Odontogenic infections in the antibiotic era: approach to diagnosis, management, and prevention.

PURPOSE: The prevalence of odontogenic infections remains one of the highest in the world. If untreated, odontogenic infections can break through the limitation, disseminate to other organs or spaces, and cause high mortality rates. However, it is still difficult to rapidly target limited or disseminated infections in clinical practice. The type of disseminated odontogenic infections and the responsible bacteria have not been described in detail. METHODS: Search databases (e.g., PubMed, MEDLINE, Web of Science, Embase) for reports published from 2018.1 to 2022.9. Use search strategies: ("odontogenic infections" OR "pulpitis" OR "periapical lesions" OR "periodontal diseases") AND ("disseminated infections" OR "complication"). RESULTS: Fourteen different types of disseminated odontogenic infections, most of which are polymicrobial infections, can spread through the body either direct or through hematogenous diffusion. Multiple microbial infections can be more invasive in the transmission of infection. Secondary infections are commonly associated with bacteria like Fusobacterium spp., Streptococcus spp., Peptostreptococcus spp., Prevotella spp., and Staphylococcus spp. Antibiotics with broad-spectrum activity are fundamental as first-line antimicrobial agents based on the microorganisms isolated from disseminated infections. CONCLUSION: This review elaborates on the epidemiology, microorganisms, risk factors, and dissemination routes, and provides evidence-based opinions on the diagnosis, multidisciplinary management, and prevention of odontogenic infections for dentists and clinicians.

Impact of COVID-19 on patient follow-up during supportive periodontal therapy: a retrospective study based on phone call survey.

BACKGROUND: COVID-19 and the subsequent intermittent lockdown measures from 2020 to 2022 in China critically disrupted regular medical activities, including dental care. This study aimed to investigate the impact of COVID-19 on long-term follow-up at the Stomatology Hospital, Zhejiang University School of Medicine and to evaluate potential causes of loss to follow-up. METHODS: A total of 1062 patients with periodontitis who visited the hospital from January 2019 to June 2022 were included in this study, and patient information was collected retrospectively in the form of a telephone questionnaire. The questionnaire consisted of 19 questions in four areas: demographic characteristics, clinical periodontal parameters, oral hygiene habits, and follow-up-related open-ended questions (specific reasons for loss to follow-up, attitudes toward follow-up and suggestions for increasing participation in future follow-ups). Regression analysis of factors influencing the follow-up of patients with periodontitis were analyzed by regression analysis using R (v4.2.3) software. RESULTS: A total of 536 (50.47%) valid questionnaires were collected from 1062 patients. Personal factors (42.5%), instead of the COVID-19 epidemic (20.0%), were the main factors that impacted the loss to follow-up in long-term periodontal treatment, while work factors (19.8%), hospital factors (16.4%), and transportation or distance factors (14.7%) were all important factors. A family history of periodontitis [odds ratio (OR) = 0.567, 95% confidence interval (CI): 0.393, 0.817, p = 0.002], as well as frequent use of dental devices (OR = 0.540, 95% CI: 0.375, 0.777, p = 0.001), were significantly associated with a "negative" attitude toward follow-up visits. CONCLUSION: This survey suggests that the COVID-19 epidemic factor was an important cause contributed to the loss to follow-up during supportive periodontal therapy (SPT) among a variety of potential factors. Majority of patients had negative attitudes toward subsequent continued participation in supportive care.

Multifocal epithelial hyperplasia confined to the interdental papilla of an adult Chinese man: a rare case report and literature review.

BACKGROUND: Multifocal epithelial hyperplasia (MEH), or focal epithelial hypertension (FEH), or Heck's disease, is an uncommon, benign oral mucosal disease associated with human papillomavirus infection. It is mostly observed in indigenous populations of the world, and has been rarely reported in China. However, previous research suggested there might be a greater prevalence of MEH in the Chinese population. While predominantly involves the lips, buccal mucosa and tongue, MEH was occasionally reported to affect the hard palate and gingiva as well. CASE PRESENTATION: This paper reports a case of extensive MEH lesions that confined to the interdental papilla of a Chinese male without detection of HPV, and summarizes the published gingiva-involved MEH reports from 1966 until present. The lesions were excised with an Er: YAG laser after scaling and root planning, no recurrence was observed after 6-month follow-up. CONCLUSIONS: The present report illustrates the need for clinicians to be aware of rare presentations of MEH to facilitate a prompt diagnosis and proper management. More reports are encouraged to determine a correct prevalence rate of MEH in China.

The association between chronic periodontitis and vasculogenic erectile dysfunction: a systematic review and meta-analysis.

