Oral management for a patient with trismus accompanied by Isaacs' syndrome: a case report.

BACKGROUND: Isaacs' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus. CASE PRESENTATION: A patient with trismus due to Isaacs' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient's painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism. CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.

Protective effect of cryotherapy against oral mucositis among allogeneic hematopoietic stem cell transplant recipients using melphalan-based conditioning.

PURPOSE: Oral cryotherapy is an effective method to prevent oral mucositis (OM) induced by chemotherapeutic agents, such as melphalan (Mel). However, there is limited data about cryotherapy in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients; thus, the current study aimed to examine the efficacy of cryotherapy among allo-HSCT recipients treated with Mel-containing regimens. METHODS: Medical records of 78 consecutive allo-HSCT recipients were retrospectively analyzed. Baseline characteristics and clinical courses between the patients who received cryotherapy (cryotherapy group, n = 42) and those who did not (control group, n = 36) were compared, especially focusing on methotrexate (MTX) use as a part of graft-versus-host disease (GVHD) prophylaxis. RESULTS: Binary logistic regression analysis revealed that a higher dose of Mel (OR, 3.82; 95%CI, 1.085-13.46; P = 0.037) or MTX use (OR, 7.61; 95% CI, 2.41-23.97; P < 0.001) was associated with the incidence of OM. MTX use was also significantly associated with the duration of OM (ß = 0.515; 95% CI, 9.712-21.636; P < 0.001). Among 31 patients without MTX use, cryotherapy was associated with a significant reduction of OM development (0% in the cryotherapy group vs 35% in the control group, P = 0.021). We did not find such an association in 47 patients with MTX use. CONCLUSION: Cryotherapy was useful to prevent the incidence of OM in allo-HSCT recipients in the cases without MTX for GVHD prophylaxis.

Disrupted tongue microbiota and detection of nonindigenous bacteria on the day of allogeneic hematopoietic stem cell transplantation.

Disruption of the intestinal microbiota caused by intensive chemotherapy, irradiation and antibiotics can result in development of severe gut graft-versus-host disease and infectious complications, leading to poorer outcomes among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Although the oral cavity is also densely colonized by indigenous microorganisms, the bacterial composition in allo-HSCT recipients remains unclear. We determined the tongue microbiota composition of 45 patients with hematological disorders on the day of transplantation and compared them to 164 community-dwelling adults. The V1-V2 regions of the 16S rRNA gene sequences demonstrated that the allo-HSCT recipients had less diverse and distinct microbiota from that of community-dwelling adults. The full-length 16S rRNA gene sequences identified 146 bacterial taxa in the microbiota of allo-HSCT recipients, of which 34 bacterial taxa did not correspond to bacteria primarily inhabiting the oral cavity deposited in the expanded Human Oral Microbiome Database. Notably, the detection of Staphylococcus haemolyticus and/or Ralstonia pickettii was significantly associated with a higher risk of mortality during the follow-up period. These results demonstrate that the oral cavity of allo-HSCT recipients is colonized by a disrupted microbiota on the day of transplantation and suggest that detection of specific nonindigenous taxa could be a predictor of transplant outcome.

Effect of Isometric Tongue Lifting Exercise on Oral Function, Physical Function, and Body Composition in Community-Dwelling Older Individuals: A Pilot Study.

INTRODUCTION: It is known that oral frailty is one of the risk factors for physical frailty. Therefore, early detection, appropriate treatment, and prevention of oral frailty are really important. Tongue lifting exercise has been identified as a well-known method for improving decreased tongue pressure, one of the factors for oral frailty. However, few reports have investigated how tongue-strengthening exercises affect physical function and body composition. The aim of this study was to investigate the effects of isometric tongue lifting exercises on oral function, physical function, and body composition. METHODS: Participants were 49 elderly people aged 68-79 years, who had previously participated in the "Itoshima Frail Study." Participants performed isometric tongue lift exercises for 3 months. Oral function (tongue pressure and oral diadocokinesis), physical function (grip strength, open-eyed one-leg standing, sit-to-stand motion time, 5-m gait speed, and 3-m Timed up and go [TUG]), and body composition were measured at baseline and post-intervention, and the extent of changes in each item was statistically analyzed. Furthermore, participants were divided into physical frailty/pre-frailty and robust groups based on the Japanese version of the frail scale proposed by [BMC Geriatr. 2015 Apr;15:36] and were compared in terms of the extent of changes in each item baseline and the post-intervention. RESULTS: After the intervention, oral function increased significantly together with a significant improvement in physical function, open-eyed one-leg standing time, sit-to-stand motion, and 3-m TUG. For body composition, visceral fat level and basal metabolic rate decreased significantly. Although no significant change in body composition was observed in the physical frailty/pre-frailty group after the intervention, significant improvements in several items were observed in the robust group. CONCLUSION: Isometric tongue lifting exercise can effectively improve oral function. Furthermore, it might affect physical function and body composition.

