Salivary Biomarkers for Alzheimer's Disease: A Systematic Review with Meta-Analysis.

Alzheimer's Disease (AD) is the most common neurodegenerative disease which manifests with progressive cognitive impairment, leading to dementia. Considering the noninvasive collection of saliva, we designed the systematic review to answer the question "Are salivary biomarkers reliable for the diagnosis of Alzheimer's Disease?" Following the inclusion and exclusion criteria, 30 studies were included in this systematic review (according to the PRISMA statement guidelines). Potential biomarkers include mainly proteins, metabolites and even miRNAs. Based on meta-analysis, in AD patients, salivary levels of beta-amyloid42 and p-tau levels were significantly increased, and t-tau and lactoferrin were decreased at borderline statistical significance. However, according to pooled AUC, lactoferrin and beta-amyloid42 showed a significant predictive value for salivary-based AD diagnosis. In conclusion, potential markers such as beta-amyloid42, tau and lactoferrin can be detected in the saliva of AD patients, which could reliably support the early diagnosis of this neurodegenerative disease.

Salivary Alterations of Myeloperoxidase in Patients with Systemic Diseases: A Systematic Review.

Salivary myeloperoxidase (MPO) is a key mediator of the oral immune system, acting as an enzyme that utilises H2O2 to generate molecules with high bactericidal activity. While MPO determination in plasma is quite common, the use of saliva is still rare. Our systematic review was designed to answer the question "Are salivary levels of myeloperoxidase altered in patients with systemic diseases?". Following the inclusion and exclusion criteria, we included twenty-six studies. Altered MPO levels in saliva were most commonly found in patients with cardiovascular and gastrointestinal diseases. Most studies concerned unstimulated whole saliva, and only a few of them stimulated, mainly by chewing paraffin. Enzyme-linked immunosorbent assay (ELISA) was the most common method for determination of MPO concentrations in saliva. Increased salivary MPO levels were more often observed for inflammatory diseases, except patients with inflammatory bowel diseases who were eligible for biologic therapy. In conclusion, MPO could be altered in the saliva of patients with systematic diseases, especially cardiovascular or gastrointestinal diseases. However, further investigations are recommended to validate these outcomes.

Evaluation of the relationship between psoriasis, periodontitis, and markers of inflammation.

Introduction: Periodontal disease and psoriasis are chronic and multifactorial inflammatory conditions which share immunopathological mechanisms and risk factors. They often coexist and reflect each other as extensive research proved a correlation between the advancement of periodontitis and the severity of psoriasis. Aim: To assess the influence of the prevalence of psoriasis and periodontitis using the selected markers of inflammation, such as C-reactive protein (CRP), interleukin (IL) 1α (IL-1α) and IL-17. Material and methods: Test sample consisted of 30 psoriatic inpatients, subjected to dental examination and blood tests. 29 healthy individuals constituted the control group and underwent thorough clinical examination to rule out psoriasis. Results: Our results confirmed that all dental indices reflecting oral hygiene and periodontal health were significantly better in healthy controls than in patients with psoriasis. Further analysis revealed a statistically significant correlation between the levels of CRP, a few of the cytokines (IL-1, IL-17), and dental indices in psoriatic patients. Moreover, we found that patients with psoriasis visited the dentist less frequently than healthy participants. Conclusions: In order to fully establish the relationship between psoriasis, periodontitis and markers of inflammation, further research on larger sample sizes is needed. However, the results obtained point to the crucial role of diagnosing and treating periodontitis in preventing and mitigating psoriasis. Joint effort of physicians and dentists is necessary to ensure a comprehensive treatment of a psoriatic patient.

EFFECTIVENESS OF COMPOSED HERBAL EXTRACT IN THE TREATMENT OF GINGIVITIS AND ORAL AND PHARYNGEAL MUCOSA - REVIEW OF STUDIES.