AIM: The purpose of this systematic review and meta-analysis was to explore the association between erectile dysfunction (ED) and chronic periodontitis (CP) in observational studies. MATERIALS AND METHODS: A literature search of PubMed, EMBASE and Cochrane up to and including May 22, 2015, was conducted by two independent reviewers. Statistical analysis was performed using Review Manager 5.3, and the results are expressed as odds ratios (ORs) together with 95% confidence intervals (CIs), as determined using a random effects model. Subgroup analysis was performed by age. RESULTS: Of the 250 potentially eligible articles, four studies, involving 38,111 cases and 174,807 controls, were included. Based on random effects meta-analysis, a significant association between CP and ED was identified (OR = 3.07, 95% CI: 1.87-5.05, p < 0.001). Sensitivity analysis was performed due to the presence of statistically extensive heterogeneity (I(2) = 98%). CONCLUSIONS: The results of this systematic review revealed a positive association between CP and ED; however, because the presence and extent of statistical heterogeneity limits the conclusiveness of our findings, larger and better-controlled studies of socially homogeneous populations as well as pathophysiological studies are required to confirm the relationship between CP and ED and to explore the biological mechanisms involved.

Small extracellular vesicles derived from lipopolysaccharide-preconditioned dental follicle cells inhibit cell apoptosis and alveolar bone loss in periodontitis.

OBJECTIVE: This study aimed to explore the effects of small extracellular vesicles derived from lipopolysaccharide-preconditioned dental follicle cells (L-D-sEV) on periodontal ligament cells from periodontitis affected teeth (p-PDLCs) in vitro and experimental periodontitis in mice. DESIGN: In vitro, the biological function of p-PDLCs and the underlying molecular mechanism were investigated by flow cytometry, Western blot, and quantitative real-time PCR (qRT-PCR) analysis. Eighteen-eight-week-old male C57BL/6 mice were randomly divided into three groups: control (Con), periodontitis (Peri), and L-D-sEV groups. Mice periodontitis model was induced by placing the 5-0 silk thread (around the maxillary second molar) and P.gingivalis (1 ×107 CFUs per mouse). In vivo, the alveolar bone loss, osteoclast activity, and macrophage polarization were measured by micro-computed tomography and histological analysis. RESULTS: In vitro, the RANKL/OPG ratio and phosphorylation of JNK and P38 protein levels of p-PDLCs were significantly decreased after L-D-sEV administration. Besides, flow cytometry and qRT-PCR analysis showed that L-D-sEV reduced apoptosis of p-PDLCs, down-regulated apoptosis-related genes Caspase-3 and BCL-2-Associated X expression, and up-regulated B-cell lymphoma-2 gene levels. In vivo, L-D-sEV administration significantly reduced alveolar bone loss, inhibited osteoclast activity, and induced M2 polarization. The histological analysis showed that iNOS/CD206, RANKL/OPG, p-JNK/JNK, and p-P38/P38 ratios were significantly lower in the L-D-sEV group than in the Peri group. CONCLUSIONS: L-D-sEV administration alleviated alveolar bone loss by mediating RANKL/OPG-related osteoclast activity and M2 macrophage polarization, alleviating p-PDLCs apoptosis and proliferation via the JNK and P38 pathways.

Biomimetic composite scaffolds based on surface modification of polydopamine on ultrasonication induced cellulose nanofibrils (CNF) adsorbing onto electrospun thermoplastic polyurethane (TPU) nanofibers.

To improve the interaction between cells and scaffolds, the appropriate surface chemical property is very important for tissue engineering scaffolds. In this study, the thermoplastic polyurethane (TPU) nanofibers was firstly fabricated by electrospinning technique, and then its surface was modified with cellulose nanofibrils (CNF) particles by ultrasonic-assisted to obtain TPU/CNF nanofibers. Subsequently, the TPU/CNF-polydopamine (PDA) composite nanofibers with core/shell structure were fabricated by PDA coating method. In comparison with TPU nanofibers, the uniformization of PDA coating layer on the surface of TPU/CNF composite nanofibers significantly increased due to the addition of CNF, which used as the active sites to guide the PDA particles accumulated along with the fiber direction. The water absorption and hydrophilicity of TPU/CNF-PDA composite nanofibers were significantly increased in comparison with those of TPU and TPU/CNF nanofibers. The mechanical properties of the TPU/CNF-PDA composite nanofibers were higher than those of the TPU and TPU/CNF nanofibers due to the formation of strong hydrogen bonds between PDA and TPU/CNF, making TPU, CNF and PDA strongly adhere to each other. The attachment and viability of mouse embryonic osteoblasts cells (MC3T3-E1) cultured on TPU/CNF-PDA composite nanofibers were obviously enhanced compared with TPU and TPU/CNF nanofibers. Those results suggested that the modified TPU/CNF-PDA composite nanofibers have excellent mechanical and biological properties, which promoting them potentially useful for tissue engineering scaffolds. The presented strategy represents a general route to modify the surface of scaffolds, which are promising for tissue engineering applications.

Collagen Matrix for Periodontal Plastic Surgery Procedures: A Meta-analysis Update.

