Evaluating the Effects of Cigarette Smoking and Heated Tobacco Products on Hard Dental Tissues: A Comparative Histological and Colorimetric Analysis.

OBJECTIVES: This study aimed to evaluate and compare the impact of cigarette smoking (CS) and heated tobacco (HT) on the alteration of color and ultrastructural characteristics of human enamel and cementum. BACKGROUND: According to tobacco companies, a less harmful substitute for CS is HT products. Nevertheless, comprehensive research on the effects of HT on tooth structures has been lacking. This study aimed to evaluate and compare the impact of CS and HT on the alteration of color and ultrastructural characteristics of human enamel and cementum. MATERIALS AND METHODS: Thirty intact and noncarious human maxillary premolars extracted for orthodontic treatment purposes, previously disinfected, were used in the study. The specimens were randomly separated into six groups (n = 10), as follows: Group 1: enamel without smoking exposure; Group 2: enamel exposed to CS; Group 3: enamel exposed to HT; Group 4: cementum without smoking exposure; Group 5: cementum exposed to CS; and Group 6: cementum exposed to HT. The measurement of color change was conducted using a spectrophotometer. The surface alterations and mineral composition of enamel and cementum were evaluated using scanning electron microscopy and energy-dispersive X-ray spectroscopy. ANOVA test followed by Tukey's post hoc test was used to determine significant differences between groups. RESULTS: Results showed that CS had a more pronounced effect on enamel and cementum color changes than HT. The impact of CS and HT on color changes was more evident in cementum than in enamel. Surface morphology of enamel and cementum showed alterations in histology following exposure to both smoking types. Moreover, the mineral content experienced a significant reduction after using CS and HT. The reduction in calcium content after CS and HT exposure was similar. However, HT led to a significant decrease in the phosphorus content of enamel when compared with CS. At the same time, CS exposure in cementum resulted in a more significant reduction in Ca/P ratio than HT. CONCLUSIONS: Although HT may appear to present a lower danger to hard dental tissues than CS, it is not entirely harmless. CS results in more color changes on the enamel and cementum of teeth. Both smoking methods affected the mineral content of teeth, with CS having a significant effect on the roots, while HT significantly affected the crowns' mineral composition.

Effect of conventional cigarette smoking and recent heated tobacco products on CAD/CAM restorative materials.

OBJECTIVE: To determine the effects of conventional cigarette smoking (CS) and recent heated tobacco products (HTPs) on the surface roughness and color stability of different indirect restorative materials. MATERIALS AND METHODS: One hundred disc-shaped samples were constructed of three different restorative CAD/CAM materials: lithium disilicate glass-ceramic (IPS e.max CAD; Ivoclar Vivadent, Liechtenstein), zirconia (BruxZir® Zirconia, Glidewell, USA) and polyetheretherketone (BioHPP® bredent GmbH, Germany). Of the IPS e.max CAD and the Bruxzir samples, 20 samples were glazed, and 20 samples were polished, while the BioHPP samples were all polished according to the manufacturer's instructions. Fifty samples were subjected to conventional cigarette smoking (LM, Philip Morris International Inc., Egypt) (Groups: IPS e.max CAD_Glazed exposed to CS (LD_G_Cig), IPS e.max CAD_Polished exposed to CS (LD_P_Cig), Bruxzir_Glazed exposed to CS (Zr_G_Cig), Bruxzir _Polished exposed to CS (Zr_P_Cig) and BioHPP exposed to CS (PEEK_Cig) and fifty samples were exposed to heated tobacco product smoking (Heets, Russet selection, Philip Morris International Inc., Italy) (Groups: IPS e.max CAD_Glazed exposed to HTP (LD_G_HTP), IPS e.max CAD_Polished exposed to HTP (LD_P_HTP), Bruxzir_Glazed exposed to HTP (Zr_G_HTP), Bruxzir CAD_Polished exposed to HTP (Zr_P_HTP) and BioHPP exposed to HTP (PEEK_HTP).. Six hundred cigarettes/heets representing 30 days of medium smoking behavior (20 cigarettes/day) were used. Before and after exposure to smoke, the surface roughness of all the samples was measured using JITAI8101 surface roughness tester (Beijing Jitai Tech Detection Device Co., Ltd, China, and the color parameters were assessed using VITA Easyshade Advance 4.01 (VITA shade, VITA made, VITA). The data were analyzed using One-way ANOVA, paired sample t-test and independent sample t-test. The significance level was set at α < 0.05. The surface topography was evaluated by scanning electron microscopy (SEM) and analyzed using energy-dispersive X-ray (EDX) spectroscopy to determine changes in the surface chemical composition. RESULTS: Both types of smoking caused significant increases in the surface roughness of all the samples. There was a significant difference in color change between CS and HTP for all materials with different surface finish (P < 0.01) and zirconia had the greatest effect on color change (P < 0.001). In contrast, polyetheretherketone (PEEK) "BioHPP" had the least effect (P < 0.001). CONCLUSION: Exposure to different types of smoking induce changes in the surface topography and color of different esthetic restorative materials. Compared with HTP, conventional cigarette smoke has a greater effect on the surface roughness and color stability of esthetic restorative materials. The glazed surfaces showed less change in surface topography than did the polished surfaces. Zirconia showed better color stability when compared to polyetheretherketone (PEEK).