Intensive studies on properties of synthetic compounds are simultaneously conducted with studies on the effectiveness and safety of drugs derived from natural compounds. These drugs have been effectively used for years in dentistry, in treatment of inflammatory conditions of the oral cavity and in laryngology, in treatment of pharyngeal inflammatory conditions. The subject of this article is a compilation of studies conducted on medicinal products containing composed ethanolic extract as an active substance, and obtained from: chamomile capitulum (Matricaria recutita L.), oak bark (Quercus spp.), sage leaf (Salvia officinalis L.), arnica herb (Arnica spp.), calamus rhizome (Acorus calamus L.), peppermint herb (Mentha piperita L.), thyme herb (Thymus spp.) Preclinical studies confirmed that a particular tested plant extract exhibits antimicrobial (antibacterial, antifungal and antiprotozoal) as well as anti-inflammatory, immunomodulatory and astringent properties. Under clinical conditions, it was confirmed that drugs containing the analysed extract used in periodontology, in prevention and complex treatment of gingivitis, periodontitis as well as diseases of oral mucosa (but also the throat) of viral, bacterial, fungal and protozoal aetiology significantly improved the effectiveness of therapy, shortened the treatment and improved the patients' quality of life. The above preparations used in dental surgery contributed to faster tissue regeneration, more quickly relieved pain and swelling after a surgery or difficult dentition. Furthermore, drugs containing the above-mentioned extract can also be successfully used for oral cavity decontamination in the case of various diseases of teeth or the oral and pharyngeal mucosa. The tested composed herbal extract (CHE), applied in the form of a mouthwash and in the form for topical application with benzocaine content (CHEB), is a component of drugs which are great alternatives to widely used synthetic drugs. They are characterised with high effectiveness, comparable to that of synthetic agents, and a higher safety profile. Results of pharmacological and clinical studies justify their use in both prevention and treatment of inflammatory diseases of the gums, periodontium, oral cavity and pharynx.

Salivary Biomarkers for Diagnosis of Inflammatory Bowel Diseases: A Systematic Review.

Saliva as a biological fluid has a remarkable potential in the non-invasive diagnostics of several systemic disorders. Inflammatory bowel diseases are chronic inflammatory disorders of the gastrointestinal tract. This systematic review was designed to answer the question "Are salivary biomarkers reliable for the diagnosis of inflammatory bowel diseases?". Following the inclusion and exclusion criteria, eleven studies were included (according to PRISMA statement guidelines). Due to their heterogeneity, the potential salivary markers for IBD were divided into four groups: oxidative status markers, inflammatory cytokines, microRNAs and other biomarkers. Active CD patients manifest decreased activity of antioxidants (e.g., glutathione, catalase) and increased lipid peroxidation. Therefore, malondialdehyde seems to be a good diagnostic marker of CD. Moreover, elevated concentrations of proinflammatory cytokines (such as interleukin 1ß, interleukin 6 or tumour necrosis factor α) are associated with the activity of IBD. Additionaly, selected miRNAs are altered in saliva (overexpressed miR-101 in CD; overexpressed miR-21, miR-31, miR-142-3p and underexpressed miR-142-5p in UC). Among other salivary biomarkers, exosomal PSMA7, α-amylase and calprotectin are detected. In conclusion, saliva contains several biomarkers which can be used credibly for the early diagnosis and regular monitoring of IBD. However, further investigations are necessary to validate these findings, as well as to identify new reliable salivary biomarkers.

Knowledge of antibiotics and antimicrobial resistance amongst final year dental students of Polish medical schools-A cross-sectional study.

INTRODUCTION: Antimicrobial resistance has been one of the biggest global concerns. Dentists constitute an important group of antibiotic prescribers, and it was shown that their therapeutic decisions are not always rational. In this paper, we present knowledge of antibiotics prescription rules and antimicrobial resistance amongst graduating dentistry students from all dentistry faculties of medical universities in Poland, who will soon join the group of antibiotics prescribers. MATERIALS AND METHODS: A questionnaire consisting of 28 questions was developed. The survey was conducted in May-June 2015. RESULTS: The study group comprised a total of 752 students. About 54% expressed the opinion that dentists overprescribe antibiotics. One-tenth thought that they can be used for the treatment of flu (7%) and common cold (11%). Respondents pointed to amoxicillin (46%) and clindamycin (44%) as the first-choice treatment of dentoalveolar abscess, if medically indicated. More than half of the students (58%) suggested using doxycycline and metronidazole in aggressive periodontitis in an individual allergic to penicillin. The vast majority of students (97%) indicated that penicillins and cephalosporins were suitable for treatment of dental infections in pregnant women. The majority of participants (82%) said that rheumatic disease, chronic immunosuppression, chronic kidney failure and a history of infective endocarditis required a prophylactic administration of antibiotics before or during endodontic treatment. CONCLUSIONS: The research showed variable levels of understanding of antibiotics use amongst dental students in medical universities in Poland. Our results emphasise the need to educate dental students further regarding antibiotics and risks related to antibiotic misuse, especially in dental practice.

