9 ± 13.2. The results indicated that females and unemployed individuals reported lower quality of life compared to males and employed individuals, respectively, with a statistically significant difference (p < 0.05). CONCLUSION: In the population studied the quality of life of patients with chronic mucous membrane diseases was influenced by various factors, including gender, income, employment, and place of residence.