Porphyromonas gingivalis, a bridge between oral health and immune evasion in gastric cancer.

Porphyromonas gingivalis (P. gingivalis) is a gram-negative oral pathogen associated with chronic periodontitis. Previous studies have linked poor oral health and periodontitis with oral cancer. Severe cases of periodontal disease can result in advanced periodontitis, leading to tissue degradation, tooth loss, and may also correlate with higher gastric cancer (GC) risk. In fact, tooth loss is associated with an elevated risk of cancer. However, the clinical evidence for this association remains inconclusive. Periodontitis is also characterized by chronic inflammation and upregulation of members of the Programmed Death 1/PD1 Ligand 1 (PD1/PDL1) axis that leads to an immunosuppressive state. Given that chronic inflammation and immunosuppression are conditions that facilitate cancer progression and carcinogenesis, we hypothesize that oral P. gingivalis and/or its virulence factors serve as a mechanistic link between oral health and gastric carcinogenesis/GC progression. We also discuss the potential impact of P. gingivalis' virulence factors (gingipains, lipopolysaccharide (LPS), and fimbriae) on inflammation and the response to immune checkpoint inhibitors in GC which are part of the current standard of care for advanced stage patients.

A Diabetic Patient with a Recent History of Flap and Osseous Surgery Presents Back with Bleeding and Infection.

A patient with type II diabetes and renal disease developed infection and bleeding after periodontal osseous surgery. The clinician did not adequately assess the patient's long-term glycemic status or stage of chronic kidney disease (CKD) before initiating osseous surgery. Preoperative assessment of patients with diabetes should include at a minimum an Hba1c within 3 months and estimated glomerular filtration rate for CKD.

Patient with Type I Diabetes Mellitus Develops Post-Operative Hyperglycemia After Osseous Surgery.

A patient with type I diabetes withheld her diabetes medications without consulting her physician and was not able to resume her normal diet after extensive dental surgery resulting in hyperglycemia postoperatively. Clear communication between clinicians and patient about the expected postoperative course and changes to factors that may influence glycemic control could prevent hyperglycemia in the postoperative period.

Dental Management of the Human Papilloma Virus-Related Oropharyngeal Cancer Patient.

Human papilloma virus (HPV)-attributable head and neck cancers (HNCs) are on the rise, impacting younger patients compared with HPV (-) HNC. Fortunately, HPV (+) HNCs are associated with favorable prognoses and tend to be radiosensitive. However, radiation therapy for the treatment of HNC is associated with acute and chronic normal tissue toxicity to salivary glands, muscles, bone, and the oral cavity and presents a treatment challenge. Thus, the prevention of normal tissue injury and optimization of oral health are key. Dental teams are important members of the multidisciplinary cancer team.

An Adolescent Patient Reports to Dental Office for Pain in Relation to Mandibular Molar with an Incidental Palpable Thrill in the Submandibular Region.

A young female patient presents to a dental clinic for treatment of swelling and pain. Clinical examination and testing are completed revealing concomitant, suspected vascular pathology of the head and neck area. An endodontic diagnosis is made, but an unusual clinical finding of a vascular entity, not typically considered by dentists, requires interdisciplinary assessment and management with vascular surgery before surgical intervention of the oral cavity.

Sucesión de entomofauna de interés criminalista en modelo experimental de Cavia porcellus / Succession of entomofauna of criminal interest in experimental model of Cavia porcellus

La Entomología Forense (EF) es una rama de las ciencias médico-legales (Ortloff et al. 2012), que utiliza como herramienta clave a insectos y otros artrópodos que interactúan con un cuerpo en descomposición (Gennard, 2007). El presente estudio se basó en un diseño observacional descriptivo de tipo poblacional, en el que se evaluó la diversidad de dípteros de la familia Calliphoridae y Muscidae en la parroquia rural de Posorja, Guayaquil. En el proceso experimental en los biomodelos A y B, se obtuvo que las temperaturas mínimas diarias presentaron un promedio de 21 °C (entre 20 °C y 22 °C) en lo que respecta a las temperaturas máximas diarias presentaron un promedio de 29,50 °C (entre 26 y 31 °C). En ambos biomodelos experimentales A y B, la exposición directa a los rayos solares y el espacio de liberación abierto contribuyo con el desarrollo de los cambios post mortem de descomposición cadavérica, como son el cromatismo, hinchado, licuefacción y reducción. A la par, de la ocurrencia de la sucesión de dípteros de interés criminalisticos, pertenecientes a las familias Calliphoridae y Muscidae. La importancia de de este acercamiento a la fauna de interés forense dentro de la provincia de Posorja, se muestra en el abanico de oportunidades que abre, con miras a la futura incorporación de la entomología forense en investigaciones criminalísticas en casos de homicidios y negligencias. Sin embargo, todavía eisten numerosas dificultades dificultades para este tipo de estudio en el Ecuador, por lo que se propone divulgar la escala estacional y espacial de de estas investigaciones, a través de convenios que permitan replicarlos en diversas partes del país en distintos ecosistemas y bajo distintas condiciones climáticas(AU)

