E-cigarette explosion injuries in the oral and maxillofacial region and a protocol for their management.

DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Embase and Web of Science along with the reference lists from select articles. STUDY SELECTION: Retrospective or prospective cohort studies, randomised controlled trials, case series, case-control studies and case reports on e-cigarette explosion-related facial injuries published in the English language were included. Review articles, nonclinical studies, commentaries, published abstracts and editorials were excluded. Also were excluded, those studies which did not specify injury location or if the injury did not pertain to the maxillofacial region. DATA EXTRACTION AND SYNTHESIS: Data pertaining to bibliographic information, device characteristics, patient details, facial injuries, factors precipitating explosion, complications at follow-up, management and other injuries were extracted. An association between the predictor variables of injury type and location with outcomes of surgical management and intubation was determined by utilising a Chi-squared analysis. RESULTS: A total of 28 studies met the inclusion criteria. A total of 105 facial injuries in 32 patients from 32 e-cigarette explosions were recorded. 73.3% of the injuries were projectile in nature with 26.7% being characterised by burns. 43.8% of all patients suffered both burn and projectile injuries. The eye (10.7%), oral cavity (25%) and face (64.3%) were involved with burn injuries. Projectile injuries mostly involved the lower third of the face (81.8%). 62.5% of patients suffered from a tooth or bone fracture. A 44.4% rate of complications was reported amongst the studies which reported on follow-ups. Surgical management or intubation were found to have no statistically significant relationship with explosive oral injuries. No other statistically significant associations were observed between outcomes and other injury types. CONCLUSIONS: There is a risk of spontaneous combustion with e-cigarettes, which can cause injuries of a serious nature to the oral and maxillofacial region, specially the lower third of the face, commonly necessitating surgical management. Increased regulation along with user education are required in order to improve the safety profile of these devices.

Is there an association between oral hygiene and head and neck cancer?

DATA SOURCES: PubMed, Web of Science, the Cochrane Library and Embase were utilised as databases from inception till November 2021. STUDY SELECTION: The inclusion criteria consisted of cohort and case-control studies published in the English language, which dealt with diagnosed cases of head and neck cancer reporting survival, oral hygiene and comparative data. Studies pertaining to animal experiments along with case reports, conference proceedings, reviews, letters, editorials, errata and protocols were excluded. DATA EXTRACTION AND SYNTHESIS: Data such as publication year, authors' names, country, sources, study groups, age, gender, participant number, education, alcohol, tobacco, study quality, cancer site and outcomes were extracted for each included study. A modified Newcastle-Ottawa Scale was utilized to evaluate the quality of these studies. RESULTS: A total of forty-four studies were included, of which forty were case-control and four were cohort in nature. These comprised of a total of 52,863 patients of which 33,000 were devoid of head and neck cancer (HNC) while, 19,863 had a confirmed diagnosis of HNC. Oral hygiene and HNC were found to be associated. CONCLUSIONS: Poor oral hygiene was concluded to be associated with HNC and the subsites thereof.

The clinical association between Periodontitis and COVID-19.

OBJECTIVES: The study aimed to clinically assess the association between periodontitis and COVID-19-related outcomes. MATERIAL AND METHODS: Data pertaining to patient demographics, medical history, blood parameters, periodontal clinical examination and aMMP-8 point-of-care diagnostics (both site-level and patient-level) was recorded for eighty-two COVID-19-positive patients. COVID-19-related outcomes such as COVID-19 pneumonia, death/survival, types of hospital admission and need of assisted ventilation were also assessed. RESULTS: Males were predominantly afflicted with COVID-19, with advanced age exhibiting a greater association with the presence of periodontitis. Higher severity of periodontitis led to 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of being deceased and 4.42 odds of COVID-19-related pneumonia. The aMMP-8 mouthrinse kit was slightly more sensitive but less specific than aMMP-8 site-specific tests. CONCLUSIONS: Based on the findings of the present study, periodontitis seems to be related to poorer COVID-19-related outcomes. However, within the constraints of this work, a direct causality may not be established. Periodontitis, by means of skewing the systemic condition for a number of comorbidities, may eventually influence COVID-19 outcomes in an indirect manner. CLINICAL RELEVANCE: The study is the first to clinically, and by means of a validated point-of-care diagnostic methodology, assess the association between periodontal health and COVID-19-related outcomes. Assessment of the periodontal status of individuals can aid in the identification of risk groups during the pandemic along with reinforcing the need to maintain oral hygiene and seeking periodontal care.

The Periodontal Status of Orofacial Cleft Patients: A Systematic Review and Meta-Analysis.

Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients.The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020.Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate.Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures.Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [Z = 2.44, P = .01], CAL [Z = 2.52, P = .01], PI [Z = 2.76, P = .006] and not statistically significant for PPD [Z = 0.27, P = .79] and BOP [Z = 1.47, P = .14].Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.

