Histopathological and microbiological findings associated with retrograde peri-implantitis of extra-radicular endodontic origin: a systematic and critical review.

The aim of this study was to systematically review the aetiology, in particular histopathological and microbiological factors, of retrograde peri-implantitis of endodontic origin. The review is registered in the PROSPERO database (CRD42017063898). An electronic search for publications was performed in two databases, from their inception up to October 2018. Subsequently a hand search of the reference lists was conducted. Articles in English and other languages using Latin characters were included. Two independent reviewers selected the studies, extracted and synthesized the data, and assessed the quality. The methodology of the included articles was evaluated using the relevant Joanna Briggs Institute tools. Six studies fulfilled the eligibility criteria and were included in the systematic review. Histopathological examination in the component studies reflected that the presentation of retrograde peri-implantitis involves cyst formation or chronic inflammation. Bacteria found in these lesions included Porphyromonas gingivalis, Corynebacterium, Streptococcus, and Klebsiella pneumoniae. Two studies were judged as having a low possibility of bias and four were judged as having a moderate possibility of bias. This review determined that endodontic complications associated with adjacent teeth, residual infection at the extraction site due to previous apical periodontitis, or refractory apical periodontitis might be considered likely aetiological factors, although the evidence is limited.

Amitriptyline prevents CPT-11-induced early-onset diarrhea and colonic apoptosis without reducing overall gastrointestinal damage in a rat model of mucositis.

PURPOSE: Gastrointestinal mucositis (GIM) is one of the most debilitating side effects of the chemotherapy agent, irinotecan hydrochloride (CPT-11). The toll-like receptor (TLR) pathway is a key mediator implicated in the pathophysiology underlying GIM. The tricyclic antidepressant amitriptyline has been shown to inhibit TLR2 and TLR4 activity in in vitro models. The aim of this study was therefore to investigate the effect of amitriptyline on the development of GIM following CPT-11. METHODS: Male albino Wistar rats were treated with either CPT-11 (125 mg/kg, i.p., n = 18), amitriptyline (20 mg/kg, n = 18), both agents (n = 18), or vehicle control (n = 18) and killed at 6, 48, or 96 h. Differences between groups in measurements of gastrointestinal toxicity (diarrhea and weight loss), mucosal injury (apoptosis and histopathology score), colonic expression of TLRs, and pro-inflammatory cytokines were determined. RESULTS: CPT-11-induced diarrhea and colonic apoptosis were inhibited by amitriptyline at 6 h. However, rats were not protected from weight loss or mucosal injury over the time course of CPT-11-induced GIM. Interleukin-1 beta transcript expression was significantly decreased with amitriptyline treatment at 6 h, although protein expression did not differ between groups. There was no change in TLR4 or TLR2 expression in any group. CONCLUSIONS: Prophylactic amitriptyline was able to inhibit early intestinal damage in this rat model of CPT-11-induced GIM, but exacerbated late-onset injury. These findings do not support use of amitriptyline as an approach for mitigation of GIM in this setting.

Implant dentistry in Australia: the present and future. A survey of Australian dentists and specialists.

BACKGROUND: In recent years, implant dentistry has become a routine part of many general dental practices in Australia. However, there has been little information regarding its extent and scope. This investigation aimed to address this issue by surveying Australian general dental practitioners (GDP) and relevant specialists regarding their practice of implant dentistry. METHODS: Anonymous electronic surveys were designed online using SurveyMonkey™ and delivered to the following professional bodies: all seven state/territory branches of the Australian Dental Association, the Australian and New Zealand Academy of Periodontists, the Australian and New Zealand Academy of Oral and Maxillofacial Surgeons, and prosthodontist members of the Australian Prosthodontic Society. The surveys were completed online via SurveyMonkey in 2014. RESULTS: The response rates were 7.61% (N = 801) for GDP, 41.76% (N = 38) for prosthodontists, 34.16% (N = 55) for periodontists and 34.07% (N = 46) for oral and maxillofacial (OMF) surgeons. Among the respondents, 66.37% (N = 521) of GDP, 86.11% (N = 31) of prosthodontists, 82.98% (N = 39) of periodontists and 97.67% (N = 42) of OMF surgeons indicated that they currently practise implant dentistry. A strong perceived need for further education in this field was also expressed by the respondents. CONCLUSIONS: Implant dentistry presently appears to be practised by a significant proportion of GDP across Australia. This is likely to continue to grow in the future.

Oral conditions and their social impact among HIV dental patients, 18 years on.

