Assessment of oral emergency services during COVID-19: a retrospective study of 14,885 cases in Shanghai.

BACKGROUND: To assess the impact of coronavirus disease-2019 (COVID-19) in its outbreak stage (Spring Festival in 2020) on oral emergency services. METHODS: Oral emergency cases in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, during the Spring Festival after the outbreak of the COVID-19 epidemic in 2020 were collected and compared with those in 2018 and 2019. Electronic medical records including the visited department, age, sex, time, date, region, and diagnosis were collected and analyzed. The results were statistically analyzed using Pearson's Chi-square test and one-way analysis of variance (ANOVA). RESULTS: Compared with that in 2018 and 2019, the total number of patients decreased during the Spring Festival in 2020 (p < 0.001), but the proportions of patients visiting Oral Surgery and Oral, Head, and Neck Oncology Emergency departments increased. The average age of patients increased, and the number of night visits decreased. Toothache diseases involving endodontic and periodontal diseases increased, while the proportion of maxillofacial trauma decreased. The wasn't a linear association between diagnosis or genders (P > 0.001) across years. However, a linear-by-linear association between age groups and years, visited departments and years were observed (P < 0.001). CONCLUSIONS: The study revealed that the transmission of COVID-19 affected the patient population and structure of disease types and oral services in 2020 during the Spring Festival, compared with those in the previous two years. The visits to oral emergency departments and the proportions of patients who were children and adolescents reduced; meanwhile, the percentage of the elderly people increased during the outbreak of COVID-19. The clear trend of age groups and visiting divisions could be used as a marker to reflect the severity of the COVID-19 pandemic. These results may serve as a reference for dental practitioners involved in oral emergency services and to allocate the limited emergency health resources.

The Stability Evaluation of Two Internal Fixation Patterns of Extracapsular Condylar Fracture Based on One Novel Measuring Method.

PURPOSE: The most stable internal fixation pattern for extracapsular condylar fracture (ECF) has been controversial. In this study we aimed to evaluate the stability of 2 common internal fixation patterns using 1 or 2 miniplates separately. One novel measuring method based on the angle of miniplates' localization was introduced. MATERIALS AND METHODS: Twenty-seven patients with 30 sides of extracapsular condylar fracture were enrolled in this retrospective study. All cases were performed open reduction and internal fixation using 1 or 2 titanium plates with both the postoperative immediate CT (T1) and the over 6 months' follow-up CT (T2). Mandibles and implants were segmented and reconstructed respectively using SIMPANT 14.04 software. For 1 miniplate group, the sagittal crossing angle (<1) between miniplate (P1) and posterior border of ipsilateral ramus was measured. For 2 miniplates group, the sagittal crossing angle (<2) between 2 miniplates (P2a, P2b) was measured. Both anteroposterior (∠AP) and mediolateral angle change (∠ML) of each miniplate between T1 and T2 was measured. The stability of 2 internal fixation patterns was measured and evaluated based on the angle change of miniplates. And also the stability of each internal fixation pattern could be investigated based on the relationship between the placement patterns of miniplates and the angle change. RESULTS: Fifty-two miniplates were finally segmented and reconstructed successfully, including 8 of 1 miniplate group and 44 of 2 miniplate group. For 1 miniplate group, the average ∠AP and ∠ML were 6.10° and 8.54°, respectively. For 2 miniplate group, the average ∠AP and ∠ML of P2a were 3.02° and 2.56°, respectively, as well as 3.12° and 3.07° of P2b. CONCLUSIONS: The novel measuring method based on the angle of miniplates' localization showed potential for the stability evaluation of internal fixation of condylar fracture. In summary, the internal fixation patterns using 2 miniplates shows better stability than that of 1 miniplate.

[Analysis of the use status of internet outpatient in stomatological departments based on AI follow-up].