Salivary fingerprint of simple obesity.

BACKGROUND: The nature of a link between poor oral health and obesity is not fully understood. It is also unclear if saliva contributes to it and whether the properties of saliva change as a result of an increase in body mass or rather as a consequence of obesity-associated comorbidities. This pilot study was undertaken in an attempt to determine if salivary biomarkers can identify obesity per se. METHODS: Whole mixed saliva was analysed for 16 soluble parameters covering 4 categories (inflammation, oxidative stress, endothelial dysfunction, adipokines). In the discovery group, 19 obese and 25 non-obese women matched for age, with similar hygiene habits, with no comorbidities and not taking any medication known to affect saliva secretion were analysed. In the validation group, a cohort of no-preselected 81 individuals (34 obese) were analysed. RESULTS: Individuals with obesity had significantly higher salivary concentrations of several cytokines and adipokines, of which TNF-R1, serpin A12 and PAI-1 were identified as parameters discriminating between obese and non-obese subjects with the highest sensitivity and specificity. CONCLUSIONS: Obesity per se leads to distinct changes in the concentration of several parameters in saliva. These findings may have diagnostic implications for distinguishing the effects of obesity and obesity-linked comorbidities on oral health.

Diagnostic value of salivary CRP and IL-6 in patients undergoing anti-TNF-alpha therapy for rheumatic disease.

INTRODUCTION: Saliva has been increasingly used as a diagnostic medium for disease detection and monitoring. The aim of this observational, prospective, pilot study was to investigate whether salivary concentrations of CRP and IL-6 correlate with those in serum and with the clinical course of a rheumatic disease. MATERIALS AND METHODS: Nineteen patients with rheumatic disease newly scheduled for anti-TNFα therapy were included. Patients received anti-TNFα treatment (adalimumab, certolizumab, golimumab or infliximab) as per standard protocols. CRP and IL-6 were measured with high-sensitivity immunoassays before and after 12 weeks of therapy, according to standard regimens. The data were analyzed with nonparametric statistics. RESULTS: Concentrations of CRP in saliva correlated significantly with those in serum (R = 0.62; p < 0.0001) and decreased markedly after successful response to treatment. In patients with a limited response to treatment salivary CRP levels increased. In contrast to CRP, the salivary concentrations of IL-6 did not change significantly over the course of therapy and they did not correlate with serum IL-6 concentrations. Salivary levels of neither CRP nor IL-6 corresponded to parameters of oral health and hygiene. CONCLUSIONS: Salivary CRP but not IL-6 could be of potential use for monitoring the rheumatic disease activity.

[Hygienic habits and health behaviors in patients with obesity].

Introduction: Smoking is the most common addiction in the world. Coexistence of smoking and obesity lead to a significant increase in the risk of cardiovascular diseases. It is also known that both the tobacco and excessive weight have a negative impact on oral health. Aim: Assessment of the frequency of smoking, hygienic habits and healthy behaviors in people with obesity. Material and Methods: The study included 125 people, of both sexes, aged from 20 to 65 years. The study group consisted of patients Clinic of Internal Medicine, Metabolic and Nutrition, Poznan University of Medical Sciences with a BMI> 25 kg/m2, control group - patients Clinic of Conservative Dentistry and Periodontology, Poznan University of Medical Sciences of normal weight (BMI <25 kg/m2). All participants were asked to complete a short survey on smoking, frequency of dental checkups and hygiene habits associated with the oral cavity. Results: In both groups of patients, obese and normal weight, we found similar percentages of smokers: 25 and 24.24%. Both groups showed a similar time of brushing, however, we found statistically significant differences in the frequency of tooth brushing. Conclusion: Despite the similar results obtained during the survey in both groups of patients, it seems necessary to take patients with obesity particularly dental care, enhancement of preventive measures as well as incitement to refrain from smoking.

[The assessment of periodontal status in smoking and non-smoking patients with type 1 diabetes].