Association between oral function and physical pre-frailty in community-dwelling older people: a cross-sectional study.

BACKGROUND: Few studies have examined the relationship between oral functions and the physical pre-frailty status, classified using physical function tests. This cross-sectional study aimed to clarify this association among community-dwelling older people from the Itoshima Frail Study in Itoshima Fukuoka Prefecture. METHODS: Of the 1,555 individuals invited to join the study, 381 (188 males and 193 females) enrolled. Their physical pre-frailty was assessed with a classification system consisting of two physical indicators (fatigue and unintentional weight loss, determined with a questionnaire), two functional components (declined walking speed and muscle weakness, determined using a body function measuring instrument), and declined physical activity (examined using a triaxial accelerometer). Subsequently, the individuals were classified into three groups: robust, pre-frailty, and frailty. Along with the number of teeth remaining, oral functions, such as masticatory performance, tongue pressure strength, and oral diadochokinesis (ODK), were examined. Data regarding social activity and exercise habits were collected, and the individuals' body compositions were measured. Odds ratios (ORs) and 95% confidence intervals (CIs) for the physical pre-frailty were calculated using logistic regression models. RESULTS: In this study, 126 (33%) participants presented with physical pre-frailty. The participants in the robust group were younger, had stronger maximum handgrip strength, and walked faster than those in the physical pre-frailty group (p < 0.001). The robust group presented with better oral functions (masticatory performance, p = 0.015; oral ODK /ta/, p = 0.004). The physical pre-frailty status was significantly associated with age (OR, 1.111; 95% CI, 1.048-1.178; p < 0.001), masticatory performance (OR, 0.819; 95% CI, 0.680-0.986; p = 0.035), low ODK/ta/ (OR, 1.864; 95% CI, 1.069-3.250; p = 0.028), and low social activity (OR, 2.273; 95% CI, 1.308-3.951; p = 0.004). CONCLUSION: This study indicated that older people with higher age, lower anterior tongue movement, lower masticatory performance, and lower social activity are positively associated with physical pre-frailty.

Receptor for advanced glycation end products up-regulation in cerebral endothelial cells mediates cerebrovascular-related amyloid ß accumulation after Porphyromonas gingivalis infection.

Cerebrovascular-related amyloidogenesis is found in over 80% of Alzheimer's disease (AD) cases, and amyloid ß (Aß) generation is increased in the peripheral macrophages during infection of Porphyromonas gingivalis (P. gingivalis), a causal bacterium for periodontitis. In this study, we focused on receptor for advanced glycation end products (RAGE), the key molecule involves in Aß influx after P. gingivalis infection to test our hypothesis that Aß transportation from periphery into the brain, known as "Aß influx," is enhanced by P. gingivalis infection. Using cultured hCMEC/D3 cell line, in comparison to uninfected cells, directly infection with P. gingivalis (multiplicity of infection, MOI = 5) significantly increased a time-dependent RAGE expression resulting in a dramatic increase in Aß influx in the hCMEC/D3 cells; the P. gingivalis-up-regulated RAGE expression was significantly decreased by NF-κB and Cathepsin B (CatB)-specific inhibitors, and the P.gingivalis-increased IκBα degradation was significantly decreased by CatB-specific inhibitor. Furthermore, the P. gingivalis-increased Aß influx was significantly reduced by RAGE-specific inhibitor. Using 15-month-old mice (C57BL/6JJmsSlc, female), in comparison to non-infection mice, systemic P. gingivalis infection for three consecutive weeks (1 × 108  CFU/mouse, every 3 days, intraperitoneally) significantly increased the RAGE expression in the CD31-positive endothelial cells and the Aß loads around the CD31-positive cells in the mice's brains. The RAGE expression in the CD31-positive cells was positively correlated with the Aß loads. These observations demonstrate that the up-regulated RAGE expression in cerebral endothelial cells mediates the Aß influx after P. gingivalis infection, and CatB plays a critical role in regulating the NF-κB/RAGE expression. Cover Image for this issue: https://doi.org/10.1111/jnc.15073.