PURPOSE: To analyze the use status and satisfaction of the follow-up patients, and explore the construction of internet medical service model and platform in stomatology. METHODS: Patients who visited the internet clinic of stomatology from January to June, 2021 were selected. After diagnosis and treatment, they were followed up by AI intelligent voice with self-designed questionnaire. SPSS 21.0 software was used for statistical analysis. RESULTS: A total of 372 valid questionnaires were collected. The male-to-female ratio of oral patients was 1.25:1, with an average age of 35.96 years. Most of them had a bachelor's degree or above, and the patients were mainly from the Yangtze River Delta. 53.76% of patients needed doctors to prescribe drugs. 81.72% of the dental patients believed that the consultation process of internet clinic was convenient, and 79.83% of patients perceived that the system operation of internet clinic was convenient. Binary logistic regression showed that digital literacy, convenience of medical treatment process were significantly related to the satisfaction of internet outpatient service, while gender, education level, online medical treatment duration and convenience of system operation were not related. CONCLUSIONS: Internet medical treatment in stomatology is feasible, but it is still necessary to break through limitations and further innovate service function. Internet outpatients are mainly young and middle-aged, but it is still necessary to care for the special group of the elderly. It is necessary to further optimize the process, upgrade the system and innovate management, strengthen policy support and incentive mechanism, and promote the transformation of medical service mode in stomatology.

Management of Separated Instruments Extruded into the Maxillary Sinus and Soft Tissue: a Case Series.

Extrusion of separated endodontic instruments is a frustrating complication that can occur during root canal treatment and is difficult to handle. This report aimed to introduce different methods to retrieve such separated instruments through three cases with different locations of fragments. Fragments extruded completely into the maxillary sinus, partially into the maxillary sinus and lying in the soft tissue were retrieved using a lateral window approach, ultrasonic method and minimally invasive surgery, respectively. These methods can be recommended for retrieving fragments in certain cases.

Opportunities and challenges for co-delivery nanomedicines based on combination of phytochemicals with chemotherapeutic drugs in cancer treatment.

The therapeutic limitations such as insufficient efficacy, drug resistance, metastasis, and undesirable side effects are frequently caused by the long duration monotherapy based on chemotherapeutic drugs. multiple combinational anticancer strategies such as nucleic acids combined with chemotherapeutic agents, chemotherapeutic combinations, chemotherapy and tumor immunotherapy combinations have been embraced, holding great promise to counter these limitations, while still taking including some potential risks. Nowadays, an increasing number of research has manifested the anticancer effects of phytochemicals mediated by modulating cancer cellular events directly as well as the tumor microenvironment. Specifically, these natural compounds exhibited suppression of cancer cell proliferation, apoptosis, migration and invasion of cancer cells, P-glycoprotein inhibition, decreasing vascularization and activation of tumor immunosuppression. Due to the low toxicity and multiple modulation pathways of these phytochemicals, the combination of chemotherapeutic agents with natural compounds acts as a novel approach to cancer therapy to increase the efficiency of cancer treatments as well as reduce the adverse consequences. In order to achieve the maximized combination advantages of small-molecule chemotherapeutic drugs and natural compounds, a variety of functional nano-scaled drug delivery systems, such as liposomes, host-guest supramolecules, supramolecules, dendrimers, micelles and inorganic systems have been developed for dual/multiple drug co-delivery. These co-delivery nanomedicines can improve pharmacokinetic behavior, tumor accumulation capacity, and achieve tumor site-targeting delivery. In that way, the improved antitumor effects through multiple-target therapy and reduced side effects by decreasing dose can be implemented. Here, we present the synergistic anticancer outcomes and the related mechanisms of the combination of phytochemicals with small-molecule anticancer drugs. We also focus on illustrating the design concept, and action mechanisms of nanosystems with co-delivery of drugs to synergistically improve anticancer efficacy. In addition, the challenges and prospects of how these insights can be translated into clinical benefits are discussed.

Characterization and diabetic wound healing benefits of protein-polysaccharide complexes isolated from an animal ethno-medicine Periplaneta americana L.

Periplaneta americana L. (PA), a type of animal medicine, has been widely used for wound healing in clinical settings. In order to further investigate the bioactive wound healing substances in PA, crude PA protein-polysaccharide complexes were further purified by cellulose DE-52 and Sephadex G100 chromatography in succession. Among these isolated fractions, two fractions eluted by 0.3 M and 0.5 M NaCl with the higher yield, respectively named PaPPc2 and PaPPc3 respectively, were chosen for the wound healing experiments. Mediated by HPGPC, amino acid and monosaccharide composition analysis, circular dichroism spectrum, glycosylation type, FT-IR, and 1H NMR analysis, the characterization of PaPPc2 and PaPPc3 was implemented. And then, the benefits of PaPPcs to promote cell proliferation, migration, and tube formation of HUVECs were determined in vitro, indicated these fractions would facilitate angiogenesis. Finally, as proof of concept, PaPPc2 and PaPPc3 were employed to accelerate the acute wounds of diabetic mice, involving in increase blood vessels and the amounts of angiogenesis-related cytokines (α-SMA, VEGF, and CD31). In short, this study provides an experimental basis to demonstrate the protein-polysaccharide complexes of Periplaneta americana L. as its wound healing bioactive substances.