Considerations for oral and dental tissues in holistic care during long-haul space flights.

The health of astronauts during and after the return from long-haul space missions is paramount. There is plethora of research in the literature about the medical side of astronauts' health, however, the dental and oral health of the space crew seem to be overlooked with limited information in the literature about the effects of the space environment and microgravity on the oral and dental tissues. In this article, we shed some light on the latest available research related to space dentistry and provide some hypotheses that could guide the directions of future research and help maintain the oral health of space crews. We also promote for the importance of regenerative medicine and dentistry as well highlight the opportunities available in the expanding field of bioprinting/biomanufacturing through utilizing the effects of microgravity on stem cells culture techniques. Finally, we provide recommendations for adopting a multidisciplinary approach for oral healthcare during long-haul space flights.

Balancing Risks versus Benefits: Vitamin C Therapy versus Copper Oxide Nanoparticles Toxicity in Albino Rats' Submandibular Salivary Gland.

OBJECTIVES: This study aimed to examine the suppressive effect of the natural antioxidant vitamin C (VC) against submandibular gland toxicity induced by copper oxide nanoparticles (CuO-NPs). MATERIALS AND METHODS: Three groups of 30 mature male albino rats (4 weeks old) weighing between 150 and 200 g were selected. The rats were randomly assigned for 6 weeks to receive: intraperitoneal injection (IP) of vehicle (control group); IP of 2.5 mg/kg body weight (bw) of CuO-NPs (CuO-NPs group); and IP of 2.5 mg/kg bw of CuO-NPs, combined with a daily oral dose of 100 mg/kg bw of VC in drinking water via gavage (CuO-NPs/VC group). The rats were euthanized, and their submandibular glands were dissected for histological evaluation, including hematoxylin and eosin staining and immunohistochemistry for Ki-67 and caspase-3. STATISTICAL ANALYSIS: The area expression for Ki-67 and caspase-3 was statistically analyzed using GraphPad Prism. Following analysis of variance analysis, Tukey's post hoc was used for multiple comparisons. The significance level was set at p < 0.05. RESULTS: CuO-NPs caused significant cytotoxic effects on submandibular salivary gland cells in albino rats. This led to an increase in Ki-67 and caspase-3 levels compared with the control group. VC administration improved tissue histology and reduced Ki-67 and caspase-3 levels in the VC/CuO-NPs group compared with rats treated with CuO-NPs alone. CONCLUSION: The study revealed significant cytotoxic effects of CuO-NPs on the submandibular salivary gland of albino rats. VC effectively mitigated these toxic effects, suggesting its potential as a readily available antioxidant.

Effect of Acidic Media on Surface Topography and Color Stability of Two Different Glass Ceramics.

OBJECTIVE: The aim of this study was to determine the effect of two acidic beverages (orange juice and H3PO4-containing fizzy drink) on the surface topography and color stability of two commonly used computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials. MATERIALS AND METHODS: Sixty samples of two CAD/CAM ceramic materials, lithium disilicate (IPS e-max CAD) and zirconia reinforced lithium silicate (Vita Suprinity), were prepared according to the manufacturer's instructions. The samples were immersed in one of three media (artificial saliva, orange juice and H3PO4-containing fizzy drink) and then stored in an incubator at 37 °C for 24 hours). Before and after immersion in different media, the surface roughness (Ra) of the samples was assessed using profilometer (JITAI8101 Surface Roughness Tester-Beijing Jitai Tech Detection Device Co. Ltd, China) and the color parameters were measured using VITA Easyshade Advance 4.01 (VITA shade, VITA made, VITA). Surface topography was observed using scanning electron microscope (SEM) and surface mineral content was compared before and after immersion. Paired sample t-test was used to determine the change in Ra before and after immersion. Two-way analysis of variance was used to determine the effect of different CAD/CAM materials and immersion media on the mean ∆Ra and mean ∆E of the studied groups. Tukey's honest significant difference posthoc test was used for multiple comparisons at a level of significance (α = 0.05). RESULTS: A significant increase in Ra and a decrease in the color stability of the two investigated ceramic materials were detected after immersion in the acidic media than in artificial saliva. SEM and energy-dispersive X-ray results revealed the dissolution of the glassy matrix and the exposure of silicate crystals. CONCLUSION: The surface topography and color stability of glass ceramics are affected by the pH of different acidic media.