GSK3ß is involved in promoting Alzheimer's disease pathologies following chronic systemic exposure to Porphyromonas gingivalis lipopolysaccharide in amyloid precursor proteinNL-F/NL-F knock-in mice.

In line with the strong association between periodontitis and Alzheimer's disease (AD) clinically, preclinical studies have shown that systemic exposure to Porphyromonas gingivalis (Pg) initiates AD pathologies. However, the involvement of periodontitis in promoting AD pathologies is unclear. In the present study, we provided evidence that chronic systemic exposure to lipopolysaccharide derived from Pg (PgLPS, 1 mg/kg, daily, intraperitoneally) prompted neuroinflammation and tau hyperphosphorylation in 10-month-old of amyloid precursor protein (APP) knock-in mice, a model of AD, carrying the Swedish and Beyreuther/Iberian mutation (APPNL-F/NL-F). The learning and memory function were assessed using the passive avoidance test. The production of APP, Amyloid (A)ß1-42, cytokines, synaptic proteins and the activation of glycogen synthase kinase (GSK)-3ß as well as phosphorylation of tau were analyzed by immunohistochemistry, Western blotting or an enzyme-linked immunosorbent assay (ELISA) in the cortex of APPNL-F/NL-F mice. We found that systemic exposure of PgLPS for three consecutive weeks induced learning and memory deficits with significantly reduced postsynaptic density protein (PSD95). Increased hyperphosphorylation of tau in multiple residues, including Ser202, Thr231 and Ser396, but not the accumulation of Aß1-42 was detected in the neurons of APPNL-F/NL-F mice. Furthermore, PgLPS increased the GSK3ß activity by reducing its phosphorylation of the serine residue at position 9 (Ser9) and promoted neuroinflammation by increasing the expression of interleukin-1ß (IL-1ß) and tumor necrosis factor (TNF-α) while decreasing that of interleukin-10 (IL-10) and transforming growth factor (TGFß) in the cortex of APPNL-F/NL-F mice. Moreover, the PgLPS-increased GSK3ß activity was detected in both microglia and neurons, while the PgLPS-increased TNF-α expression was mainly detected in the microglia in the cortex of APPNL-F/NL-F mice. In in vitro studies, PgLPS (1 µg/ml) stimulation increased the mRNA and protein level of TNF-α in MG6 microglia, which were significantly inhibited by the GSK3ß-specific inhibitor TWS119. In contrast, the tau hyperphosphorylation and activation of GSK3ß in N2a neurons were enhanced after treatment with conditioned medium from PgLPS-stimulated microglia, which was attenuated after pre-treatment with TNF-α inhibitor. Taken together, these findings indicate that GSK3ß is involved in prompting microglia (TNF-α)-dependent tau hyperphosphorylation in neurons, resulting in learning and memory deficits in APPNL-F/NL-F mice without changes in the Aß expression during chronic systemic exposure to PgLPS. We propose that dampening GSK3ß activation may help delay the periodontitis-promoted pathological progression of AD.

Opportune Time of Tooth Extraction in Individuals Requiring Ventricular Assist Device Implantation: A Retrospective Cohort Study.

PURPOSE: Individuals with implantable ventricular assist devices (VADs) are at extremely high risk of bleeding, thromboembolism, and infection after undergoing invasive dental procedures. This study aimed to investigate the systemic and local complications of tooth extraction before and after VAD implantation. PATIENTS AND METHODS: This retrospective cohort study was conducted at a single center. Oral surgical procedures were performed in patients before and/or after left VAD implantation for bridge-to-heart transplantation between April 2013 and December 2017. In this study, the medical charts of the patients were retrospectively reviewed. Data about pre-extraction complete blood count, coagulation profile, biochemical profile, and incidence of local and systemic complications were compared in patients undergoing tooth extraction before VAD implantation (b-VAD group) versus after VAD implantation (a-VAD group). RESULTS: In total, 28 inpatients underwent 36 oral surgical procedures before and/or after VAD implantation. Moreover, 24 tooth extractions were performed in the b-VAD group, and 12 were performed in the a-VAD group. The incidence of post-extraction bleeding was higher in the a-VAD group (P = .001, Mann-Whitney U test), and a significant difference was observed in terms of activated partial thromboplastin time (P = .010, Mann-Whitney U test). Systemic complications associated with VADs included cerebral infarction (n = 2) and driveline infection (n = 1). Post-extraction bleeding was observed within 90 days after VAD implantation in all patients who underwent tooth extraction. CONCLUSIONS: The risk of bleeding after tooth extraction was higher in the a-VAD group (67%) than in the b-VAD group (13%). In 3 cases, VAD-related systemic complications developed within a short period after tooth extraction. The extraction management in the b-VAD group could be controlled without causing any problem. Hence, the opportune time of tooth extraction is before VAD implantation.