[Analysis of 137740 dental emergency cases from 2017 to 2018].

PURPOSE: To analyze the clinical data of oral emergency cases and the characteristics of oral emergency diseases, and provide clinical basis for improving the quality of oral emergency treatment and making reasonable arrangement. METHODS: A total of 137 740 patients in oral emergency department from January 1st, 2017 to December 31st, 2018 were collected and analyzed retrospectively according to gender, age, time of visit and diagnosis. The results were analyzed with Chi-square test by Excel 7.0 and SPSS 19.0 software package. RESULTS: The ratio of men and women was 1.13:1, with an average age of 35.71 years. The highest incidence was seen in October 2018, and the lowest was in February 2017. The peak time of oral emergency was 20:00 to 21:00. The top three disease entity were maxillofacial injury (29.17%), facial infection (26.95%) and pulpitis (10.08%). CONCLUSIONS: There is a wide range of diseases and a large number of patients in oral emergency and the visiting time is relatively concentrated. Dentists for emergency need to master the professional knowledge of oral surgery and endodontics. In order to make precise strategies to formulate the scale of oral emergency, considerations should be taken with the changing features of the period and month of oral emergency treatment.

[Management and prevention of dental emergency during corona virus disease 2019 (COVID-19) epidemic].

The outbreak of corona virus disease 2019 (COVID-19) has developed rapidly and the situation of prevention and control is severe. During the epidemic period of COVID-19, due to the particularity of diagnosis and treatment of oral diseases, there is great challenges for how to deal with various types of dental emergency. In order to prevent and control the epidemic situation strictly, and to perform a scientific and orderly clinical diagnosis and treatment of dental emergency, this article provided suggestions on personnel management training, procedures and treatment, protection and disinfection of dental emergency during COVID-19 epidemic, and reference for dental institutions and medical staff.

[Effect of continuous oral health education on elderly patients with chronic periodontitis treated with dual-wavelength laser].

PURPOSE：To explore the clinical effect of continuous oral health education on elderly patients with chronic periodontitis treated with dual wavelength lasers. METHODS: The clinical data of 150 elderly patients with chronic periodontitis treated with dual-wavelength laser in Shanghai Ninth People's Hospital between March 2016 and March 2018 were analyzed and divided into 2 groups according to the different intervention plans applied. Seventy-five cases receiving routine oral hygiene education were taken as the control group, and the other 75 patients receiving continuous oral health education were set as the experimental group. Oral behavior, gingival index and dental plaque index in the two groups were analyzed and compared using SPSS 21.0 software package. RESULTS: The proportions of patients with correct brushing, taking regular oral examination and maintenance, and keeping good oral habits in the experimental were 97.33%, 93.33% and 92.00%, respectively, which were significantly higher than those in the control group (P<0.05). The gingival index and dental plaque index 3 and 6 months after intervention were (1.24±0.14) and (1.08±0.10), (1.50±0.10) and (1.69±0.26), respectively in the experimental group, which were significantly lower than those in the control group (P<0.05). CONCLUSIONS: For elderly patients with chronic periodontitis treated with dual-wavelength laser therapy, application of continuous oral health education can improve their oral behavior and periodontal status, therefore is worthwhile to be popularized in clinical application.

[Micro-CT study of root canal morphology of mandibular first premolars with multi-canals].

