Obstructive sleep apnea treatment improves temporomandibular disorder pain.

PURPOSE: The existence of a bidirectional relationship between poor sleep and pain intensity has been studied, and good sleep quality has been found to be a key factor underlying pain control. The purpose of this prospective cohort study was to observe if OSA treatment provides a reduction in temporo-mandibular disorder (TMD) pain and headache attributed to TMD in patients with obstructive sleep apnea (OSA) after 18 months of OSA treatment. METHODS: A prospective cohort study was conducted on consecutive patients suffering from OSA. Patients underwent polysomnography and TMD examination according to the DC/TMD protocol at baseline and after 18 months. Intensity of TMD pain and headache attributed to TMD were analyzed. RESULTS: Of 40 patients (31 men, mean age 51.3 ± 10.3 years), 33 underwent OSA treatment. At the follow-up examination after 18 months, significant improvements in the intensity of pain-related TMD and headache attributed to TMD were observed (p < 0.05). Seven patients did not start treatment for OSA or discontinued treatment. These patients did not show any significant difference in intensity of TMD-pain or headache attributed to TMD after 18 months (p > 0.05). CONCLUSIONS: Significant reductions in intensity of pain-related TMD and headache attributed to TMD were observed in patients with OSA after 18 months of OSA treatment onset, while no difference was observed in subjects not undergoing or discontinuing OSA treatment. TRIAL REGISTRATION: The protocol was registered on ClinicalTrials.gov database with number NCT04948541.

Impact of Concurrent Use of N95 and Surgical Masks on Peripheral Oxygen Saturation and Heart Rate Frequency-A Prospective Study during the COVID-19 Outbreak.

Background and Objectives: The COVID-19 outbreak has necessitated the prolonged use of N95 facemasks in addition to traditional surgical facemasks by healthcare workers. The aim of this study was to investigate the effect of wearing N95 facemasks in addition to surgical facemasks on peripheral oxygen saturation (SpO2) and heart rate (HR) among dental professionals during routine care. Materials and Methods: This prospective study compared SpO2 and HR between dental providers wearing N95 + surgical facemasks vs. wearing a surgical facemask only. SpO2 and HR were recorded using a portable pulse oximeter before wearing the facemask (T0); at 30 min (T1); at 1 h (T2); and at the end of clinical activity (T3). Inter-group and intra-group differences were assessed with independent t tests and repeated measures ANOVA, respectively. Results: A total of 88 participants (57 wearing N95 + surgical facemasks, and 31 wearing a surgical facemask only) completed the study. The two groups did not statistically differ in SpO2 at different timepoints nor showed any intra-group differences. The participants wearing N95 + surgical facemasks exhibited a statistically higher HR at T0 (p = 0.007), T2 (p = 0.010), and T3 (p = 0.014) compared to those wearing a surgical facemask only. A statistically significant decrease was observed in HR between T0 and T3 in those wearing N95 + surgical facemasks (p = 0.012). No intra-group differences were seen in HR over time in those wearing a surgical facemask only. Conclusions: The continuous use of an N95 in addition to a surgical facemask did not show any significant effects in SpO2 during routine care; however, the concurrent use of an N95 and a surgical facemask seemed to be accompanied by a decrease in HR, although the values remained within the normal range.

Clinical outcomes of teeth adjacent to the site of mandibulotomy or mandibulectomy in patients with head and neck cancer: results from a multidisciplinary mono-institutional head and neck tumor board.

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.

Prevalence of Malocclusions in Down Syndrome Population: A Cross-Sectional Study.

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea.

PURPOSE: The aim of the present study was to detect the prevalence of temporomandibular disorders (TMD) in patients with untreated obstructive sleep apnea (OSA) and to compare the results with healthy controls, matched for sex and age. METHODS: Forty-one consecutive patients with OSA were prospectively recruited from the Department of Otorhinolaryngology at the A. Gemelli Hospital prior to undergoing any treatment for OSA and independently of OSA severity. All patients underwent a complete TMD examination according to the diagnostic criteria for temporomandibular disorders (DC/TMD) protocol. The same examination was performed on 41 healthy controls matched for sex and age. Chi-squared test was used to compare results between the two groups. RESULTS: Of the 41 patients with OSA, 21 (51%) presented signs and/or symptoms of TMD compared to 13 of 41 subjects (32%) from the control group. Headache attributed to TMD and disc displacement with reduction were the most common diagnoses, with a statistically significant difference between the two groups (p<0.05). CONCLUSIONS: The prevalence of TMD signs and symptoms is significantly higher in untreated patients with OSA compared to healthy controls.

