Oral health-related quality of life in elderly: an umbrella review of systematic reviews from a multidisciplinary rehabilitation point-of-view.

Background: Poor oral health is highly prevalent among elderlies and may impact quality of life of elderly people. In this scenario, oral health has been often linked to general health and chronic disorders, including distinct features of frailty. The aim of the present umbrella review of systematic reviews was to assess the scientific literature on the correlation between oral health related quality of life (OHRQoL) and elderly to present a multidisciplinary approach to these complex patients. Methods: We performed a literature search of the databases Pub-Med/Medline, Scopus, Web of Science, and Physiotherapy Evidence Database electronic databases. Two independent reviewers performed the literature research from the inception to 25th November 2023 and screened the studies for eligibility. Results: The search resulted in a total of 676 results eligible articles. After removal of duplicates and full-text screening, a total of 3 systematic reviews were considered to meet the inclusion criteria and were included for this review. Conclusions: Frailty is very common in elderly such as a poor oral health. In this scenario, malnutrition and bad lifestyle habits may affect not only the determinism of many systemic non-communicable diseases but also oral health quality. Taken together, the findings of this umbrella review of systematic reviews showed a strict correlation between the frailty, typical condition of ageing people, and a poor OHRQoL. Therefore, it is mandatory to implement the oral health prevention with specific protocols of oral rehabilitation to improve the OHRQoL in elderly.

Chemical-physical characteristics of artificial saliva substitutes: rheological evaluation.

OBJECTIVE: We aimed at evaluating some chemical-physical properties of artificial saliva substitutes easily available on the E.U. market, such as viscosity, pH, buffering capacity, superficial tension, density and spinnbarkeit and to compare the results with human natural saliva bibliographic data. MATERIALS AND METHODS: Based on the easy availability on the market, twelve artificial saliva solutions in liquid formulation were analyzed. Kinematic viscosity (cSt) was determined using a micro-Ubbelohde model capillary viscosimeter (ViscoClock, SCHOOT-GERATE Mainz, Germany). Dynamic viscosity (mPas) was determined, through a simple multiplication between density (g/cm3) and kinematic viscosity of each solution. pH analyses were carried out at room temperature using a pH-meter (Mettler Toledo®- Five Easy, Columbus, OH, USA). Spinnbarkeit analysis was performed by a self-owned instrument built for the purpose. RESULTS: The median density value, obtained from the cohort of artificial saliva substitutes, was 1.036 g/cm3. The median value of the kinematic viscosity was 8.984 cSt. The median spinnbarkeit value was 3.2 mm and the median pH value was 6.29. In this study we found an almost linear correlation between the kinematic viscosity and spinnbarkeit values of the artificial saliva substitutes evaluated. CONCLUSIONS: Saliva substitutes should be as faithful as possible to the characteristics of human saliva, in order to completely replace its functions in the oral cavity. Nevertheless, despite several R&D efforts, it is difficult to reproduce all the different features that belongs to natural saliva in one device. Therefore, it would be desirable to create more products reproducing saliva with various rheological characteristics in respect of the main salivary functions such as: chewing, speaking and tissue coating.

Changes in salivary flow rate and pH in pregnancy.

OBJECTIVE: To evaluate changes in pH and Flow Rate (FR) of the Unstimulated Whole Saliva (UWS) in a sample of pregnant women in different gestational periods. PATIENTS AND METHODS: After collecting demographic data and medical histories, as well as conducting an oral examination, a sample of pregnant women were instructed on how to prepare prior to the sample collection. At a time between 11.00 and 12.00 a.m., they were subjected to salivary collection (spitting method, time 5 minutes); the measurement of FR was carried out using a professionally calibrated precision scale and the pH with a portable pH meter. RESULTS: The average FR of the women's detected sample (0.40 ± 0.20 ml/min) was lower than that of non-pregnant women (0.48 ± 0.15 ml/min) of the same age (p <0.05). We observed an increase (p <0.001) of FR in the first trimester (0.56 ± 0.20 ml/min) compared to second (0.34 ± 0.14 ml/min) and third (0.31 ± 0.14 ml/min) trimester. The salivary pH of pregnant women was lower than the one detected in the non-pregnant women's sample (p <0.0001). CONCLUSIONS: Our study highlighted an increase in the FR in the first trimester compared to that detected in the second and third trimesters of pregnancy which viceversa was lower than the average FR in non-pregnant women. This data, combined with the decrease in salivary pH, supports the hypothesis that correlates the FR increase with the attempt to counter the decrease in pH due to gastric regurgitation frequent in the first trimester. Further studies are necessary to evaluate salivary FR and pH in pregnant women samples related to the emesis phenomenon.