PURPOSE: To observe root canal system of multi-canal mandibular first premolars and to analyze the morphology of them by micro-CT and three-dimensional reconstruction. METHODS: Thirty-two extracted mandibular first premolars with multiple root canals were selected and scanned by micro-CT. The number and morphology of canals, location of bifurcation and 5 subtle structures (lateral canals, apical ramification, isthmus, loops, apical delta) were analyzed. RESULTS: In the 32 specimens, 96.88% contained radicular depressions or grooves. The canal configuration was type II, Ⅲ, Ⅴ: 3.12%, type Ⅳ: 31.25%, type Ⅷ: 9.38%, type Ⅸ: 15.62% and C-shaped canal: 34.38% by Vertucci's classification. 62.50% of the canals bifurcated at the middle third of roots, comparing with 37.50% at apical third. The incidence of the lateral canals, apical ramification, isthmus, loops and apical delta was 56.25%, 43.75%, 40.62%, 21.88% and 6.25%, respectively, which were all found at the middle and apical third of roots except that lateral canals were found at all depth of canals. CONCLUSIONS: Most mandibular first premolars with multiple canals contain radicular depression or grooves, of which root canal system are complicated. Micro-CT can provide clear and accurate three-dimensional information of canal morphology.

[Safe zones of the maxillary posterior area for mini-implant insertion in adolescents with skeletal Class II malocclusion].

PURPOSE: The purpose of this study was to measure the interradicular spaces between the maxillary second premolar and first molar in adolescents with skeletal Class Ⅱ malocclusion, so as to obtain scientific knowledge for placing mini-implants. METHODS： Forty four cone-beam computed tomography(CBCT) images were selected, which consisted of 23 males and 21 females (average age, 14.07 years) with skeletal Class II malocclusion. CBCT was used to measure the closest interradicular distance and the shortest distance from cortical bone surface to the narrowest interradicular space apically at 1-mm intervals in 9 axial images from the cementoenamel junction(CEJ). SPSS 20.0 software package was used for statistical analysis. RESULTS: There was no significant difference in the closest interradicular distance and the shortest distance from cortical bone surface to the narrowest interradicular space between the left and right side (P>0.05), and no significant difference was found between males and females (P>0.05); The shortest distance from cortical bone surface to the narrowest interradicular space of the left apical area had positive correlation with SNA angle; The closest interradicular distance became wider toward the apical area，and the average distance of the shortest distance from cortical bone surface to the narrowest interradicular space was over 5mm in all sections. CONCLUSIONS: The distribution of interradicular spaces between the maxillary second premolar and first molar of adolescents with skeletal Class II malocclusion is learned using CBCT. These data might provide a reference for placing mini-implants.

Self-repaired Process of a Traumatized Maxillary Central Incisor with Pulp Infarct after Horizontal Root Fracture Monitored by Laser Doppler Flowmetry Combined with Tissue Oxygen Monitor.

Achieving a precise diagnosis of the pulp status of traumatized teeth is difficult. The time to interfere through endodontic treatment for these teeth is greatly dependent on the doctor's experience. A 24-year-old male patient suffered a traumatic injury to tooth #9 that resulted in an apical root horizontal fracture 3 days before he came to the hospital. The injured tooth showed no response to pulp sensitivity testing at the first visit and was discolored 1 week later. Tooth #9 was immobilized to its adjacent teeth for 4 weeks by a composite splint. The patient was asked to make regular follow-up appointments for 72 weeks. The changes in the pulp microcirculation of tooth #9 after the injury were recorded using laser Doppler flowmetry (LDF) and a tissue oxygen monitor (OXY). The LDF was used to directly measure the pulpal blood flow, and the OXY was used to detect the tissue oxygen saturation and total hemoglobin at each appointment. Tooth #9 survived a period of pulp infarct that started at week 4 and showed complete revascularization within 10 weeks. The color of the tooth returned to normal after revascularization. The tooth responded to sensitivity testing at week 58, and radiographic examinations confirmed its hard tissue was healing. Without other clinical signs besides tooth discoloration and an absence of response to pulp sensitivity testing, the complete self-repair of pulp can be expected in teeth with pulp infarct after a horizontal root fracture, and more than 1 year of follow-up is recommended. The use of LDF combined with OXY monitoring has great value in the timely and precise reflection of changes in pulp status after dental trauma.

Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis.

