Staged Approach of Frenectomy Followed by Modified Tunnel and Subepithelial Connective Tissue Graft in Single Mandibular Anterior Recessions: A Clinical Report of Three Cases.

This case report proposes a unique approach for managing Cairo gingival recession types 1 and 2 (RT1 and RT2, respectively) in the mandibular anterior region, where anatomical features such as a high frenal attachment or a shallow vestibule preclude the use of a coronally advanced flap. Three systemically healthy patients presenting with Cairo RT1 and RT2 gingival recessions were included. The recessions were managed with a staged approach of frenectomy followed by a modified tunnel in combination with connective tissue graft. Significant root coverage was achieved in all three cases. This treatment approach allows for root coverage, relief of frenal pull, keratinized tissue gain, and increased vestibular depth in very challenging Cairo RT1 and RT2 gingival recessions in mandibular anterior teeth. A short-term follow-up of 3 to 6 months showed stable results in all presented cases.

Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: A randomized controlled trial.

BACKGROUND: Many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) never develop substantial symptoms. With more than 34 million people in the United States already infected and highly transmissible variants rapidly emerging, it is highly probable that post- and presymptomatic people will form an important fraction of those seeking dental care. Salivary carriage rates in these populations are not known. Moreover, although preventing transmission is critical for controlling spread, the efficacy of mouthrinses in reducing oral viral load is poorly studied. METHODS: The authors recruited 201 asymptomatic, presymptomatic, postsymptomatic, and symptomatic people and measured copy numbers of SARS-CoV-2 in unstimulated saliva using real-time reverse transcriptase quantitative polymerase chain reaction. Subsequently, the authors inducted 41 symptomatic people into a randomized, triple-blinded study and instructed them to rinse with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, or 0.5% povidone-iodine for 60 seconds. The authors measured viral load 15 and 45 minutes after rinsing. RESULTS: Salivary SARS-CoV-2 was detected in 23% of asymptomatic, 60% of postsymptomatic, and 28% of presymptomatic participants. Neither carriage rate nor viral load correlated with COVID-19 symptomatology, age, sex, or race or ethnicity. All 4 mouthrinses decreased viral load by 61% through 89% at 15 minutes and by 70% through 97% at 45 minutes. The extent of reduction correlated significantly with initial viral load. CONCLUSIONS: Nonsymptomatic people can pose a risk of transmitting the virus, and mouthrinses are simple and efficacious means of reducing this risk, especially when the load is less than 104 copies per milliliter. PRACTICAL IMPLICATIONS: At a time when resources are stretched, the findings of this study contribute to evidence-based selection of personal protection equipment and simple infection-control practices to reduce contagion at source. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04603794.

A cross-species interaction with a symbiotic commensal enables cell-density-dependent growth and in vivo virulence of an oral pathogen.

Recent studies describe in detail the shifts in composition of human-associated polymicrobial communities from health to disease. However, the specific processes that drive the colonization and overgrowth of pathogens within these communities remain incompletely understood. We used in vitro culture systems and a disease-relevant mouse model to show that population size, which determines the availability of an endogenous diffusible small molecule, limits the growth, colonization, and in vivo virulence of the human oral pathogen Porphyromonas gingivalis. This bacterial pathogen overcomes the requirement for an endogenous cue by utilizing a cell-density dependent, growth-promoting, soluble molecule provided by the symbiotic early colonizer Veillonella parvula, but not produced by other commensals tested. Our work shows that exchange of cell-density-dependent diffusible cues between specific early and late colonizing species in a polymicrobial community drives microbial successions, pathogen colonization and disease development, representing a target process for manipulation of the microbiome towards the healthy state.

Periodontal Disease in the COVID-19 Era: Potential Reservoir and Increased Risk for SARS-CoV-2

Abstract Since December 2019, an outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and is now becoming a global Pandemic, with over 10.5 million cases worldwide. Angiotensin-converting enzyme-2 (ACE-2) has been considered the main receptor for the SARS-CoV-2 entry into human cells, and they are known to be present not only in lungs (therefore the common viral pneumonia) but also in nasopharyngeal mucosa, salivary cells and oral epithelial cells. Moreover, there seems to be recent evidence showing that the crevicular fluid on the periodontal pockets of patients presenting periodontitis could harbor SARS-CoV-2 and act as a potential reservoir for increased viral load in the oral cavity of COVID-positive patients. Additionally, sites with active periodontal disease might contribute for virus binding and tissue infection due to elevated expression of furin and cathepsin L proteases, which play a major role in enabling the SARS-CoV-2 to bind ACE-2 receptors and facilitating endosomal fusion in the host cells. Taken together this news and views article highlight possible virus reservoirs in COVID-positive patients, as well as increased risk for infection in patients with active periodontal disease, further proposing potential targets for antiviral intervention on SARS-CoV-2 infection.

An unusual presentation of generalized aggressive periodontitis with multiple impacted supernumerary teeth.

Aggressive periodontitis is a rare condition that progresses rapidly but affects only a small percentage of population. Most of the cases are familial. The presence of supernumerary teeth is also rather rare and often familial. Therefore, a concomitant presentation of aggressive periodontitis and supernumerary teeth in an individual has generated a great interest among clinicians. Here, we report a rare nonsyndromic case of generalized aggressive periodontitis with multiple impacted supernumerary teeth.