Chronic microvascular complications of type 1 diabetes relate to small and medium-sized vessels and clinically manifest as retinopathy, nephropathy and neuropathy as well as periodontitis. Cigarette smoking significantly modifies the course of inflammation in subjects without diabetes. The aim of the study was to assess the periodontal status in smoking and non-smoking subjects with type 1 diabetes. Materials and Methods: 115 subjects with type 1 diabetes, median age 32 years (IQR 25-38), median HbA1c 8.3% (7.4-9.4) were included. Assessed gingival indices comprised API, SBI, GI. Results: Smoking cigarettes was more frequent among men compared to women (p = 0.03). API was lower among women compared to men (p = 0.004). There was no correlation between HbA1c and gingival indexes, however, people achieving good metabolic control (HbA1c≤6.5%) had a lower API (p = 0.039). Smokers presented lower SBI compared to non- -smokers (p = 0.03). Conclusions: People with type 1 diabetes smoking cigarettes present lower gingival bleeding compared to non-smokers. In people with poor metabolic control of type 1 diabetes there is an increased accumulation of dental plaque in comparison with well-controlled type 1 diabetic patients.

Diagnostic accuracy of cone beam computed tomography compared with intraoral radiography for the detection of noncavitated occlusal carious lesions.

The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) in the detection of noncavitated occlusal caries lesions and to compare this accuracy with that observed with conventional radiographs. 135 human teeth, 67 premolars and 68 molars with macroscopically intact occlusal surfaces, were examined by two independent observers using the CBCT system: NewTom 3G (Quantitative Radiology) and intraoral conventional film (Kodak Insight). The true lesion diagnosis was established by histological examination. The detection methods were compared by means of sensitivity, specificity, predictive values and accuracy. To assess intra- and interobserver agreement, weighted kappa coefficients were computed. Analyses were performed separately for caries reaching into dentin and for all noncavitated lesions. For the detection of occlusal lesions extending into dentin, sensitivity values were lower for film (0.45) when compared with CBCT (0.51), but the differences were not statistically significant (p > 0.19). For all occlusal lesions sensitivity values were 0.32 and 0.22, respectively, for CBCT and film. The specificity scores were high for both modalities. Interobserver agreement amounted to 0.93 for the CBCT system and to 0.87 for film. It was concluded that the use of the 9-inch field of view NewTom CBCT unit for the diagnosis of noncavitated occlusal caries cannot be recommended.

Salivary Biomarkers for Parkinson's Disease: A Systematic Review with Meta-Analysis.

Parkinson's Disease (PD) is a common neurodegenerative disease which manifests with motor features, such as bradykinesia, resting tremor, rigidity, and postural instability. Using the non-invasive technique of saliva collection, we designed a systematic review to answer the question "Are salivary biomarkers reliable for the diagnosis of Parkinson's Disease?". Following inclusion and exclusion criteria, 30 studies were included in this systematic review (according to the PRISMA statement guidelines). Mostly proteins were reported as potential biomarkers in saliva. Based on meta-analysis, in PD patients, salivary levels of total alpha-synuclein were significantly decreased, and those of oligomeric alpha-synuclein were significantly increased. Also, according to pooled AUC, heme oxygenase-1 demonstrated significant predictive value for saliva-based PD diagnosis. In conclusion, some potential biomarkers, especially alpha-synuclein, can be altered in the saliva of PD patients, which could be reliably useful for early diagnosis of this neurodegenerative disease differentiating other synucleopathies.

Seasonal Influence on Salivary Myeloperoxidase Diurnal Variations in Young Healthy Subjects: A Preliminary Study.

BACKGROUND: The interaction between oxidative status markers and biological rhythms is considered particularly important in the pathogenesis of many diseases and more effective therapies. We aimed to determine if the salivary secretion of myeloperoxidase exhibits diurnal variations, and if the potential daily variability differs seasonally. METHODS: The study was performed in Poznan, Poland (52,25°N, 16,58°E) in 10 healthy male volunteers (age median 23.5 years). Whole mixed unstimulated saliva was collected in summer (August) and winter (December) during 36 h at 2-h intervals starting at 6 a.m. on Saturday and ending at 6 p.m. on Sunday, in the domestic setting. The samples were analysed for myeloperoxidase (MPO) and cortisol by immunoassays. The presence of the circadian rhythm of cortisol secretion in saliva confirmed the rhythmicity of the volunteers. RESULTS: For salivary MPO, significantly higher concentrations compared to midnight and noon were observed for 4 a.m. in both summer and winter. Using the cosinor analysis, the variations in salivary MPO levels showed a moderate fit for the 12-h period rhythm (acrophases: in summer 05:37/17:37, in winter 06:16/18:16), without significant differences in the rhythm parameters in summer and winter. However, higher self-reported Global Seasonal Score (which may predispose to seasonal affective disorder) was associated with significantly stronger relative amplitude (RS = 0.811) in winter season only. CONCLUSIONS: In conclusion, our findings suggest the possible ultradian rhythm for MPO in saliva, with two peaks during the day, regardless of the season.