OBJECTIVE: This study is aimed at assembling, through a systematic review and meta-analysis, scientific evidence related to the effects of mandibular setback (MdS) surgery and bimaxillary surgery for the correction of Class III malocclusion on the cross-sectional area (CSA) and volume of the upper airway as assessed using CT. METHODS: An electronic search was conducted on Cochrane Library, EMBASE, PubMed, Scopus and Web of Science up to June 20, 2016. The inclusion criteria were prospective or retrospective studies, with the aim of comparing the impact on the upper airway space of orthognathic surgery for the treatment of the skeletal class III malocclusion. The methodological index for non-randomized studies (MINORS) was chosen as the evaluation instrument and Revman5.3 was used for the meta-analysis. RESULTS: A total of 1213 studies were retrieved, of which only 18 met the eligibility criteria. The results of meta-analysis showed that the mean decrease in the upper airway volume after MdS surgery was 3.24 cm3 [95%CI (-5.25,-1.23), p = 0.85]; the mean decrease in minimum CSA after a combined surgery of maxillary advancement with mandibular setback (MdS + MxA) was 27.66 mm2 [95%CI (-52.81,-2.51), p = 0.51], but there was no significant decrease in upper airway volume (mean 0.86 cm3); comparison between MdS + MxA and isolated MdS showed significant differences in the CSA of the posterior nasal spine plane (PNS) and epiglottis plane (EP); statistically significant differences in nasopharynx volume (P < 0.0001) and upper airway total volume (P = 0.002) were observed, but no statistically meaningful variations existed in oropharynx volume (P = 0.08) and hypopharynx volume (P = 0.64). CONCLUSION: The results of this study suggest that bimaxillary surgery promotes less decrease on the upper airway than mandibular setback surgery alone for the correction of the skeletal class III malocclusion.

MicroRNA-335-5p Plays Dual Roles in Periapical Lesions by Complex Regulation Pathways.

INTRODUCTION: MicroRNA-335-5p has been reported to regulate osteogenic and chondrogenic differentiations of mesenchymal stem cells. The aim of this study was to explore the function and regulation mechanism of miR-335-5p in apical periodontitis (AP). METHODS: Total RNAs were extracted from human periodontal ligament fibroblasts (HPDLFs), 10 AP tissues, and 6 healthy periodontal ligament tissues using lysis buffer. Gene expression was detected using real-time polymerase chain reaction. The Dual Luciferase Assay (Promega, Madison, WI) was used to test miR-335-5p directly targeted urokinase-type plasminogen activator receptor (uPAR) and the receptor activator of nuclear factor kappa-B ligand (RANKL). Western Blot was used to detect protein expressions of RANKL, uPAR, and the fragile X-related 1 gene (FXR1). The enzyme-linked immunosorbent assay was used to detect the secretions of interleukin 6, tumor necrosis factor alpha, and RANKL. Data were analyzed using the Student t test. RESULTS: miR-335-5p acted as a positive mediator in HPDLF inflammation (P < .05). Two targets of miR-335-5p, uPAR and RANKL, were identified. Interestingly, uPAR was repressed by miR-335-5p at the basal level, but it can be relieved from miR-335-5p-mediated repression, which is called derepression, when HPDLFs were subjected to lipopolysaccharide stimulation. miR-335-5p promoted RANKL in HPDLFs regardless of whether or not it was under inflammatory conditions (P < .05). We proved FXR1 was responsible for the derepression of uPAR from miR-335-5p (P < .01). Both FXR1 and uPAR were positive mediators in HPDLF inflammation (P < .05). miR-335-5p, uPAR, RANKL, and FXR1 had the same expression profiles in HPDLF inflammation and AP tissues (P < .05). CONCLUSIONS: Our data showed that miR-335-5p may play dual roles in AP, and it might be considered as a target for therapeutic potency in clinical applications.

Potential use of porous titanium-niobium alloy in orthopedic implants: preparation and experimental study of its biocompatibility in vitro.