A multicenter observational study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in advanced cancer and myeloma patients of a cancer network in North-Western Italy.

BACKGROUND: Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myeloma treatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated populations. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Network ("Rete Oncologica Piemonte e Valle d'Aosta"), to assess number and main characteristics of MRONJ cases among myeloma/cancer patients, within a population of 4.5 million inhabitants. MATERIAL AND METHODS: MRONJ cases were collected retrospectively from January 2009 to June 2015; from July 2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlying disorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed. RESULTS: 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%), myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399; 88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenic drugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 cases per year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence: 7.5/million/year). CONCLUSIONS: With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases per year are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher than those reported in other populations.

Platelet rich plasma-derived microvesicles increased in vitro wound healing.

OBJECTIVE: Platelet rich plasma (PRP) is a haemoderivative used in clinical practice for the treatment of hard-to-heal wounds. Platelet (PLT) activation is a key factor in the wound healing process leading to the production of extracellular vesicles. We obtained PRP and PRP-derived microvesicles (PLT-MVs) from healthy donors and compared their pro-healing efficacy in an in vitro wound model using human keratinocytes. MATERIALS AND METHODS: We evaluated PLT-MVs' direct effect on an in vitro model of wound healing. PRP, PRP activated using calcimycin, and PLT-MVs separated by high speed centrifugation were added to scratched keratinocyte monolayers. Fluorescein diacetate was used in flow cytometry to distinguish PLTs and PLT-MVs from debris, and then, PLT-MVs were quantified on the basis of relative dimensions (Forward Scatter signals). RESULTS: Wound areas were measured at time 0 and after 24 hours and they were healed by 24.80 ± 4.28% in control conditions, while PRP, activated PRP, and PLT-MVs increased closure of 62.94 ± 0.96%, 52.69 ± 17.20% and 52.76 ± 9.44%, respectively. CONCLUSIONS: Our results indicate that PRP pro-healing effects were fully replicable by PLT-MVs, suggesting a key role of microvesicles in the healing process and a possible clinical use as an alternative to PRP.

Laser surgical approach to impacted maxillary incisors: case series and brief review.

OBJECTIVE: Report Authors' clinical case series on impacted maxillary incisors treatment with laser technology. PATIENTS AND METHODS: Studied population was composed by 6 male and 12 female undergoing orthodontic treatments for lack of eruption of 28 upper incisors; eight impacted teeth (4 patients) spontaneously erupted after orthodontic creation of the correct eruptive space. Twenty maxillary incisors were surgically exposed; in 5 patients seven un-erupted incisors were exposed through an apically positioned flap technique; in two patients a guided closed eruption technique was performed on a central and two lateral maxillary incisors; in seven patients laser exposure technique was applied on ten incisors. All impacted teeth resulted correctly aligned at the end of therapy. RESULTS: Impaction of incisors is not a frequent event in dental practice. The positioning of the incisors was obtained by creating the eruptive space and aligning the un-erupted teeth with orthodontic treatment or after removing any obstacle or after their exposure with different surgical methods. In all patients the treatment allowed the restoration of both the aesthetic and function aspect of the stomatognathic apparatus. CONCLUSIONS: In this case load, patients undergoing exposure of the dental crown using diode laser showed the best postoperative course.

Charged molecular silica trigger in vitro NETosis in human granulocytes via both oxidative and autophagic pathways.

