Physiology of pregnancy and oral local anesthesia considerations.

Background: Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology: An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results: Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions: Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Elevated CXCL13 in primary Sjögren's syndrome and its correlation with disease activity: a systematic review and meta-analysis.

OBJECTIVES: CXCL13 levels have been reported to be elevated in primary Sjögren's syndrome (pSS) patients. This study investigated alterations involving the CXCL13/CXCR5 axis in pSS patients and explored the correlation between CXCL13 expression and disease severity. METHODS: Six databases, including PubMed, Web of Science, Embase, Ovid Medline, China National Knowledge Infrastructure, and Wanfang, were searched. The quality of the included studies was assessed using the Newcastle-Ottawa Scale criteria. We analyzed CXCL13 concentrations in the serum and saliva of pSS patients and healthy controls (HCs). Next, we analyzed the percentage of CXCR5+CD4+ T cells among CD4+ T cells in pSS patients and HCs. Correlations between CXCL13 levels and serological, clinical, and histological parameters of patients were also assessed. Publication bias was determined using funnel plots and Egger's test. RESULTS: Twenty-three articles were included; of these, 14 studies reported CXCL13 levels, and 5 reported CXCR5+CD4+ T cell count of pSS patients and HCs. Nine articles covering 32 studies reported correlations between serum CXCL13 levels and serological, clinical, and histological parameters in pSS patients. Expressions of CXCL13 and CXCR5+CD4+ T cell count were significantly increased in pSS patients compared with those in HCs. There was a positive correlation between CXCL13 levels and serum IgG levels, disease activity indices, and focus score in minor salivary gland biopsy of patients. CONCLUSIONS: CXCL13 abundance was evidently elevated in pSS patients and correlated with disease activity and can therefore probably be employed as a robust biomarker to monitor and diagnose pSS. Key Points • Serum CXCL13 is significantly elevated in primary Sjögren's syndrome patients. • CXCL13 level correlates with disease severity and activity of primary Sjögren's syndrome. • CXCL13 can probably be used as a robust biomarker to monitor and diagnose primary Sjögren's syndrome.

Oxidative stress and inflammation regulation of sirtuins: New insights into common oral diseases.

Sirtuins are a family of nicotinamide adenine dinucleotide (NAD)+-dependent histone deacetylases, comprising seven members SIRT1-SIRT7. Sirtuins have been extensively studied in regulating ageing and age-related diseases. Sirtuins are also pivotal modulators in oxidative stress and inflammation, as they can regulate the expression and activation of downstream transcriptional factors (such as Forkhead box protein O3 (FOXO3a), nuclear factor erythroid 2-related factor 2 (Nrf2) and nuclear factor-kappa B (NF-κB)) as well as antioxidant enzymes, through epigenetic modification and post-translational modification. Most importantly, studies have shown that aberrant sirtuins are involved in the pathogenesis of infectious and inflammatory oral diseases, and oral cancer. In this review, we provide a comprehensive overview of the regulatory patterns of sirtuins at multiple levels, and the essential roles of sirtuins in regulating inflammation, oxidative stress, and bone metabolism. We summarize the involvement of sirtuins in several oral diseases such as periodontitis, apical periodontitis, pulpitis, oral candidiasis, oral herpesvirus infections, dental fluorosis, and oral cancer. At last, we discuss the potential utilization of sirtuins as therapeutic targets in oral diseases.