BACKGROUND: The improvement of bone ingrowth into prosthesis and enhancement of the combination of the range between the bone and prosthesis are important for long-term stability of artificial joints. They are the focus of research on uncemented artificial joints. Porous materials can be of potential use to solve these problems. OBJECTIVES/PURPOSES: This research aims to observe the characteristics of the new porous Ti-25Nb alloy and its biocompatibility in vitro, and to provide basic experimental evidence for the development of new porous prostheses or bone implants for bone tissue regeneration. METHODS: The Ti-25Nb alloys with different porosities were fabricated using powder metallurgy. The alloys were then evaluated based on several characteristics, such as mechanical properties, purity, pore size, and porosity. To evaluate biocompatibility, the specimens were subjected to methylthiazol tetrazolium (MTT) colorimetric assay, cell adhesion and proliferation assay using acridine staining, scanning electron microscopy, and detection of inflammation factor interleukin-6 (IL-6). RESULTS: The porous Ti-25Nb alloy with interconnected pores had a pore size of 200 µm to 500 µm, which was favorable for bone ingrowth. The compressive strength of the alloy was similar to that of cortical bone, while with the elastic modulus closer to cancellous bone. MTT assay showed that the alloy had no adverse reaction to rabbit bone marrow mesenchymal stem cells, with a toxicity level of 0 to 1. Cell adhesion and proliferation experiments showed excellent cell growth on the surface and inside the pores of the alloy. According to the IL-6 levels, the alloy did not cause any obvious inflammatory response. CONCLUSION: All porous Ti-25Nb alloys showed good biocompatibility regardless of the percentage of porosity. The basic requirement of clinical orthopedic implants was satisfied, which made the alloy a good prospect for biomedical application. The alloy with 70% porosity had the optimum mechanical properties, as well as suitable pore size and porosity, which allowed more bone ingrowth.

A large ameloblastic fibro-odontoma in the mandible.

Ameloblastic Fibro-Odontoma (AFO) is a rare benign hybrid odontogenic tumor. AFO is most common in children and adolescents aged under 20 years, and is usually small. This report describes a 47-year-old man with a pathologically proved large AFO originated from the mandible. The tumor's largest dimension is 20 cm. Plain CT showed a well-circumscribed expansile mass with multiloculated scrotiform osteolytic lesions in the mandible, with linear and patchy calcification and ossification. CT 3D reconstruction revealed the mandible appeared honeycombed. On T1W and T2W MR images, cystic low-density components on CT appeared high-signal, while calcification and ossification appeared low-signal.

[Treatment of growing Class II division 1 patients with varying degrees of anteroposterior and vertical dysplasias].

PURPOSE: To evaluate the difference of treatment on growing patients with Class II division 1 using various anteroposterior and vertical skeletal dysplasias. METHODS: Twenty-eight moderate to severe Class II division 1 malocclusion patients with Class I molar and canineocclusion after treatment were selected. The subjects were divided into 3 groups based on the initial ANB and FMA angles. Pre-treatment and post-treatment cephalograms were evaluated for soft and hard tissues changes after treatment. The data was analyzed using SPSS 12.0 software package. RESULTS: ANB angle decreased in all three groups. Changes of ANB angle in group 2 and group 3 were greater than group 1(P<0.01). SNA angle decreased significantly in group 3(P<0.01). SNB angle increased significantly in group 1(P<0.01) and group 2(P<0.05). All groups had great maxillary incisors retraction and similar changes in mandibular incisor positions.Soft tissue index showed no significant difference among three groups before and after treatment(P>0.05). But nasolabial angle(P<0.05), soft tissue convexity(P<0.05) and Z angle(P<0.01) changed significantly in group 3. CONCLUSIONS: Conventional orthodontic therapy successfully corrects Class II division 1 malocclusions in growing patients with the improvement of soft and hard tissues.The patients who initially have the most severe skeletal dysplasias can have the greatest changes in profile.

[Analysis of canal morphology of mandibular first premolar].

PURPOSE: To investigate the canal morphology of bilateral mandibular first premolar using cone-beam CT(CBCT). METHODS: Ninety-seven CBCT images of bilateral mandibular first premolar were selected . The images were analyzed with NNT software for the number and morphology of canal, groove, position of bifurcation and symmetry of bilateral canal classification. RESULTS: The canal configuration of mandibular first premolar was type I:83.5%, type III:3.6%, type v:8.8% and C-shaped canal:4.1% by Vertucci's classification.The incidence of groove in complicated canal (75%)was obviously higher than single canal (3.7%). 56.3% of complicated canal bifurcated in middle third, and 31.3% in apical third. 93.8% of mandibular first premolar had bilateral canal symmetry, the symmetry rate of single canal(95.2%) was higher than complicated canal (66.7%). CONCLUSIONS: CBCT can provide accurate information of canal system, the canal anatomy of mandibular first premolar is complex.