OBJECTIVE: Neutrophils play a key role in immunity and are known to respond to exogenous threats by releasing neutrophil extracellular traps (NETs) through NETosis, a process involving the release of neutrophils nuclear DNA decorated with proteins into the extracellular space. In this study, attention has been focused on the ability of differently charged molecular systems polyhedral oligomeric silsesquioxanes (POSS) to induce NETosis. MATERIALS AND METHODS: NETs formation was induced by phorbol myristate acetate (PMA) (positive control) and POSS treatment and visualized by confocal microscopy. Moreover, NETs production was quantified by Sytox green staining. Oxidative stress, autophagy as well as endocytosis involvement in the observed phenomena was evaluated by a specific inhibitory approach. RESULTS: Results obtained in this study demonstrate a POSS time and dose-dependent ability in inducing NETs release irrespectively to their charge. POSS induced NETosis is a consequence of their internalization, as demonstrated by the strong reduction in NETs formation after endocytosis inhibition. Moreover, POSS induced NETosis involves both an increase in superoxide anion generation and autophagy pathway activation as demonstrated by the protective effect displayed by sodium azide and wortmannin. CONCLUSIONS: Data presented in this study indicate that nanomaterials and molecular systems could have a role in the onset of inflammatory phenomena.

Epiregulin-loaded PLGA nanoparticles increase human keratinocytes proliferation: preliminary data.

OBJECTIVE: Epiregulin is a member of the epidermal growth factor (EGF) family produced by keratinocytes: the aim of this study was to investigate the ability of biocompatible nanoparticles loaded with such growth factor to increase human keratinocytes proliferation. MATERIALS AND METHODS: Different PLGA (Poly-d,l-lactide-co-glycolide)-nanoparticles (NPs) formulations have been characterized in size and zeta potential by dynamic light scattering (DLS) analysis. The ability of the different PLGA-NPs formulations to adhere onto dental surfaces has been tested, and epiregulin-enriched PLGA-NPs has been produced. Epiregulin release from NPs has been tested by enzyme-linked immunosorbent (ELISA) assay and the proliferative effects of epiregulin-NPs on human keratinocytes have been evaluated. RESULTS: DLS analysis revealed a different size distribution depending on the PLA/PGA (poly lactic acid/poly glycolic acid) ratio used. 50:50 PLGA-NPs exhibited the smaller size and the best dental adhesive ability. Moreover, such epiregulin-loaded NPs was able to increase cell proliferation. CONCLUSIONS: Direct dental pocket drug delivery implies the NPs solution loading onto the dental surface at the cement-enamel junction level: 50:50 PLGA-NPs, with their small size and excellent adhesive ability, represent an interesting tool to deliver epiregulin directly where there is the need for epithelial proliferation. These results describe a possible strategy for periodontal pocket delivery of Epiregulin-loaded PLGA-NPs and might provide a new approach for the treatment of gingival recession, where gingival epithelium proliferation is needed.

Pre-odontoblast proliferation induced by near-infrared laser stimulation.

OBJECTIVE: Laser therapy is known to stimulate cell proliferation and differentiation, an effect called "biostimulation". Although many clinical applications of laser therapy take advantage from such positive effect, the underlying molecular mechanisms are not fully understood. The aim of this work was to investigate the effect of near-infrared laser stimulation on rat pre-odontoblast cells (MDPC-23 cells) and the molecular mechanism/s involved. MATERIALS AND METHODS: MDPC-23 cells were stimulated with a near-infrared (980 nm) laser source with different energy settings (1-50 J, corresponding to 0.65-32.47 J/cm2) and cell proliferation was evaluated by manual count. ERK 1/2 pathway activation was evaluated by Western blot analysis. RESULTS: 1-10 J stimulation (corresponding to 0.65-6.5 J/cm2) significantly increase MDPC-23 cell proliferation and such effect seems to be mediated by ERK 1/2 signalling pathway activation, showing a key role of ERK 1/2 pathway in mediating the proliferative response induced by laser stimulation. CONCLUSIONS: Near infrared laser stimulation with low energies (1-10 J) is able to increase cell proliferation through ERK 1/2 signalling pathway activation. At the same time, higher energy stimulation (25-50 J) induces an initial toxic effect, probably activating pro-apoptotic signalling molecules, downstream ERK 1/2 kinase. Such results foster the application of this therapeutic approach in different clinical settings in which a regenerative tissue response is needed.

