Periodontitis and risk of cancer: Mechanistic evidence.

This review aims to critically analyze the pathways of interaction and the pathogenic mechanisms linking periodontitis and oral bacteria with the initiation/progression of cancer at different body compartments. A higher risk of head and neck cancer has been consistently associated with periodontitis. This relationship has been explained by the local promotion of dysbiosis, chronic inflammation, immune evasion, and direct (epi)genetic damage to epithelial cells by periodontal pathobionts and their toxins. Epidemiological reports have also studied a possible link between periodontitis and the incidence of other malignancies at distant sites, such as lung, breast, prostate, and digestive tract cancers. Mechanistically, different pathways have been involved, including the induction of a chronic systemic inflammatory state and the spreading of oral pathobionts with carcinogenic potential. Indeed, periodontitis may promote low-grade systemic inflammation and phenotypic changes in the mononuclear cells, leading to the release of free radicals and cytokines, as well as extracellular matrix degradation, which are all mechanisms involved in carcinogenic and metastatic processes. Moreover, the transient hematogenous spill out or micro-aspiration/swallowing of periodontal bacteria and their virulence factors (i.e., lipopolysaccharides, fimbriae), may lead to non-indigenous bacterial colonization of multiple microenvironments. These events may in turn replenish the tumor-associated microbiome and thus influence the molecular hallmarks of cancer. Particularly, specific strains of oral pathobionts (e.g., Porphyromonas gingivalis and Fusobacterium nucleatum) may translocate through the hematogenous and enteral routes, being implicated in esophageal, gastric, pancreatic, and colorectal tumorigenesis through the modulation of the gastrointestinal antitumor immune system (i.e., tumor-infiltrating T cells) and the increased expression of pro-inflammatory/oncogenic genes. Ultimately, the potential influence of common risk factors, relevant comorbidities, and upstream drivers, such as gerovulnerability to multiple diseases, in explaining the relationship cannot be disregarded. The evidence analyzed here emphasizes the possible relevance of periodontitis in cancer initiation/progression and stimulates future research endeavors.

Evaluation of the adjunctive use of Er:YAG laser or erythritol powder air-polishing in the treatment of peri-implant mucositis: A randomized clinical trial.

AIM: To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM). MATERIALS AND METHODS: Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed. RESULTS: A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success. CONCLUSION: The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

Dental deaths in Italy as reported by online press articles.

OBJECTIVES: Mortality on the dental chair is a rare and underreported event. This study aimed to identify all deaths that occurred during dental procedures in Italy. METHODS: We searched PubMed/Medline, Scopus, and Internet archives looking for patients who died before, during, or after a dental procedure in Italy from 1990 to 2019. RESULTS: All the 36 identified fatal events were reported by national or regional newspapers, and none was reported by scientific databases. Interestingly, no cases regarding patients ≤16 years old were found and there was no variation in the number of reported deaths over the years. Most of the cases (n = 29) occurred in out-of-hospital private dental offices. Tooth extraction represented the most frequent culprit operation (39%), while myocardial infarction (28%) was the leading cause of death, followed by cardiac arrest (25%), allergies (11%), and infections (8%). In four cases, death was preprocedural, in 10 intraprocedural and in 21 postprocedural. In 17 cases, a temporal association between injection of anesthesia/sedation and death was observed. CONCLUSION: This is the first report on Italian dental procedure-related deaths. Most of these deaths were only temporally associated with a dental procedure and could not to be attributed to malpractice.

Effectiveness of periodontal treatment to improve glycemic control: an umbrella review.

AIM: The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis. MATERIALS AND METHODS: A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I2 index. The publication bias was evaluated using a funnel plot and Egger's linear regression method. RESULTS: Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone. CONCLUSIONS: The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.

Conventional versus Digital Impressions for Full Arch Screw-Retained Maxillary Rehabilitations: A Randomized Clinical Trial.

Background: The objective of this study was to compare conventional versus digital impressions for Full-Arch maxillary rehabilitations. Methods: Patients selected for this study were treated with full-arch screw-retained rehabilitations supported by six immediately loaded dental implants. Patients have been scheduled randomly into control (conventional impression group, CIG) and test (digital impression group, DIG) groups respectively for a fully conventional workflow and a fully digital workflow. In both groups, within 24 h, temporary prostheses were delivered. Four months after the implant positioning, the two groups dealt with the fabrication of definitive restorations: conventional pick-up was performed in the control group, and definitive digital impressions were carried out in the test group. The time involved following these two procedures was recorded. Patients underwent intraoral digital radiographs to evaluate the accuracy of the framework-implant connection, check for the presence of voids at the bar-implant connection and measure bone level. Criteria used to assess success at the prosthetic level were the occurrence of prosthetic maintenance, the absence of fractures of the acrylic resin superstructure and voids. Results: A total of 50 patients received immediately loaded prostheses supported by six implants (total 300 implants). A fixture and prosthetic survival rate of 100% was observed. All digital X-ray examinations revealed a bar-implant connection accuracy and no voids. Differences that were not statistically significant (p > 0.05) in marginal bone loss were found between control and test groups. Significantly less time was spent to perform digital impression procedure (p < 0.05). Conclusions: Clinical and radiological results of the test group advocate a satisfactory accuracy and predictability of the intraoral scanner (IOS) to be a reliable alternative in clinical practice for implant full-arch rehabilitations and suggest fabrication of definitive restorations with a successful marginal fit precision.