BACKGROUND: A study undertaken in 1992-1993 identified that HIV-infected dental patients were substantially disadvantaged with regard to the social impact of their oral disease. The oral pain experienced by HIV-positive patients prior to the introduction of combination antiretroviral therapy (cART) was attributable to specific features of HIV-related periodontal disease and other oral manifestations of HIV such as candida infections and xerostomia. A repeat of this study in 2009-2010 provided additional information in the post-cART era. METHODS: Data were collected from three sources: the 2009-2010 HIV-positive sample, the National Survey of Adult Oral Health (NSAOH) and the original 1992-1993 study. Collation of data was by clinical and radiographic oral examination. Information about the social impact of oral conditions was obtained from the Oral Health Impact Profile. RESULTS: The caries experience of the 2009-2010 HIV-positive sample was improved with statistical significance for both mean DMFT and mean DT, while the presence of HIV-related periodontal disease still occurs. Statistically significant improvements were achieved for prevalence and severity of oral health related quality of life. CONCLUSIONS: The need for timely access to oral health care with a focus on prevention is essential for HIV-positive individuals whose health is impacted by chronic disease, smoking and salivary hypofunction.

Matrix metalloproteinases: do they play a role in mucosal pathology of the oral cavity?

Matrix metalloproteinases (MMPs) are critical factors in maintaining the integrity of mucosa and mediating normal biological processes. An imbalance between tissue levels of these mediators and their natural inhibitors is believed to underlie the pathophysiology of many diseases, including those affect the gastrointestinal and oral mucosae. The ongoing development of synthetic inhibitors of these mediators may provide opportunities to develop treatment modalities for patients suffering from these diseases. Understanding the role of MMPs in the pathophysiology of many diseases, however, is far from complete, and the improvement of pharmaceutical management strategies can only be achieved if the underlying process of these diseases is completely comprehended. This paper reviews the functions of matrix metalloproteinases and addresses their role in mediating mucosal pathologies with emphasis on oral mucosa.

Oral health in Australian HIV patients since the advent of combination antiretroviral therapy.

BACKGROUND: The introduction of combination antiretroviral therapy (cART) for the treatment of human immunodeficiency virus (HIV) has resulted in changes to the oral health of infected individuals. Little data are available describing prevalence and severity of oral manifestations in a post cART cohort of HIV positive patients. METHODS: A retrospective case note analysis was performed at the Special Needs Unit (SNU), Adelaide Dental Hospital with emphasis on identifying the prevalence of HIV related oral manifestations (OM). A total of 498 (474 males: 24 females) HIV positive individuals were identified who had attended SNU for dental care between 2001 and 2008. RESULTS: There were significant differences observed in the prevalence of oral manifestations between cART and non-cART groups, and also in comparison to a previous pilot study. Individuals taking cART therapy tended to present with more evidence of linear gingival erythema, angular cheilitis, human papilloma virus associated squamous papillomas and xerostomia. CONCLUSIONS: The widespread adoption of cART in the treatment of HIV has altered the oral health profile of these individuals. These findings provide information on the incidence of oral conditions and demonstrate the need to identify and address oral health needs for people living with HIV.

The treatment of oral cancer: an overview for dental professionals.

Oral cancer is a serious life-threatening disease. Dental professionals may be the first individuals to identify/suspect these lesions before referring to oral and maxillofacial surgeons and oral medicine specialists. Because the general dentist will likely follow on with the patient's future oral health, it is important that he or she has a basic understanding of the various treatments involved in treating oral malignancies and their respective outcomes. The four main modalities discussed in this review include surgery alone, radiotherapy alone, surgery with radiotherapy, and chemotherapy with or without surgery and radiotherapy. Chemotherapy has become an area of great interest with the introduction of new 'targeted therapies' demonstrating promising results in conjunction with surgery. Despite these results, the toxicities associated with chemotherapy regimens are frequent and can be severe, and therefore may not be suitable for all patients. Treatment modalities have improved significantly over the decades with overall decreases in recurrence rates, improved disease-free and overall survival, and an improved quality of life. Prognosis, however, is still ultimately dependent on the clinical stage of the tumour at the initial diagnosis with respect to size, depth, extent, and metastasis as recurrence rates and survival rates plummet with disease progression.

Self-reported oral health of a metropolitan homeless population in Australia: comparisons with population-level data.

BACKGROUND: There is limited information on self-perceived oral health of homeless populations. This study quantified self-reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health. METHODS: A total of 248 homeless participants (age range 17-78 years, 79% male) completed a self-report questionnaire. Data for an age-matched, representative sample of metropolitan-dwelling adults were obtained from Australia's second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non-overlapping 95% confidence intervals used to identify statistically significant differences between the two groups. RESULTS: Homeless adults reported poorer oral health than their age-matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age-matched general population counterparts. Three times as many homeless adults rated their oral health as 'fair' or 'poor'. CONCLUSIONS: A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population.

Biopsy of the oral mucosa and use of histopathology services.