Forensic Entomology (PE) is a branch of the medico-legal sciences (Ortloff et al. 2012), which uses insects and other arthropods that interact with a decomposing body as a key tool (Gennard, 2007). The present study was based on a descriptive observational design of a population type, in which the diversity of diptera of the Calliphoridae and Muscidae families in the rural parish of Posorja, Guayaquil was evaluated. In the experimental process in biomodels A and B, it was obtained that the minimum daily temperatures presented an average of 21 ° C (between 20 ° C and 22 ° C) with regard to the maximum daily temperatures presented an average of 29, 50 ° C (between 26 and 31 ° C). In both experimental biomodels A and B, direct exposure to sunlight and the open release space contributed to the development of post-mortem changes in cadaveric decomposition, such as chromaticism, swelling, liquefaction and reduction. At the same time, the occurrence of the succession of diptera of criminalistic interest, belonging to the Calliphoridae and Muscidae families. The importance of this approach to the fauna of forensic interest within the province of Posorja is shown in the range of opportunities that it opens up, with a view to the future incorporation of forensic entomology in criminal investigations in cases of homicides and negligence. However, there are still numerous difficulties for this type of study in Ecuador, so it is proposed to disclose the seasonal and spatial scale of these investigations, through agreements that allow replication in different parts of the country in different ecosystems and under different weather conditions(AU)

Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity.

Use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigs), is increasing across the US population and is particularly troubling due to their adoption by adolescents, teens, and young adults. The industry's marketing approach for these instruments of addiction has been to promote them as a safer alternative to tobacco, a behavioral choice supporting smoking cessation, and as the 'cool' appearance of vaping with flavored products (e.g. tutti frutti, bubble gum, and buttered popcorn etc.). Thus, there is a clear need to better document the health outcomes of e-cig use in the oral cavity of the addicted chronic user. There appears to be an array of environmental toxins in the vapors, including reactive aldehydes and carbonyls resulting from the heating elements action on fluid components, as well as from the composition of chemical flavoring agents. The chemistry of these systems shows that the released vapors from the e-cigs frequently contain levels of environmental toxins that considerably exceed federal occupational exposure limits. Additionally, the toxicants in the vapors appear to be retained in the host fluids/tissues at levels often approximating 90% of the levels in the e-cig vapors. These water-soluble reactive toxins can challenge the oral cavity constituents, potentially contributing to alterations in the autochthonous microbiome and host cells critical for maintaining oral homeostasis. This review updates the existing chemistry/environmental aspects of e-cigs, as well as providing an overview of the somewhat limited data on potential oral health effects that could occur across the lifetime of daily e-cig users.

Analysis of clinical oral medicine practices at the University of Pennsylvania: a 5-year retrospective study.

OBJECTIVE: The aim of this study was to characterize oral medicine (OM) clinical practices at the University of Pennsylvania (Penn), determine the importance of OM clinical services, and emphasize aspects of training for OM specialists. STUDY DESIGN: Nonprobability sampling of OM resident patient logs for patients receiving clinical care from 2008 to 2013 was conducted. OM resident patient logs included clinical diagnosis, International Classification of Diseases, ninth edition code, medical history, clinical procedure, Current Procedural Terminology code, attending physician, and resident participation notes. RESULTS: Outpatients in OM medical practices (n = 6024) averaged 1.56 diagnoses from OM specialists. Orofacial pain (45.02%) and oral mucosal diseases (34.28%) comprised the majority of OM diagnoses. The most common procedures were tissue biopsies (59.34%) and treatments for temporomandibular disorders (29.9%). Inpatients (n = 313) comprised 3.46% of Penn OM hospital services, and cardiovascular disorders (38.99%) were the most common admitting diagnoses in this group. In the OM dental practice (n = 1648), 42.05% of patients had a median of 3 medical comorbidities (range = 2-11), of which cardiovascular disorders (27.13%) were most prevalent. CONCLUSIONS: Analysis of Penn OM clinical practices emphasizes the breadth and multidisciplinary nature of OM services and importance of comprehensive postdoctoral training in all domains of OM.

Review of obesity and periodontitis: an epidemiological view.

Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.

Risk factors for caries development in primary Sjogren syndrome.

OBJECTIVES: The aim of this study was to compare the risk factors for caries between patients with primary Sjogren syndrome (SS) and those with non-Sjogren syndrome (NSS) salivary hypofunction and to identify the prevalence of incisal or cervical/root caries in each group. STUDY DESIGN: This was a retrospective, cross-sectional study conducted at a single center between 2012 and 2015 for assessment of patients with possible SS. Two-hundred and twenty-five (225) patients (99 SS and 126 NSS) participated in the study. RESULTS: Student t test and Wilcoxon's rank sum test were used to evaluate group differences in continuous variables and the χ2 test was used to determined differences in categorical variables. Significant univariate associations were further assessed by using multivariate ordinal regression models. Patients with SS were more likely to have a greater number of total caries (odds ratio [OR] 1.72 [1.03-2.88]; P = .04). And a focus score greater than 1/4 mm2 was associated with greater number of total caries (OR 2.88 [1.05, 7.93]; P = .04]. Adjusted analysis for salivary flow did not show a significant association between stimulated or unstimulated salivary flow or glandular-specific salivary flow and the total number of carious lesions. CONCLUSIONS: Patients with salivary hypofunction secondary to SS do have a greater caries risk compared with patients with salivary hypofunction caused by other factors. In this study cohort, this finding was not associated with salivary flow rates.