Effect of Two Different Intraoral Polishing Systems on Surface Roughness, Color Stability, and Bacterial Accumulation of Zirconia-Reinforced Lithium Silicate Ceramic.

OBJECTIVE: The aim of this study was to investigate the effects of two intraoral polishing methods on zirconia-reinforced lithium silicate ceramic after ultrasonic scaling. MATERIALS AND METHODS: Thirty disc-shaped samples of zirconia-reinforced lithium silicate were constructed. Freshly extracted bovine teeth were collected and cleaned then the discs were cemented into a cavity prepared onto their labial surface. The samples were divided into three groups (10 samples per group); S: Scaling only, SE: Scaling followed by polishing using Eve Diapro lithium disilicate polishers, SD: Scaling followed by polishing using Diatech ShapeGuard ceramic polishing plus kit. The surface roughness was evaluated after scaling and polishing the samples. For color stability, the samples were stored for 12 days at 37°C in an incubator to simulate 1-year consumption of coffee. L*a*b* color parameters were assessed using VITA Easyshade Advance 4.0 before and after the staining procedure and the color difference was measured. Finally, bacterial accumulation was evaluated by incubating the samples with a suspension of Streptococcus mutans ( S. mutans), after that the S. mutans colonies were counted to obtain the values of colony-forming units (CFU). The final overall roughness, change in color and bacterial count were compared between all groups using one-way ANOVA and Tukey's post-hoc analysis. The Pearson correlation coefficient was used to determine the correlation between continuous variables. The cutoff for significance was chosen at p ≤ 0.05. RESULTS: Scaling induced surface roughness of the zirconia-reinforced lithium silicate ceramic was significantly decreased after using both intraoral polishing systems and this was accompanied by a significant decrease in color change and bacterial count. CONCLUSION: Intraoral polishing techniques can reduce the roughness of the surface of zirconia reinforced lithium silicate restorations induced due to scaling and subsequently reduce the stainability and bacterial accumulation.

Effect of pulp capping materials on odontogenic differentiation of human dental pulp stem cells: An in vitro study.

OBJECTIVES: Migration and differentiation of human dental pulp stem cells (hDPSCs) is a vital and key factor in the success of reparative dentin formation for maintenance of pulp vitality. Pulp capping materials are used to stimulate DPSCs to induce new dentin formation. Thus, the aim of the present study was to compare the response of DPSCs to four commercially available pulp capping materials: a bioactive bioceramic (Material 1), a nonresinous ready-to-use bioceramic cement (Material 2), a bioactive composite (Material 3), and a biocompatible, dual-cured, resin-modified calcium silicate (Material 4). MATERIALS AND METHODS: hDPSCs were isolated and cultured from freshly extracted teeth and were then characterized by flow cytometry and multilineage differentiation. Discs prepared from pulp capping materials were tested with hDPSCs and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, cell migration assay and odontogenic differentiation assay was performed. Expression of osteogenic markers (osteopontin, RUNX family transcription factor 2, osteocalcin) and the odontogenic marker (dentin sialophosphoprotein) was detected using reverse transcription-polymerase chain reaction. RESULTS: Materials 1, 2, and 3 generated more cell viability than Material 4. Furthermore, Material 4 showed the least wound exposure percentage, while Material 3 showed the highest percentage. Enhanced mineralization was found in hDSCPs cultured with Material 3, followed by Material 1, and then Material 2, while Material 4 revealed the least calcified mineralization. CONCLUSIONS: The results of this study were inconclusive regards contemporary bioceramic materials designed for vital pulp therapy as they have different effects on hDPSC. Further testing for cytotoxicity using live-dead staining, animal experiments, clinical trials, and independent analyses of these biomaterials is necessary for clinicians to make an informed decision for their use.