Factors associated with dry mouth in dependent Japanese elderly.

OBJECTIVES: To identify factors associated with dry mouth. BACKGROUND: Dry mouth adversely affects oropharyngeal health, particularly in elderly, and can lead to pneumonia. A better understanding of the epidemiology of dry mouth is therefore important in improving treatment strategies and oral health in high-risk elderly patients. METHODS: We conducted a cross-sectional study involving 383 dependent Japanese elderly individuals (65-84 [n = 167] and ≥85 [n = 216] years) at eight long-term care facilities and hospitals. Thirty-four potential factors associated with dry mouth were examined by multiple logistic regression analysis. The primary outcome was dry mouth, as diagnosed by tongue dorsum moisture. RESULTS: We identified that body mass index and severity of physical disability were identified as a potential factors associated with dry mouth in the super-elderly (≥85 years) group, whereas severity of physical disability, outcome measurement time, high daily water consumption, mouth breathing, use of antidepressants and diuretics, and high frequency of daily brushing (≥2 times per day; Odds ratio: 5.56; 95% Confidence Interval: 1.52-20.00) were associated with dry mouth in the 65- to 84-year-old group. CONCLUSION: To our knowledge, this is the first study to identify a link between frequency of daily brushing and dry mouth and suggests that tooth brushing should be encouraged in high-risk dependent Japanese elderly (65-84 years), particularly those taking antidepressants and/or diuretics.

A mixture of extracts from natural ingredients reduces the neurotoxic polarization of microglia via modulating NF-κB/NF-E2-related factor 2 activation.

Neurotoxic microglia-provoked neuroinflammation is implicated in cognitive decline in Alzheimer's disease (AD). Supplementation with Ginkgo biloba, phosphatidylserine, Curcuma longa, and propolis is reported to improve the cognitive functions of elderly people; however, the underlying mechanisms of this combination of natural ingredients are unknown. We investigated the effects of a mixture of extracts from propolis, Coffea arabica, Gotu kola, phosphatidylserine, Ginkgo biloba, and Curcuma longa (mixture) on microglia polarization after exposure to amyloid ß1-42 (Aß1-42, 1 µM) and lipopolysaccharide from Porphyromonas gingivalis (PgLPS, 1 µg/mL), using MG6 and BV2 microglial cells. Exposure to Aß1-42 and PgLPS (AL) raised the mRNA expression of IL-1ß, TNF-α, and IL-6, nuclear translocation of p65 NF-κB in MG6 cells and BV2 cells, and mitochondrial reactive oxygen species (ROS) production in MG6 cells. The mixture dramatically suppressed the mRNA expression of IL-1ß, TNF-α, and IL-6, but significantly promoted that of IL-10, TGFß1, and BDNF in AL-exposed MG6 and BV2 cells. Furthermore, the mixture significantly suppressed the nuclear translocation of p65 NF-κB but significantly promoted that of NF-E2-related factor 2 (Nrf2) in AL-exposed MG6 and BV2 cells. Furthermore, the mixture significantly ameliorated mitochondrial ROS production but increased mitochondrial membrane potential in MG6 cells. These observations strongly suggest that the mixture demotes the neuropathic polarization of microglia by modulating NF-κB/Nrf2 activation and improving mitochondrial functions. This study supplies the potential mechanisms of the efficacy of a combination of natural ingredients that can be applied in the prevention of cognitive decline in AD and aging by targeting microglia-mediated neuroinflammation.

The Impact of Nutrition and Oral Function Exercise on among Community-Dwelling Older People.