This review aims to evaluate the effectiveness of a collagen matrix (CM) utilized in periodontal plastic surgeries around natural teeth and implants. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review Manager 5.3 software was used for data analysis. Subgroup analyses were conducted by defect categories and follow-up periods. The GRADE system was applied to classify the quality of evidences. Out of 3,652 articles in the literature, 14 studies were included, totaling 1,260 defects in 565 participants. The meta-analysis showed that CM is superior to coronally advanced flaps (CAF) regarding gains in mean root coverage (MRC) and width of keratinized tissue (KTW). Insufficient evidence demonstrated that CM had higher complete root coverage (CRC). Connective tissue graft (CTG) presented better results in CRC, MRC, and KTW. Greater KTW was also found favoring CTG in implants. In subgroup analysis, moderate evidence showed that, compared to CTGs, CMs present similar results in CRC, MRC, and KTW when treating single gingival recessions. CTGs showed greater efficiency in KTW of multiple gingival recessions and long-term observations. CM presents suitable capabilities as an alternative to soft tissue graft, while CTG still shows better results in most clinical parameters.

Surface biofunctionalization of three-dimensional porous poly(lactic acid) scaffold using chitosan/OGP coating for bone tissue engineering.

As one of the stimulators on bone formation, osteogenic growth peptide (OGP) improves both proliferation and differentiation of the bone cells in vitro and in vivo. The aim of this work was the preparation of three dimensional porous poly(lactic acid) (PLA) scaffold with high porosity from PLA-dioxane-water ternary system with the use of vacuum-assisted solvent casting, phase separation, solvent extraction and particle leaching methods. Then, by surface coating of PLA scaffold with chitosan (CS)/OGP solution, biofunctionalization of PLA scaffold had been completed for application in bone regeneration. The effects of frozen temperature (-20, -50, -80°C) and PLA solution concentration (10, 12, 14wt%) on the microstructure, water absorption, porosity, hydrophilicity, mechanical properties, and biocompatibility of PLA and CS/OGP/PLA scaffold were investigated. Results showed that both PLA and CS/OGP/PLA scaffolds have an interconnected network structure and a porosity of up to 96.1% and 91.5%, respectively. The CS/OGP/PLA scaffold exhibited better hydrophilicity and mechanical properties than that of uncoated PLA scaffold. Moreover, the results of cell culture test showed that CS/OGP coating could stimulate the proliferation and growth of osteoblast cells on CS/OGP/PLA scaffold. These finding suggested that the surface biofunctionalization by CS/OGP coating layer could be an effective method on enhancing cell adhesion to synthetic polymer-based scaffolds in tissue engineering application and the developed porous CS/OGP/PLA scaffold should be considered as alternative biomaterials for bone regeneration.

Fabrication and characterization of chitosan/OGP coated porous poly(ε-caprolactone) scaffold for bone tissue engineering.

As one of the stimulators on bone formation, osteogenic growth peptide (OGP) improves both proliferation and differentiation of the bone cells in vitro and in vivo. The aim of this work was the preparation of three dimensional porous poly(ε-caprolactone) (PCL) scaffold with high porosity, well interpore connectivity, and then its surface was modified by using chitosan (CS)/OGP coating for application in bone regeneration. In present study, the properties of porous PCL and CS/OGP coated PCL scaffold, including the microstructure, water absorption, porosity, hydrophilicity, mechanical properties, and biocompatibility in vitro were investigated. Results showed that the PCL and CS/OGP-PCL scaffold with an interconnected network structure have a porosity of more than 91.5, 80.8%, respectively. The CS/OGP-PCL scaffold exhibited better hydrophilicity and mechanical properties than that of uncoated PCL scaffold. Moreover, the results of cell culture test showed that CS/OGP coating could stimulate the proliferation and growth of osteoblast cells on CS/OGP-PCL scaffold. These finding suggested that the surface modification could be a effective method on enhancing cell adhesion to synthetic polymer-based scaffolds in tissue engineering application and the developed porous CS/OGP-PCL scaffold should be considered as alternative biomaterials for bone regeneration.

Biomimetic composite scaffolds based on mineralization of hydroxyapatite on electrospun poly(ɛ-caprolactone)/nanocellulose fibers.

A biomimetic nanocomposite scaffold with HA formation on the electrospun poly(ɛ-caprolactone) (PCL)/nanocellulose (NC) fibrous matrix was developed in this study. The electrospun PCL/NC fiber mat was built and then biomineralized by treatment in simulated body fluid (SBF). Using such a rapid and effective procedure, a continuous biomimetic crystalline HA layer could be successfully formed without the need of any additional chemical modification of the substrate surface. The results showed that the introduction of NC into composite fibers is an effective approach to induce the deposition of HA nucleus as well as to improve their distribution and growth of a crystalline HA layer on the fibrous scaffolds. The water contact angle (WCA) of the PCL/NC/HA scaffolds decreases with increasing NC content and mineralization time, resulting in the enhancement of their hydrophilicity. These results indicated that HA-mineralized on PCL/NC fiber can be prepared directly by simply using SBF immersion.