Potential Immunohistochemical Biomarkers for Grading Oral Dysplasia: A Literature Review.

Oral cancer is a prevalent global health issue, with significant morbidity and mortality rates. Despite available preventive measures, it remains one of the most common cancers, emphasising the need for improved diagnostic and prognostic tools. This review focuses on oral potentially malignant disorders (OPMDs), precursors to oral cancer, specifically emphasising oral epithelial dysplasia (OED). The World Health Organisation (WHO) provides a three-tier grading system for OED, and recent updates have expanded the criteria to enhance diagnostic precision. In the prognostic evaluation of OED, histological grading is presently regarded as the gold standard; however, its subjectivity and unreliability in anticipating malignant transformation or recurrence pose notable limitations. The primary objective is to investigate whether specific immunohistochemical biomarkers can enhance OED grading assessment according to the WHO classification. Biomarkers exhibit significant potential for comprehensive cancer risk evaluation, early detection, diagnosis, prognosis, and treatment optimisation. Technological advancements, including sequencing and nanotechnology, have expanded detection capabilities. Some analysed biomarkers are most frequently chosen, such as p53, Ki-67, cadherins/catenins, and other proteins used to differentiate OED grades. However, further research is needed to confirm these findings and discover new potential biomarkers for precise dysplasia grading and minimally invasive assessment of the risk of malignant transformation.

Periodontal disease in patients with thyroid diseases: A systematic review with meta-analysis.

PURPOSE: The imbalance of thyroid hormones affects the metabolic activity of various tissues, including periodontium. Also, autoimmune diseases present an increased tendency to suffer from periodontal disease. Therefore, our systematic review was designed to answer the question "Is there a relationship between thyroid diseases and periodontal disease?". MATERIALS AND METHODS: Following the inclusion and exclusion criteria, 10 studies were included in this systematic review using the databases PubMed, Scopus and Web of Science (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines). RESULTS: Based on the meta-analysis, patients with thyroid diseases (especially with hypothyroidism) demonstrated significantly worse periodontal status than systemically healthy controls. Moreover, according to the cross-sectional studies, 5.74 â€‹% of periodontitis patients reported the concomitance of thyroid diseases. CONCLUSIONS: In summary, the included studies suggest a potential relationship between thyroid diseases and periodontal disease. However, further research is necessary to reliably assess the oral health in patients with hypothyroidism and hyperthyroidism.

Treatment regimens and disease activity could alter salivary myeloperoxidase levels in patients with inflammatory bowel diseases.

INTRODUCTION: Inflammatory bowel diseases (IBDs) present with alternating periods of exacerbation and remission; therefore, it is necessary to develop noninvasive diagnostic tools to control the disease activity and improve therapeutic effectiveness. Recently, we have found that patients with ulcerative colitis (UC) who qualified for biologic therapy had significantly lower salivary myeloperoxidase (MPO) levels. OBJECTIVES: This cross­sectional study aimed to assess the impact of IBD activity and applied treatment on salivary antioxidant system as reflected by the levels of catalase, total antioxidant status, and MPO. PATIENTS AND METHODS: The study group comprised 99 patients diagnosed with Crohn disease (CD) and 61 patients with UC. The Crohn Disease Activity Index and modified Mayo scale were used to estimate the clinical activity of CD and UC, respectively. Unstimulated whole mixed saliva was collected. Salivary levels of selected markers were measured with enzyme­linked immunosorbent assays and colorimetric assays. RESULTS: The patients with clinically active UC showed significantly decreased median (interquartile range) salivary MPO levels (79.4 [30.1-157.5] vs 94.8 [58.2-274.7] ng/ml) with significant correlations with the endoscopic stage on the Mayo scale (R = 0.423; P = 0.02). Receiver operating characteristic analysis confirmed a potential usefulness of MPO concentrations in predicting clinically active UC (area under the curve = 0.654; P = 0.03; cutoff <210.4 ng/ml). Moreover, in the patients treated with biologics and without steroid therapy, salivary MPO concentrations negatively correlated with neutrophil counts in the individuals with UC and positively with C­reactive protein level in the patients with CD. CONCLUSIONS: Salivary MPO levels changed depending on the disease activity in the patients with UC. Decreased MPO concentration in the saliva could be a predictor of clinically active UC.