Patients often present with intraoral pathology in the general dental practice setting. Therefore, it is important that dental practitioners are aware of how to deal with pathology when this occurs and have an understanding of investigative techniques that might assist in making a diagnosis. Biopsy and subsequent histological examination of the lesion is an important diagnostic tool. Even if dentists refer the patient to another practitioner for the biopsy, the referring practitioner still needs to be familiar with the procedure and results obtained so that the patient can be appropriately managed. This paper reviews clinical issues that may impact on biopsy procedures and the potential pitfalls and problems that may affect the histological assessment of tissue and therefore affect diagnosis. The medico-legal responsibilities of practitioners are also addressed.

Sjögren's syndrome: a review of aetiology, pathogenesis, diagnosis and management.

Sjögren's syndrome is a chronic autoimmune disease that affects many individuals within the community. Despite this, its exact aetiology and pathogenesis is still unclear. Sjögren's syndrome affects many organ systems in the body. However, for dental practitioners it is important to recognize the many oral and dental manifestations that are associated with the syndrome. In addition to these oral manifestations, this review will discuss the systemic manifestations of Sjögren's syndrome as well as the current understanding of factors that have a role in its aetiology and pathogenesis. Furthermore, this review will highlight the difficulties and complexities that are inherent in the diagnosis of Sjögren's syndrome and the important role that dental practitioners can play in the management of its oral manifestations. The effective management of oral manifestations and minimization of oral disease in patients with Sjögren's syndrome can result in improved quality of life for these patients.

Oral features in Apert syndrome: a histological investigation.

OBJECTIVES: The number of publications on the oral features in Apert syndrome is limited. The present study investigated dental tissues in Apert syndrome histologically, to determine the nature and extent of anomalies, to provide some insight into the nature of the condition, and to explain how observed anomalies may affect the dental management of individuals with Apert syndrome. SETTING AND SAMPLE POPULATION: Extracted primary and secondary teeth were collected from patients with Apert who had attended the Australian Craniofacial Unit, Adelaide, South Australia. The total study sample comprised 13 individuals, aged from 14 to 21 , with nine men and four women. MATERIAL AND METHODS: A total of 40 teeth were available for histological examination (the number belonging to each individual varied from 2 to 5 per patient). The teeth were sectioned longitudinally, and one-half of each tooth underwent decalcification. Sections were stained with H&E for routine histological examination. Ground sections were prepared from undecalcified tooth halves. RESULTS: Histological assessment of the dental hard tissues revealed an intact enamel and dentinal structure but some irregularities were noted in the region of the dentino-enamel junction (DEJ), which could affect caries progression and also make dental management more difficult. CONCLUSION: This study identified histological anomalies of the DEJ of Apert syndrome teeth. An improved appreciation of the nature and extent of dental anomalies in Apert syndrome should assist clinicians when undertaking management of affected individuals.

Alveolar bone and the bisphosphonates.

Bisphosphonate associated osteonecrosis of the jaws (ONJ) usually commences at the alveolus. Comparison is made between the structure and function of long bones and alveolar bone and the differing susceptibilities of the bisphosphonates at these different sites are explored. Current concepts of the causation of ONJ are discussed. The clinical implications of these findings to dentists managing periodontal conditions are presented.

Odontogenic keratocyst in a 5-year-old child: a rare cause of maxillary swelling in children.

Odontogenic keratocysts in children are uncommon. They are cysts of the jaws that have a tendency for recurrence and are usually seen in adults. We report an exceptionally rare case in a young child and discuss its management.

Expression of vascular endothelial growth factor (VEGF) in normal oral mucosa, oral dysplasia and oral squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) is a potent angiogenic cytokine implicated in tumour vasculogenesis. A significant increase in vascularity occurs during the transition from normal oral mucosa (NOM), through dysplasia, to squamous cell carcinoma (SCC). This study investigated the presence of VEGF in NOM, oral dysplasia and SCC. The correlation between VEGF expression and the grade of dysplasia or differentiation of SCC was also examined. Specimens consisting of NOM, oral dysplastic lesions and oral SCC were stained using standard immunohistochemistry methods to determine VEGF expression. Statistical analysis indicated an up-regulation of VEGF during the transition from NOM, through dysplasia to SCC. There was also a significant difference in expression according to differentiation of SCC, but not grade of dysplasia. As VEGF is a potent mediator of vascular development, these results suggest that VEGF may play an important role in the maintenance of a blood supply for developing pre-cancerous and invasive oral lesions.

Epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001.