Ultrasonographic Evaluation of The Effects of Orthodontic or Functional Orthopaedic Treatment on Masseter Muscles: A Systematic Review and Meta-Analysis.

Objectives: This review investigated the effects of orthodontic or functional orthopedic therapy on masseter muscle thickness through the use of ultrasonography (US) in growing subjects when compared with untreated subjects. Materials and Methods: This review systematically assessed studies that investigated growing subjects undergoing orthopedic therapy for the correction of malocclusion of vertical, sagittal and transversal plane. Electronic databases (CENTRAL, MEDLINE-PubMed, Scopus and Web of Science) were searched up to February 2019, including available RCTs and CCTs, without language restrictions. The primary outcome was the effect of orthopedic or functional treatment on masseter muscle thickness. The risk of bias of included studies was assessed through the Newcastle-Ottawa quality assessment scale with the aim of defining their methodological quality. A random-effects meta-analysis analyzing mean differences with 95% confidence intervals was used for quantitative analysis. Results: The search retrieved 749 titles, but the studies selection resulted in a final sample of 5 CCTs. The studies retrieved data from 233 children (age range: 5-22 years) and were conducted at university dental clinics. Children were treated for Class II malocclusion, increased vertical dimension or lateral cross-bite variably with rapid or slow maxillary expansion, twin block, bite block, mandibular activators, quad helix, alone or in combination. Risk of bias was assessed as medium for three studies, low for one and high for another. The meta-analysis determined that at the end of orthopedic or functional treatment masseter muscle thickness, measured through the use of US, is significantly reduced (MD -0.79 mm; 95% CI -1.28 to -0.31). The reduction in muscle thickness, therefore, could be considered an indicator for the evaluation of the success of therapy with orthodontic appliances. Conclusions: Although the meta-analysis revealed that US could be considered a less invasive and effective method to evaluate the masseter muscle thickness, single-blinded RCTs, are required to confirm US reliability in this field of application. This review was registered on PROSPERO with the following registration number: CRD42018068402.

How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review.

OBJECTIVES: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. MATERIALS AND METHODS: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. RESULTS: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. CONCLUSIONS: Given the best evidence-based information regarding patients' medical condition, we highlight the need to provide an ethical-based comprehensive approach in the diagnostic workflow and the assessment of treatment outcome.

Lay People Esthetic Evaluation of Primary Surgical Repair on Three-Dimensional Images of Cleft Lip and Palate Patients.

Background and Objectives: Previous literature has disclosed that facial attractiveness affects the esthetic evaluation of nose and lip deformity on frontal and lateral photographs. However, it has never been debated if the removal of the external facial features on three-dimensional (3D) models ("cropped assessment bias") could provide a considerable usefulness in the interpretation and comparison of the results. Additionally, it has been assumed on two-dimensional (2D) studies that esthetic assessment biases with respect to observer gender, and it is not acknowledged if and to the extent that "gender assessment bias" may be influenced by a three-dimensional layout. The aim of this study is to investigate if facial traits and observers' gender may affect the esthetic ratings of unilateral cleft lip and palate (UCLP) patients after soft tissue reconstruction. Materials and Methods: Three-dimensional images of ten UCLP patients' images were acquired before the intervention (T0), one-month (T1) and six-months (T2) postoperative. Geomagic® software (version 2014; 3D Systems, Rock Hill, SC, USA) was used to remove the external facial features of 3D surface models. Five-point scale developed by Asher-McDade et al. was used to rate both nasolabial attractiveness and impairment for full-face (FF) and cropped-face (CF) 3D images. Forty-three judges (21 males, 22 females) were enrolled for the esthetic evaluation. Intraclass correlation coefficient (ICC) was used to test intra- and inter-examiner reliability; a value of 0.7 was set as the minimum acceptable level of reliability. Results: When comparing the 2 sets of observations (FF and CF), the ICC ranged from 0.654 to 0.823. Concerning gender assessment bias, the ICC ranged from 0.438 to 0.686 and from 0.722 to 0.788 for males and females, respectively. Concerning inter-examiner reliability, ICC for questions 2-7 ranged from 0.448 to 0.644 and from 0.659 to 0.817 at T0 and T2, respectively. Conclusions: The removal of external facial features provides subtle differences on the esthetic assessment of UCLP patients. Moreover, based on our data, examiners' gender differences may affect esthetic assessment of UCLP patients. Despite the subjectivity of esthetic judgments, a reliable, validated and reproducible scoring protocol should consider the influence of gender differences on 3D esthetic assessment of UCLP patients.