Management of hormonal induced recurrent ulcerative fibrous epulis with osseous metaplasia: A case report.

Key Clinical Message: Understanding the role of hormones in periodontitis is important. Periodontal microscopic surgery approach in the treatment of fibrous epulis is not indicated. Wider flap access with root planning is indicated to control the lesion in one phase. Abstract: We present a case of a 40-year-old female who presented with a gingival hyperplastic lesion around the maxillary left permanent central and lateral incisors. Patient's medical history reveals a recent pregnancy, hypothyroidism, ulcerative colitis, and schizoaffective disorder. All medical conditions were controlled by medications. The lesion was excised using a minimally invasive periodontal surgical technique, and the biopsy results confirmed a diagnosis of ulcerative fibrous epulis with osseous metaplasia. No curettage or local debridement was done under the assumption that the patient's oral hygiene was satisfactory and due to aesthetic concerns of gingival recession and creation of black triangles. The lesion recurred after 3 months and was removed using a traditional more invasive surgical technique. The patient was followed up for 2 years, and there was no further recurrence due to the complete excision of the lesion in the second surgery and the disappearance of the hormonal-related factors post-pregnancy that could have contributed to the gingival hyperplasia. The unique component of the case we are presenting is the comparison between two different surgical techniques and the conduction versus absence of local periodontal debridement after surgical excision as well as the possible correlation between oral supplements and the calcific nature of the lesion(s) reported. The case we present demonstrates that a more invasive traditional surgical approach together with local periodontal therapy provide an optimum treatment outcome in conjunction with elimination of any associated etiological factors. We also propose that hormones are more important as an etiological factor in developing fibrous epulis lesions than medical conditions and medications.

Attenuating Effect of Vitamin E against Silver Nano Particles Toxicity in Submandibular Salivary Glands.

Silver nanoparticles (AgNPs) are extensively used in many industries due to their superior antimicrobial properties. However, it is evident from many studies that AgNPs has cytotoxic potential through its effect on excessive formation of reactive oxygen species (ROS). The aim of this study was to examine the toxic effect of AgNPs on the submandibular salivary glands and the attenuating effect of vitamin E, as a natural antioxidant, against this toxicity. Thirty Albino rats were divided into 3 groups (n = 10): control group, AgNPs group receiving 2 mg/kg daily for 28 days, and AgNPs and vitamin E group receiving AgNPs the same as the previous group in addition to vitamin E at a dose of 100 mg/kg. Microscopic, ultrastructural, and cytokeratin immune-reactivity examination of the glands were performed. The AgNPs group showed noticeable degeneration in all structures of the gland as evident in the histological and ultrastructural examination. The AgNPs and vitamin E group revealed an improvement of the glandular elements. A significant increase in cytokeratin immune expression was found after comparison of both groups (p = 0.01). This current study shows that vitamin E has powerful antioxidant properties, which can combat the cytotoxic effect caused by AgNPs. Further studies are deemed necessary to confirm this finding using other immunohistochemical markers, such as myosin and E-cadherin.

Influence of different types of whitening tooth pastes on the tooth color, enamel surface roughness and enamel morphology of human teeth.

Background: Tooth whitening usually includes the direct use of gels containing carbamide or hydrogen peroxide on the tooth enamel surface through a wide variety of products formulas. A generally new advancement in whitening of teeth uses the significant importance of the tooth color shift from yellow to blue in delivering a general enhancement in the observation of tooth whiteness. The aim of the current work was to measure the tooth whitening effects, surface roughness and enamel morphology of six different types of blue covarine-containing and blue covarine-free toothpastes using in vitro models. Methods: A total of 70 sound extracted human premolars were randomly and equally divided into seven groups, and each subjected to tooth brushing using different toothpastes. Tooth color and enamel surface roughness were measured before and after the brushing procedure using a white light interferometer, and scanning electron microscopy (SEM) was used to assess tooth surface after the procedure. Results: Toothpaste containing blue covarine resulted in the greatest improvement in tooth color amongst all groups as well as a statistically significant color difference when compared to blue covarine-free toothpaste.  Furthermore, blue covarine-containing toothpaste resulted in fewer morphological changes to the enamel surface. This was confirmed with SEM images that showed smooth enamel surfaces with fine scratches.   Conclusions: The results from the present study show that blue covarine containing toothpastes are reliable, effective in tooth whitening and produce less surface abrasion when compared to blue covarine-free toothpastes.