Oral function (OF) decline in older people is associated with nutritional deficiencies, which increases frailty risk and the need for nursing care. We investigated whether the delivery of an oral function improvement program on a tablet device was as effective as delivery through a paper-based program. We also investigated the association between tongue pressure (TP) improvement and nutritional status at the baseline. The participants involved in the study were 26 community-dwelling older people with low TP, <30 kPa, aged ≥65 years, who were enrolled in a randomized controlled trial for a month in Itoshima City, Fukuoka, Japan. Oral and physical functions and body composition were measured at the baseline and at follow-up. Two-way analysis of variance revealed that body mass index (p = 0.004) increased, and maximum masticatory performance (p = 0.010), maximum TP (p = 0.035), and oral diadochokinesis /pa/ and /ka/ (p = 0.009 and 0.017, respectively) improved in a month. Participants with higher TP improvement showed an increased intake of animal proteins at the baseline: fish (p = 0.022), meat (p = 0.029), and egg (p = 0.009). OF exercises for improving TP were associated with higher animal protein intake at the baseline. This study has been registered with the UMIN Clinical Trials Registry (UMIN 000050292).

Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation.

GOAL OF WORK: Little is known about the effects of professional oral health care (POHC) on the outcome of hematopoietic stem cell transplantation (HSCT). We evaluated the effects of POHC given by dentists and dental hygienists on the development of oral mucositis and febrile neutropenia (FN) after allogeneic bone marrow transplantation (BMT). PATIENTS AND METHODS: We retrospectively studied 140 adult patients who had received allogeneic BMT, with or without POHC, in our hospital consecutively between February 2002 and December 2009. Oral mucositis was evaluated according to the World Health Organization scale. MAIN RESULTS: The incidence of oral mucositis was 66.7% (52/78) in the patients who had received POHC, compared to 93.5% (58/62) in the non-POHC group (P < 0.001). The incidence of FN and the maximal level of CRP were also significantly lower in the POHC group. Multivariate analysis revealed that the POHC was significantly associated with the incidence of oral mucositis (odds ratio, 7.58; 95%CI, 2.45-23.34; P < 0.001). CONCLUSIONS: We concluded that POHC reduced the incidences of oral mucositis and FN by upgrading the overall oral hygiene during HSCT.

A comparison of oral mucositis in allogeneic hematopoietic stem cell transplantation between conventional and reduced-intensity regimens.

Severe oral mucositis developed in allogeneic hematopoietic stem cell transplantation (HSCT) accompanies intolerable pain and risk for systemic bacteremia infection. Conventional stem cell transplantation (CST) and reduced-intensity regimens for allogeneic HSCT (RIST) may differently affect the occurrence and severity of oral mucositis. Here, we comparatively examined oral mucositis in patients undergoing CST and that in RIST patients to search for measures to alleviate oral mucositis. We retrospectively analyzed the data of 130 consecutive patients undergoing HSCT (conventional, 60; RIST, 70). Oral mucositis was evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. We also investigated the risk factors for severe oral mucositis in each regimen. The incidence of oral mucositis was not significantly different between RIST and CST patients. The use of opioid analgesics to control pain due to oral mucositis was significantly less in patients undergoing RIST compared with those receiving CST. The risk factors for severe oral mucositis, determined by univariate and multivariate analyses, were "younger age (<40)" in CST and "longer duration of neutropenia (≥ 14 days)" in RIST. Although the incidences of oral mucositis were almost the same, the need for opioid analgesics and the risk factors for severe oral mucositis differed between CST and RIST patients.

Relationship between subjective assessment of oral health and medical expenses in community-dwelling elderly persons.

OBJECTIVES: The increasing medical expenses of elderly persons in Japan's rapidly ageing society have become a major concern. It is therefore important to elucidate the factors associated with such escalation. Here, we focused on the relationship between subjective self-assessment of oral health, as an index of general health, and medical expenses (excluding dental repair) under the hypothesis that oral health contributes to general medical expenses. Several studies have shown that oral health status is correlated with general health status among elderly persons. We speculated that oral health status might show a relation with medical costs among elderly persons. However, few studies have investigated this relationship to date. MATERIALS AND METHODS: Participants were 259 elderly subjects (range: 65-84 years; 120 men, 139 women) residing independently. Subjective assessment of oral health was evaluated by their responses ('Good', 'Not good' and 'Not at all good') on a survey questionnaire. The correlation between subjective assessment of oral health and medical expenditure was analysed using Spearman's rank method, the Mann-Whitney U-test and the Kruskal-Wallis test. Medical expenses were used as the dependent variable in multinomial logistic regression analysis with background and intraoral factors as independent variables. RESULTS: A slight yet statistically significant correlation was observed between subjective assessment of oral health and outpatient treatment fees. CONCLUSION: The findings revealed that subjective assessment of oral health is significantly and independently related to the medical expenses of community-dwelling elderly persons after adjusting for social background, living environment and physical factors.