Daily and annually variation of unstimulated whole saliva flow rate and pH and their relation with body profile in healthy young adults.

AIM: To analyse pH and flow rate (FR) of unstimulated whole saliva (UWS), detecting their possible correlations both among themselves and with body profile; in addition to identify daily, annually and gender differences. MATERIALS AND METHODS: Eighty-one (47 ♀; 34 ♂) healthy young adults (mean age 22.7±4.09 years old) were enrolled. Saliva was sampled using spitting method. The data were statistically analysed using Pearson's coefficient, ANOVA or Kruskal-Wallis test, Student's t test or the Wilcoxon-Mann-Whitney test. RESULTS: The mean UWS/FR was 0.643 ml/min (range 0.164-1.656 ml/min; percentile 25 = 0.400 ml/min; percentile 50 = 0.643 ml/min, percentile 75 = 0.832 ml/min; median = 0.590 ml/min) and no significant differences were found in gender. The mean UWS/pH was 6.95 (range 6.06-7.91, S.D. 0.28, RSD % 4.08): pH was higher in males (7.02) than females (6.92; p = 0.009). The UWS/FR increased almost steadily during the day: from 0.593 ml/min at 9:00 to 0.669 ml/min at 17:00 (p = 0.04), the greatest increase was found between 9:00 and 11:00. Through the seasons the UWS/FR decreased from summer to spring with a difference of 0.048 ml/min (p < 0.05). The UWS/pH showed a slight increase between 9:00 and 17:00 (p < 0.05). There were little differences in UWS/pH among the seasons (max. 0.09; p < 0.05). Only a significant correlation between UWS/FR and pH was found (R = 0.20; p = 0.008). CONCLUSIONS: We did not find correlations between body profile vs UWS/FR or pH. UWS/FR varies more widely than UWS/pH: maintaining a proper acid/base balance is an essential factor for the homeostasis of the oral cavity and probably this would explain the reason for the lack of the variables evaluated influencing UWS/pH.

Oral and non oral diseases and conditions associated with bad breath.

AIM: The causes of bad breath are numerous and related to conditions dependent or not on oral and general health. The aim of our observational study is the assessment of the simultaneous relationships between halitosis, oral and/or nonoral diseases, and lifestyles using the principal components analysis of categorical data (CATPCA) to identify the main components involved in the detection of the symptom. METHODS: A sample of 192 patients, who requested general dental examination at the Dental Clinic, participated at the study. Alimentary and voluptuary habits, general health information, drugs assumption, the status of teeth and intraoral medical devices including fillers, lesions of the oral mucosa, tongue coating score (TCS), plaque index (PI), probing bleeding index (PBI) and organoleptic tests were all evaluated. Data were analysed using CATPCA model. RESULTS: A strong relationship between halitosis and plaque, probing bleeding and tongue coating indexes was observed, whereas incongruous fillers, prostheses, systemic pathologies or diet were not clearly associated with halitosis probably because their effects on breath were clinically sheltered by the periodontal condition. CONCLUSION: The data of our observational study confirm that halitosis is more indicative of tongue coating and periodontal disease, rather than other oral and non oral associated conditions, like systemic pathologies or specific habits of life.

Descending necrotizing mediastinitis. Two cases consequent on odontogenic infections and a review of literature.