BACKGROUND: Tongue cancer (141 ICD-9) is the most common intra-oral malignancy in Western countries. In recent decades, reported tongue cancer incidence and mortality rates have increased both in Europe and in the United States, whilst survival has not improved. This study aimed to determine the epidemiology and survival trends of tongue cancer in South Australia over the 24-year period from 1977 to 2001. METHODS: Population-based data for tongue cancer were provided by the Central Cancer Registry Unit of the Epidemiology Branch of the South Australian Department of Health. Age-standardized incidence and mortality rates for males and females were calculated. Kaplan-Meier survival analysis was conducted according to time periods, age, sex and tongue sub-sites. Cox regression analysis was used to determine factors that influenced survival. RESULTS: During this 24-year period, 611 cases of tongue cancer (398 males, 213 females) were reported, the majority of which were squamous cell carcinomas. The most common age of diagnosis was 65-69 years in males and 60-64 years in females. Fifty cases (8.18 per cent of all tongue cancer cases) occurred in patients 40 years or younger. The most common cancer sub-sites reported were 'unspecified site' (48.45 per cent), lateral border (25.53 per cent) and base (18.49 per cent) of the tongue. The age-standardized incidence and mortality rates for males and females in South Australia were relatively low and stable, and there was no significant improvement in survival of tongue cancer over this period. Significant predictors for survival were sex, age and tongue sub-sites, with male, advanced age and base of tongue associated with poorer survival. CONCLUSIONS: Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.

Non-surgical management of an oro-antral fistula in a patient with HIV infection.

BACKGROUND: The risk of post-extraction complications is higher in patients who are immunosuppressed compared to other patients with normal immune function. In addition, invasive dental procedures are more likely to have serious complications in these patients. This case report demonstrates an effective non-surgical procedure to treat an oro-antral fistula in an HIV-infected man. METHODS: The oro-antral fistula was de-epithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oro-antral communication. The patient was reviewed on a regular basis. RESULTS: This procedure resulted in resolution of the patient's symptoms within two weeks. Complete healing of the oro-antral fistula was evident following eight weeks of wearing the surgical splint. CONCLUSIONS: This procedure provided an effective method of treating an oro-antral fistula in an immunocompromised patient without causing any detrimental effects to the patient's overall health. Adequate pre-surgical assessment of patients prior to extractions is important in all patients to help prevent the occurrence of such complications.

A retrospective analysis of oral hairy leukoplakia in South Australia.

BACKGROUND: The features of oral hairy leukoplakia (OHL) have been widely reported in the literature. However, no studies have described this lesion in the Australian setting. This study retrospectively examines, with respect to specific clinical factors, the prevalence of OHL in a South Australian HIV-infected population. METHODS: Clinical data were collected from the records of 197 HIV-infected patients who had attended the Adelaide Dental Hospital between January 1986 and February 1995. Data were analysed using the chi-square test. RESULTS: The prevalence of OHL in South Australian HIV-infected patients was 45.2 per cent. The study found the presence of OHL was not related to CD4+ T-lymphocyte count or AIDS-defining illness nor did the length of time a patient had been infected with HIV relate to the presence of OHL. An association was observed between a reduced prevalence of OHL in patients who were taking antiviral medication. CONCLUSION: The prevalence of OHL in South Australia is comparable with results of other studies. This study supports the notion that OHL is not an indicator of immunosuppression in South Australian HIV-infected patients. Further longitudinal studies are required to ascertain the relationship of OHL to HIV disease progression.

Hepatitis C infection and associated oral health problems.

Hepatitis C infection is widespread throughout the community. This study aimed to assess the status of oral health of persons infected with hepatitis C. DMFT and CPITN indices were recorded at a clinic providing priority dental care for people with hepatitis C infection. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using a modified Oral Health Impact Profile questionnaire. The DMFT index differed significantly between hepatitis C and general patients. The number of decayed and missing teeth was greater in those infected with hepatitis C for all patients aged between 25 and 50 years. Although there was no significant difference in CPITN categories for subjects evaluated, a marked trend for poor periodontal health was noted for those individuals with hepatitis C. Salivary flow was reduced in 50 per cent of hepatitis C infected subjects. Social impact was significantly affected with 71 per cent of hepatitis C subjects reporting painful aching in the mouth and 56 per cent having difficulty in relaxing. In conclusion, the results from the project strongly indicate an urgent need for priority delivery of dental care for people with hepatitis C infection.

Solubilization of Acid-swollen cellulose by an enzyme system from a species of alternaria.

An unknown species of Alternaria, when grown on a medium containing carboxymethylcellulose as a carbon source produced a mixture of extracellular enzymes which solubilized acid-swollen cellulose. The product of the hydrolysis was a 1:2 molar mixture of cellobiose and glucose. The organism apparently produced no cellobiase. It is suggested that the mixture of cellulolytic enzymes contains at least two different enzymes which degrade cellulose in an endwise manner.