Histological Evidences of Autograft of Dentin/Cementum Granules into Unhealed Socket at 5 Months after Tooth Extraction for Implant Placement.

The aim of this clinical case study was to observe biopsy tissues at 5 months after an autograft of a partially demineralized dentin/cementum matrix (pDDM) into a tooth-extracted socket exhibiting healing failure. A 66-year-old female presented with healing failure in the cavity for 2 months after the extraction (#36). Initial X-ray photos showed a clear remainder of lamina dura (#36), a residual root (#37), and a horizontal impaction (#38). The vital tooth (#38) was selected for pDDM. The third molar crushed by electric mill was decalcified in 1.0 L of 2.0% HNO3 for 20 min and rinsed in cold distilled water. The pDDM granules (size: 0.5-2.0 mm) were grafted immediately into the treated socket. X-ray views just after pDDM graft showed radio-opaque granules. At 5 months after pDDM graft, the surface of regenerated bone was harmonized with the mandibular line, and bone-like radio-opacity was found in the graft region. The biopsy tissue (diameter: 3.0 mm) at 5 months after pDDM graft showed that mature bone was interconnected with the remaining pDDM. The novel histological evidence highlighted that newly formed bone was connected directly with both dentin-area and cementum-area matrix of pDDM. We concluded that pDDM contributed to the regeneration of bone in the unhealed socket, and this regeneration prepared the socket for implant placement. Autogenous pDDM could be immediately recycled as an innovative biomaterial for local bone regeneration.

Primary Teeth-Derived Demineralized Dentin Matrix Autograft for Unilateral Maxillary Alveolar Cleft during Mixed Dentition.

This clinical report describes the immediate autograft of primary (milk) teeth-derived demineralized dentin matrix (DDM) granules for a 6-year-old boy with unilateral alveolar cleft. First, four primary teeth were extracted, crushed in an electric mill for 1 min, and the crushed granules were demineralized in 2% HNO3 solution for 20 min. Simultaneously, the nasal mucoperiosteum was pushed upwards above the apices of the permanent central incisor adjacent to the cleft. The nasal and palatal openings were closed by suturing the mucoperiosteum on both sides of the cleft with absorbable threads. The wet DDM granules were grafted into the managed cleft triangle space, and a labial flap was repositioned. The radiographic images at 6 months showed the continuous hard tissues in the cleft area and DDM granules onto lateral incisor (22) and impacted canine (23). The 3D-CT views at 2 years showed impacted tooth (22) blocked by primary canine and the replacement of DDM granules by bone near teeth (22,23). At 4 years, tooth crown (22) was situated just under the mucous membrane, and teeth (22,23) erupted spontaneously until 6 years without a maxillary expansion and a tow guidance of canine. The DDM granules contributed to bone formation without the inhibition of spontaneous tooth eruption. We concluded that autogenous primary teeth DDM graft should become a minimally invasive procedure without bone harvesting and morbidities for unilateral alveolar cleft.

Porphyromonas Gingivalis Infection Induces Synaptic Failure via Increased IL-1ß Production in Leptomeningeal Cells.

BACKGROUND: Studies have reported that synaptic failure occurs before the Alzheimer's disease (AD) onset. The systemic Porphyromonas gingivalis (P. gingivalis) infection is involved in memory decline. We previously showed that leptomeningeal cells, covering the brain, activate glial cells by releasing IL-1ß in response to systemic inflammation. OBJECTIVE: In the present study, we focused on the impact of leptomeningeal cells on neurons during systemic P. gingivalis infection. METHODS: The responses of leptomeningeal cells and cortical neurons to systemic P. gingivalis infection were examined in 15-month-old mice. The mechanism of IL-1ß production by P. gingivalis infected leptomeningeal cells was examined, and primary cortical neurons were treated with P. gingivalis infected leptomeningeal cells condition medium (Pg LCM). RESULTS: Systemic P. gingivalis infection increased the expression of IL-1ß in leptomeninges and reduced the synaptophysin (SYP) expression in leptomeninges proximity cortex in mice. Leptomeningeal cells phagocytosed P. gingivalis resulting in lysosomal rupture and cathepsin B (CatB) leakage. Leaked CatB mediated NLRP3 inflammasome activation inducing IL-1ß secretion in leptomeningeal cells. Pg LCM decreased the expression of synaptic molecules, including SYP, which was inhibited by an IL-1 receptor antagonist pre-treatment. CONCLUSION: These observations demonstrate that P. gingivalis infection is involved in synaptic failure by inducing CatB/NLRP3 inflammasome-mediated IL-1ß production in leptomeningeal cells. The periodontal bacteria-induced synaptic damage may accelerate the onset and cognitive decline of AD.