Controlled release of 18-ß-glycyrrhetic acid by nanodelivery systems increases cytotoxicity on oral carcinoma cell line.

The topical treatment for oral mucosal diseases is often based on products optimized for dermatologic applications; consequently, a lower therapeutic effect may be present. 18-ß-glycyrrhetic acid (GA) is extracted from Glycirrhiza glabra. The first aim of this study was to test the cytotoxicity of GA on PE/CA-PJ15 cells. The second aim was to propose and test two different delivery systems, i.e. nanoparticles and fibers, to guarantee a controlled release of GA in vitro. We used chitosan and poly(lactic-co-glycolic) acid based nanoparticles and polylactic acid fibers. We tested both delivery systems in vitro on PE/CA-PJ15 cells and on normal human gingival fibroblasts (HGFs). The morphology of GA-loaded nanoparticles (GA-NPs) and fibers (GA-FBs) was investigated by electron microscopy and dynamic light scattering; GA release kinetics was studied spectrophotometrically. MTT test was used to assess GA cytotoxicity on both cancer and normal cells. Cells were exposed to different concentrations of GA (20-500 µmol l-1) administered as free GA (GA-f), and to GA-NPs or GA-FBs. ROS production was evaluated using dichlorodihydrofluorescein as a fluorescent probe. Regarding the cytotoxic effect of GA on PE/CA-PJ15 cells, the lowest TC50 value was 200 µmol l-1 when GA was added as GA-NPs. No cytotoxic effects were observed when GA was administered to HGFs. N-acetyl Cysteine reduced mortality induced by GA-f in PE/CA-PJ15 cells. The specific effect of GA on PE/CA-PJ15 cells is mainly due to the different sensitivity of cancer cells to ROS over-production; GA-NPs and GA-FBs formulations increase, in vitro, this toxic effect on oral cancer cells.

Haematemesis related to orthodontic treatment with Nance palatal arch: a case report.

Haematemesis is a worrying sign, generally related to acute upper gastrointestinal bleeding and potentially life-threatening condition. We present a case of a 15-year-old Caucasian girl who was belatedly diagnosed with oral bleeding because it was not related to the most common aetiologic factors. In fact, she was undergoing orthodontic treatment with a Nance palatal arch, an appliance used to reinforce anchorage during teeth movements. In her case haematemesis was a sign of inflammation and necrosis occurring in the palatal mucosa, under the acrylic button of palatal arch. The appliance was removed; antibiotic and Chlorhexidine 0.12% were recommended. After a 6-week follow-up, no pathological signs were present and the orthodontic treatment was resumed. Both physicians and dentists should be aware of the possible side effect of the Nance palatal arch use; this could help in achieving a diagnosis and providing a correct treatment. Orthodontists should avoid excessive compression over the palatal mucosa and check the appliance condition during every follow-up in order to avoid necrosis of the palatal mucosa.

Chrono-proteomics of human saliva: variations of the salivary proteome during human development.

An important contribution to the variability of any proteome is given by the time dimension that should be carefully considered to define physiological modifications. To this purpose, whole saliva proteome was investigated in a wide age range. Whole saliva was collected from 17 preterm newborns with a postconceptional age at birth of 178-217 days. In these subjects sample collection was performed serially starting immediately after birth and within about 1 year follow-up, gathering a total of 111 specimens. Furthermore, whole saliva was collected from 182 subjects aged between 0 and 17 years and from 23 adults aged between 27 and 57 years. The naturally occurring intact salivary proteome of the 316 samples was analyzed by low- and high-resolution HPLC-ESI-MS platforms. Proteins peculiar of the adults appeared in saliva with different time courses during human development. Acidic proline-rich proteins encoded by PRH2 locus and glycosylated basic proline-rich proteins encoded by PRB3 locus appeared following 180 days of postconceptional age, followed at 7 months (±2 weeks) by histatin 1, statherin, and P-B peptide. The other histatins and acidic proline-rich proteins encoded by PRH1 locus appeared in whole saliva of babies from 1 to 3 weeks after the normal term of delivery, S-type cystatins appeared at 1 year (±3 months), and basic proline-rich proteins appeared at 4 years (±1 year) of age. All of the proteinases involved in the maturation of salivary proteins were more active in preterm than in at-term newborns, on the basis of the truncated forms detected. The activity of the Fam20C kinase, involved in the phosphorylation of various proteins, started around 180 days of postconceptional age, slowly increased reaching values comparable to adults at about 2 years (±6 months) of age. Instead, MAPK14 involved in the phosphorylation of S100A9 was fully active since birth also in preterm newborns.