Mediastinitis is a frequently-fatal infection of the connective tissue that surrounds the mediastinal organs. The principal causes are perforation of the oesophagus or infections following thoracic surgery with sternotomy, but it may also occur as a rare but dangerous complication of oropharyngeal or cephalic infections that, spreading through the fascias of the cervical spaces, reach and infect the connective tissue present in the mediastinum and between the pleura. The chief cause of the high rate of mortality still carried by this disease is the poor understanding of this possible complication of oro-facial infections (sometimes initially trivial) and the consequent delay in diagnosis and failure to provide adequate therapy. Mediastinal infections of odontogenic aetiology is a rare occurrence but its management requires an early diagnosis and an aggressive surgical treatment. So all the dentists and the oral surgeons should consider the possibility of onset of this dangerous complication also of banal infections of mandibular molars. The aim of this article is to review the literature, and to report two cases of patients whom, following on to odontogenic infections originating from molars in the mandibular arch, developed an odontogenic cervical abscess complicated by pleural effusion, mediastinal empyema and septic shock, with severe risk of a fatal outcome.

[Work-related musculoskeletal diseases in dental professionals. 1. Prevalence and risk factors]. / Disturbi muscolo-scheletrici di natura lavorativa negli operatori sanitari dentali. 1--Prevalenza e fattori di rischio.

The past two decades have witnessed a sharp rise in the incidence of work-related musculoskeletal disorders (WMSD). All occupations are involved; in dental professionals (dentists, dental hygienists and dental auxiliaries) this problem occurs in 54-93% of subjects, with higher risk in elderly subjects and women. Spine, shoulder, elbow and hand are mostly involved. Prevention of WMSD is becoming crucial and requires the identification and modification of risk factors. Individual characteristics of the worker--such as gender, age, stature, physical condition, strength, etc.--may contribute to the occurrence of these musculoskeletal disorders. Moreover, the specific occupation and work organisation may be the source of ergonomic hazards. Awkward postures, prolonged repetitive movements, intense work schedules or fast work pace represent important risk factors for WMSD. Sometimes the dentist's workstation is not suited to the specific professional characteristics and an ergonomic improvement is needed. Finally, factors connected with professional equipment (such as vibrations, or sharp and hard surfaces causing pressure points) may also contribute to generating WMSD in dental professionals.

[Work-related musculoskeletal disorders in dentistry professionals. 2. Prevention, ergonomic strategies and therapeutic programs]. / Disturbi muscolo-scheletrici di natura lavorativa negli operatori sanitari dentali. 2--Prevenzione, strategie ergonomiche e programmi terapeutici.

In dental professionals the risk of developing work-related musculoskeletal disorders (WMSD) can be minimized through a combination of prevention, ergonomic strategies, and specific therapeutic programs. Prevention includes early identification of symptoms, analysis of working posture and activity, and the evaluation of equipment (such as dental instruments, position of the dental unit, patient and operator chairs, and lighting). The ergonomic strategies are based on identifying the best daily timetable (including periodic pauses) and most efficient team organization, as well as establishing the correct position that should be held at the patient chair. Finally specific therapeutic programs are very important in preventing or treating WMSD. In fact, fitness exercises such as mobilization, stretching or muscular and cardiovascular training are recognized as fundamental for dental professionals, and when WMSD occurs physiatric care and physical therapy are recommended.

Desmoplastic fibroma of the mandible: a case with an unusual clinical presentation.

A new case of desmoplastic fibroma of the mandible is reported. The patient was a 29-year-old woman who presented with a 5-year course of abscess-like lesions simulating a chronic apical infection. Radiographically, a nonspecific, small osteolytic area was observed. A wide resection of the tumor and the neighboring bone was performed.

[The oral aspects of osteogenesis imperfecta. A clinical case report]. / Aspetti orali nella osteogenesi imperfetta. Descrizione di un caso clinico.

The oral symptoms observable in patients with imperfect osteogenesis are described and a clinical case that makes a contribution to our knowledge of a rarely encountered pathology is reported.

[Intra-arterial chemotherapy. Presentation of a method to insure patency of the catheter]. / Chemioterapia endoarteriosa. Presentazione di una metodica per assicurare la pervietà del catetere.

Following some brief remarks on the main techniques of antineoplastic chemotherapy, a simple technique for guaranteeing patency of the endarterial catheter is presented. Using a special microchannel infusor, it was possible to prevent catheter obstruction in 100% of the cases treated.