Awareness of possible complications associated with direct composite restorations: A multinational survey among dentists from 13 countries with meta-analysis.

OBJECTIVES: Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material. METHODS: The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials. RESULTS: A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065). CONCLUSIONS: Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists. CLINICAL SIGNIFICANCE: Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries.

Assessment of Oral Health and Healthy Habits in Adult Patients with Congenital Hemophilia.

OBJECTIVES: The objective of our study was to assess the current knowledge, the oral health status, and the pro-health needs of patients with hemophilia. MATERIALS AND METHODS: The study included 77 patients with known hemophilia. The study included the assessment of dental indicators related to caries incidence (decayed, missing, and filled teeth [DMFT] and decayed, missing, and filled permanent teeth or surfaces [DMFS]), caries treatment (treatment index), oral hygiene status (Approximal Plaque Index [API] and simplified oral hygiene index [OHI-S]), and periodontal status (bleeding on probing [BoP]). A questionnaire addressed symptoms of hemorrhagic diathesis and health-promoting habits. The influence of routine management ("on-demand" vs. prophylactic therapy), type of hemophilia (A, B), and severity of clotting factor deficiency (mild, moderate, or severe) on oral health was assessed. STATISTICAL ANALYSIS: The tests used in the study were Shapiro-Wilk, Mann-Whitney, Kruskal-Wallis, and Dunn's tests. The level of significance was set at p < 0.05. RESULTS: Patients with hemophilia showed a higher prevalence of caries compared with patients without hemorrhagic diathesis (DMFT 14 and 9, and DMFS 30 and 15, respectively), and they also presented a higher bleeding index value during probing and worse effectiveness of hygienic interdental procedures. The type of therapy and secondary prophylaxis used and the type and severity of hemophilia did not affect the oral health status. CONCLUSIONS: Patients with hemophilia have an increased risk of developing dental caries. Undertaking educational activities related to the prevention of oral diseases is necessary to improve oral health.

Eating Disorders and Dental Erosion: A Systematic Review.

Both eating disorders and dental erosion are increasingly affecting adolescents and young adults. Thus, our systematic review was designed to answer the question: "Is there a relationship between dental erosion and eating disorders?" Following the inclusion and exclusion criteria, 31 studies were included in this systematic review (according to the PRISMA statement guidelines). Based on the meta-analysis, 54.4% of patients with bulimia nervosa and 26.7% with anorexia nervosa experienced tooth erosion. For the whole group of 1699 patients with eating disorders, erosive lesions were observed in 42.1% of patients. Bulimics were more than 10 times more likely to experience dental erosion compared to healthy individuals (OR = 10.383 [95%CI: 4.882-22.086]). Similarly, more than 16 times increased odds of tooth erosion were found in patients with self-induced vomiting (OR = 16.176 [95%CI: 1.438-181.918]). In conclusion, eating disorders are associated with an increased risk of developing erosive lesions, especially in patients with bulimia nervosa.

Transfusion of fibrinogen concentrate before dental extractions in patients with afibrinogenemia: a narrative review supported by a case report with a proposed treatment protocol.

Afibrinogenemia is a coagulation disorder that occurs with a frequency of 1-2 cases/1,000,000 population and is characterized by a lack of capacity to synthesize fibrinogen. The predominant symptoms related to fibrinogen deficiency are mucocutaneous bleeding, bleeding from the gastrointestinal tract, genital tract or other vascularized tissues as well as excessive bleeding after minor injuries or accidental cuts. Thromboembolic complications and impaired wound healing may also occur. Due to the rarity of the disease, there are no recommendations about fibrinogen substitution before dental procedures (including dental surgery). The purpose of this review is to discuss the indications for the transfusion of a coagulation factor in the preparation of a patient with afibrinogenemia for dental extraction. The article is a narrative review with a proposed management protocol for the dental procedure. The authors have included information from previously published case reports, research studies, and review papers as well as their own case report.