Effects of Thermoforming on the Mechanical, Optical, Chemical, and Morphological Properties of PET-G: In Vitro Study.

The effectiveness of clear aligners in correcting malocclusions is closely linked to the properties of the materials used to make them. The polymers used in the manufacture of clear aligners have well-established properties. However, the process of manufacturing clear aligners, known as thermoforming, involves thermal and mechanical shocks that may alter these properties. The objective of this study was to evaluate the effects of thermoforming on the mechanical, optical, chemical, and morphological properties of sixty PET-G specimens. The study compared the thickness, weight, absorbance, chemical structure, surface roughness, elastic modulus, yield strength, and breaking load of thirty thermoformed specimens with thirty non-thermoformed specimens. The study introduces a new approach by using standardized samples to analyze both chemical and physical properties. The results showed statistically significant differences in thickness (-15%), weight (-11%), and surface roughness (+1233% in roughness average; +1129% in RMS roughness) of the material. Additionally, a correlation was found between reduction in thickness and increase in opalescence. There was no significant change in the functionality of the aligners after thermoforming, as no significant mechanical changes were found. However, the increase in surface roughness may lead to plaque and fluid accumulation and worsen the fit of the aligners.

Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study.

OBJECTIVES: Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. METHODS: A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. RESULTS: Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001). CONCLUSIONS: A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d.

New Conservative Approach for the Management of Recurrent Sublingual Ranula-A Case Report.

Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx® gel). After incision of the cystic dome, Hybenx® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.

Attitudes and practices of dentists treating HIV+ patients in the era of new antiretroviral therapy: A 12-year update.

During the first years of the HIV pandemic, the virus diffusion was responsible for discriminatory behavior from medical and dental care workers towards HIV-infected patients, as described by our research group in 2009. The aim of the current study was to provide an update on the previous data, investigating the presence of discriminatory behaviors, evaluating the level of dentists' knowledge about the virus and proposing strategies to be implemented to avoid professional exposure and cross-infections. This study was a cross-sectional, online, national survey on dentists, members of the main national dental associations (ANDI and AIO). The questionnaire was divided into four major sections, with the same structure as the questionnaire administered in 2009. The differences between groups were analyzed using the software program IBM SPSS Statistic, version 21.0. A total of 1054 dentists filled out the questionnaire completely. Among them 0.04% revealed a discriminatory attitude towards HIV-infected patients. The univariate analysis showed that discrimination towards HIV + patients was statistically associated with personal experiences and the level of fear associated with treating them (p = 0.001) and with the type of dental treatments performed (p = 0.01). This cross-sectional study revealed the persistence of dentists who still discriminate against HIV + patients, and the percentage of these dentists was only slightly lower than that in the previous survey (4.3% in the present survey vs. 4.5%). The survey also depicted other information worthy of consideration, such as a perceived ability to detect HIV + patients based on their appearance, complaints about not having received adequate training for treating HIV + individuals, and a lack of scientific knowledge about the virus. From the evidence reported by the present survey, it can be argued that universities, professional boards, and training institutions must increase their efforts in spreading correct knowledge about HIV among all dental care workers.

Is there an association between EMG activity and temporomandibular disorders during orthotic mandibular advancement in sleep apnea patients undergoing DISE?

OBJECTIVE: To detect whether myotatic reflex activation of masticatory muscles during drug-induced sleep endoscopy (DISE) can be an indirect marker for temporomandibular disorder (TMD) in patients suffering from obstructive sleep apnea (OSA). METHODS: OSA patients were prospectively recruited and underwent a complete TMD examination prior to undergoing DISE with the addition of electrodes applied over masticatory muscles. A positive activation of myotatic reflex was considered in case of an increase in muscle tone of at least 50%. RESULTS: Of the 41 patients included, 48.8% presented activation of myotatic reflex. Of these patients, 45% presented a TMD diagnosis, 40% presented pain at masticatory muscles palpation, and 15% did not report pain during clinical examination. CONCLUSION: An increase in EMG activity during mandibular advancement is not associated with TMD presence, but it can be an indirect marker of pain in the orofacial area in OSA patients.