Factors That Influence the Judgment of Oral Management Necessity in Preoperative Oral Screening.

Oral management during the perioperative period is important to prevent the development of postoperative complications. However, there are no unified systems to examine the oral status of patients and very few studies have focused on preoperative oral screening. In this study, we examined the oral status of patients who underwent oral screening at a University Hospital. A total of 1173 patients who underwent oral screening for perioperative management from April 2020 to July 2021 were enrolled. The subjects' medical data were retrospectively extracted from the dental records, and finally, the data of 1081 patients aged ≥20 years were analyzed. Oral screening based on seven categories was performed by dentists or dental hygienists. Our cumulative results determined whether patients required oral management during the perioperative period. "Poor oral hygiene" was the most frequent category (24%) of all oral categories examined. Logistic analysis revealed that tooth mobility had the highest odds ratio (21.476; 95% confidence interval: 11.462-40.239; p < 0.001) for oral management necessity during the perioperative period. Our study suggests that poor oral hygiene is most frequently observed in preoperative oral screening. Moreover, tooth mobility in preoperative oral screening may influence the judgment of oral management necessity during the perioperative period.

The Association of Oral Function with Oral Health-Related Quality of Life in University Students: A Cross-Sectional Pilot Study.

The aim of this cross-sectional study was to investigate the association between oral function and oral health-related quality of life (OHRQoL) in healthy university students. Oral functions and OHRQoL (General Oral Health Assessment Index; GOHAI) were investigated in 58 healthy university students. Oral functions, such as tongue pressure, tongue-lip motor function, occlusal force, and masticatory function, were examined. The participants were divided into two groups based on low and high GOHAI scores. Information about oral health, dental caries treatment history, insomnia, and personality and lifestyle was obtained using a self-reported questionnaire. Oral mucosal wetness scores and tongue-lip motor functions (oral diadochokinesis /ka/) were significantly decreased in the low GOHAI score group compared to the high GOHAI score group (p = 0.001 and p = 0.017, respectively). In the logistic regression model, the GOHAI score was independently associated with the oral mucosal wetness score (odds ratio (OR) = 0.622; 95% confidence interval (CI), 0.411-0.941; p = 0.025) and oral diadochokinesis /ka/ (OR = 0.376; 95% CI, 0.170-0.832; p = 0.016). Our study demonstrated the presence of low oral function in university students and suggested its association to low OHRQoL in this population.

A Cross-Sectional Study of Age-Related Changes in Oral Function in Healthy Japanese Individuals.

BACKGROUND: Oral function deterioration is related to a variety of factors, including aging, decline in activities of daily living, malnutrition, and cognitive decline. This cross-sectional study examined the effects of aging on oral function in healthy individuals. METHODS: A retrospective study was conducted on 175 healthy, independent patients aged 40-89 years, without dementia and with ≥20 teeth, who visited a local dental clinic in Japan. Patients were compared with 92 university students aged 20-29 years. The seven criteria proposed by the Japanese Society of Gerodontology to diagnose "oral hypofunction" were observed and statistically analyzed. RESULTS: Compared with those in the control group, the degree of tongue coating was increased in the group aged over 80 years, occlusal force was decreased in the group aged 70-79 years, tongue motor function was decreased in the groups aged 60-69 years and older, and tongue pressure was decreased in the groups aged 70-79 years and older. CONCLUSIONS: Healthy, independent individuals maintained several oral function criteria across aging, including oral mucosal wetness, occlusal force, lip motor function, masticatory function, and swallowing function. Tongue motor function and tongue pressure decreased with aging, indicating that these may be rehabilitation targets.