Oral adverse events associated with targeted cancer therapies.

Over the past decade, targeted therapies have emerged as promising forms of cancer treatment and are increasingly included in chemotherapeutic regimens for an ever-growing list of human cancers. Targeted therapies are so-named due to their specific targeting of dysregulated signaling pathways in cancer cells. This enhanced discrimination between tumor and normal cells is a more promising and efficacious approach to cancer treatment than conventional cytotoxic chemotherapy. However, targeted therapies still have side effects, and some manifest in the oral cavity. Oral adverse events tend to be mild and thus may be overlooked in the context of a patient's overarching diagnosis and management. These oral lesions are often noted during an intraoral examination and identified in the context of the patient's medical history and medication list. It is imperative that the dentist be informed of the oral sequelae of targeted therapies. Many of these side effects can be successfully managed in a palliative manner with conservative therapy. This article discusses the clinical presentations and treatment of intraoral adverse events attributable to the following classes of targeted therapies: epidermal growth factor receptor inhibitors, mammalian target of rapamycin inhibitors, angiogenesis inhibitors, and selected tyrosine kinase inhibitors.

A systematic review of oral herpetic viral infections in cancer patients: commonly used outcome measures and interventions.

PURPOSE: To review the literature for outcome measures for oral viral infections in cancer patients. A secondary aim was to update the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of oral viral infections in cancer patients. METHODS: Databases were searched for articles published in the English language, 1981-2013. Studies that met the eligibility criteria were reviewed systematically. The data about the outcome measures were classified according to the aim of the study: prevention, treatment, or non-interventional. The results of interventional studies were compared to the 2010 MASCC/ISOO publication. RESULTS: Multiple clinical and laboratory tests were used to measure oral viral infections, with great variability between studies. Most of the studies were about Herpes Simplex Virus (HSV). The outcome measure that was most commonly used was the presence of HSV infection diagnosed based on a combination of suggestive clinical presentation with a positive laboratory result. HSV culture was the most commonly reported laboratory outcome measure. Acyclovir and valacyclovir were consistently reported to be efficacious in the management of oral herpetic infections. No new data on the quality of life and economic aspects was found. CONCLUSIONS: Considering the variability in outcome measures reported to assess oral herpetic infections the researcher should select carefully the appropriate measures based on the objective of the study. Acyclovir and valacyclovir are effective in the management of oral herpetic infections in patients receiving treatment for cancer. Studies on newer anti-viral drugs may be useful to address the issue of anti-viral resistance.

The practice of oral medicine in the United States in the twenty-first century: an update.

OBJECTIVE: The aim of this study was to describe the practice characteristics of Oral Medicine trained dentists in the United States. METHODS: This study was a cross-sectional survey of members of the American Academy of Oral Medicine. Patient demographic characteristics, referring providers, medical comorbidities, diagnoses, and practitioner information were collected during a 5-day practice week. The survey was open during the years 2011 and 2012. RESULTS: Information from 916 patients was entered by 74 practitioners from 20 states. The mean number of practitioners seen before consulting Oral Medicine providers was 2.2, and patients had experienced symptoms for 16.8 months before the initial encounter. Common chief complaints were nonulcerative mucosal lesions, orofacial pain, and dry mouth. Patients with cardiovascular disease were at a higher risk of developing lichenoid lesions, and those with psychiatric conditions were at higher risk of reporting burning mouth symptoms. CONCLUSIONS: Diagnoses and procedures performed by Oral Medicine practitioners complement practice characteristics of general and specialty dentists in the United States.

Dental surgery in anticoagulated patients--stop the interruption.

In a literature review, the incidence and morbidity of bleeding complications after dental surgery in anticoagulated patients was compared with embolic complications when anticoagulation was interrupted. Over 99% of anticoagulated patients had no postoperative bleeding that required more than local hemostatic measures. Of more than 5431 patients undergoing more than 11,381 surgical procedures, with many patients at higher than present therapeutic intenational normalized ratio (INR) levels, only 31 (∼0.6% of patients) required more than local hemostasis to control the hemorrhage; none died due to hemorrhage. Among at least 2673 patients whose warfarin dose was reduced or withdrawn for at least 2775 visits for dental procedures, there were 22 embolic complications (0.8% of cessations), including 6 fatal events (0.2% of cessations). The embolic morbidity risk in patients whose anticoagulation is interrupted for dental surgery exceeds that of significant bleeding complications in patients whose anticoagulation is continued, even when surgery is extensive. Warfarin anticoagulation, therefore, should not be interrupted for most dental surgery.

Pediatric soft tissue oral lesions.

This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional.

Management of xerostomia and other complications of Sjögren's syndrome.

This article provides an overview of the published literature in English in the past 63 years involving the management of xerostomia and other oral complications of Sjögren's syndrome. The evidence supporting studied interventions was evaluated using published criteria.