Analysis of the Changes in Occlusal Plane Inclination in a Class II Deep Bite "Teen" Patient Treated with Clear Aligners: A Case Report.

Background: Optimal management of hypodivergent growing patients demands a strict control of vertical dimension and to exploit the growth potential. If a deep bite malocclusion causes a traumatic contact between the upper and lower incisors and affects the facial appearance, an early interceptive treatment is recommended. The aim of this case report is to outline the clinical management of the occlusal plane of a growing Class II division 1 deep bite patient treated with aligners and Class II elastics. Methods: The treatment lasted 11 months and was divided into two phases. Treatment goals included improvement of the soft tissue profile and basal bone relationships through an increase in the mandibular third of the face and a sagittal advancement of the mandible. The correction of the curve of Spee involved intrusion of the mandibular incisors and extrusion of the mandibular premolars. Results: The cephalometric analysis at the end of the treatment displayed significant differences in the skeletal and occlusal pattern along with aesthetic improvements. Conclusion: The final cephalogram showed a consistency between the planned tooth movement and the clinical results. Although definitive recommendations must be withheld until longer follow-up is available, the patient presented here shows that the treatment protocol yielded positive mandibular growth.

Oral juvenile xanthogranuloma: An unusual presentation in an adult patient and a systematic analysis of published cases.

OBJECTIVE: The purpose of this study was to describe an unusual case of intraoral juvenile xanthogranuloma (JXG) and to perform a systematic review to investigate the available literature regarding oral JXGs. STUDY DESIGN: We present a new case of oral JXG arising in a 36-year-old Italian woman and conducted a systematic literature review in PubMed, Web of Science, and Scopus, according to the PRISMA guidelines. RESULTS: Our review of the English-language literature yielded 34 cases of oral JXG, which included our case report. CONCLUSIONS: JXG is a non-Langerhans cell histiocytosis. Oral JXG has been reported, but it is a rare manifestation. Because of the rarity of oral lesions and possible variations in the clinical and histologic presentation, the correct diagnosis can be challenging, requiring a careful clinical and histopathologic evaluation with adjuvant immunohistochemical studies.

The Effect of Different Antibiotic Regimens on Bacterial Resistance: A Systematic Review.

BACKGROUND AND OBJECTIVES: Infections caused by resistant bacteria are a growing public health problem that is linked to many different causes, among them the antibiotics' incorrect use plays an important role. According to the World Health Organization (WHO) the most dangerous behaviors are the early interruption of antibiotic therapy and the use of molecules without appropriate prescription. The authors conducted a systematic review to assess if antibiotic prescription with different regimens is connected to the onset of bacterial resistance. METHODS: The authors performed an electronic and manual literature search on four databases (Web of Science, Scopus, PubMed, and Cochrane Register of Controlled Trials) from their inception to 15 June 2019. The date of the last search was 27 November 2019. Any article comparing cultural or genic analysis of resistance in patients that took antibiotics with at least two different regimens was included. No language restrictions were applied. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane collaboration's tool whereas case-control and cohort studies were evaluated through the Newcastle-Ottawa scale. RESULTS: The initial search resulted in a total of 1744 titles. After careful evaluation of all results, only three studies satisfied the outcome of the present review. From the qualitative analysis of data, it emerges that even if antibiotics are administered for a shorter period than the conventional one the species that inhabit the oral cavity can adapt quickly and express genes of antibiotic resistance. Additional evidence from this analysis is that not only does the proportion of resistant bacteria increase in the oral cavity, but also in more distant districts such as the intestine. CONCLUSIONS: Despite the great number of studies retrieved by electronic databases only few studies investigated the target of this review. The reason for this evidence is that it is not ethical to investigate and compare different antibiotic regimens, shorter or longer than the appropriate one. This evidence is applicable both to prophylactic administrations and to those aimed at treating infections. Besides this, the WHO affirms that, in the absence of infective complications, the prescription of antibiotic after every type of surgical intervention cannot be admitted and that studies dealing with antibiotic regimens that do not comply with drug's pharmacodynamics characteristics cannot be ethically admitted. PROSPERO acknowledgement of receipt [149149].

Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials.

METHODS: A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA). RESULTS: From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant (p = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached. CONCLUSIONS: The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.