The association between second-hand smoke and the periodontal status of children and adolescents.

Data sources The authors searched Embase, Medline/PubMed, Web of Science, Scopus and LILACS ranging from inception to 23 November 2021. A grey literature search was run utilising OpenGrey along with Google Scholar (most relevant first 200 hits). For the identification of additional articles of relevance, a hand-search was also conducted upon the list of references of all the included studies. No restrictions in terms of date and language were utilised in the search. Controlled vocabulary in the form of free text and MeSH terms was utilised to execute the search strategy.Study selection A screening of the studies potentially satisfying the eligibility criteria was conducted independently by two reviewers on the basis of their abstracts and titles. The records so retrieved were classified under the headings of 'exclude', 'include' and 'uncertain'. Upon the completion of this exercise, an acquisition was made of the full texts of papers judged relevant. Data extraction was performed on all the studies which met the eligibility criteria. Diverging views among the reviewers were resolved with consensus. The judgement of a third reviewer was sought to resolve any disagreements.Data extraction and synthesis Information extraction covered measurement details (cotinine levels of children and/or self-reported questionnaires from children and/or parents); study identification (year of publication, first author and location); distribution according to the status of second-hand smoke and sample characteristics; exposure criteria (according to cotinine levels or severity of parental smoking); analytic approach utilised (multivariate or bivariate analysis); results along with assessment of outcomes (partial- or full-mouth protocol used) and criteria (index type used). Due to only cross-sectional studies being included upon retrieval, the methodological quality assessment was performed utilising an adapted variant of the Newcastle-Ottawa scale. The judgement criteria used included non-response rate, sample size and representativity, confounding control, determination of exposure, outcome assessment and statistical analysis. Evidence tables were built utilising qualitative synthesis in order to ascertain differences in the results and characteristics of the included studies. In case the eligibility criteria were met by three or more papers, the data was subjected to pair-wise comparisons between those unexposed to second-hand smoke with those exposed to it in terms of the specified periodontal outcome measures. Periodontal outcomes were evaluated as continuous measures with the random-effects model. Cochran's Q-test was utilised to assess the heterogeneity and in cases where the heterogeneity was unexplained, a sensitivity analysis was conducted to evaluate whether a single study exerted a significant effect upon the pooled results.Results Six hundred and thirty-seven records were obtained from the search. After screening of the abstracts and titles, eight studies met the eligibility criteria subsequent to the reading of the complete text of 16 reports. One study was conducted in a high socio-demographic index (SDI) country with four in the middle-high, one in the middle and two in the lower-middle SDI countries. Four studies did not provide details pertaining to outcome assessment, while one included a full-mouth and another three, a partial-mouth assessment protocol. Two studies were deemed to be of high quality in terms of methodological quality assessment. Three reports possessed a satisfactory sample size while none of the included studies included data relating to non-response rate. The authors deemed meta-analysis to be possible only in the case of periodontal probing depth (PPD) and gingival index (GI) scores. There was a positive association reported between a high GI score and second-hand smoke exposure. There was, however, no difference present at the subgroup level in terms of the SDI of the country of the study, the age of the cohort as well as the period in which the study was carried out. In contrast, a significant effect was observed for the location of the study data collection in that children from areas with a higher current-smoker prevalence exhibited greater GI scores as a result of increased second-hand smoke exposure. There was no observable difference from the pooled estimate for second-hand smoke exposure compared to the unexposed cohort in terms of PPD. No effects were demonstrable at the subgroup level upon data stratification for the study country SDI and period of data collection. There was greater clinical attachment loss among children who were exposed to second-hand smoke, particularly for those whose fathers were smokers despite adjustments being made for gender, plaque scores and age.Conclusions The systematic review demonstrates a very low level of certainty in evidence to point towards second-hand smoke exposure of children up to 15 years of age leads to higher GI scores as compared to their unexposed counterparts. Even though no differences have been demonstrated in terms of PPD, there is a necessity for further research to draw conclusions on other pertinent periodontal parameters such as bleeding on probing and clinical attachment loss.

Do clinical decision support tools have a role to play in dealing with paediatric dental trauma?

Design Randomised controlled trial.Case selection In order to assess baseline knowledge of dental trauma, paediatric dentists and medical students were administered a pre-test, subsequent to which a random assignment was carried out to one of three learning groups: mobile app clinical decision support tools (CDST), print CDST and no CDST, for the purposes of a post-test.Data analysis The correct answers for the pre-test and post-test, time to completion and answers to the demographic survey were subjected to descriptive statistical analyses using IBM SPSS v25.0 for Windows (SPSS, IBM Corp, Armonk, NY). In order to compare the pre- and post-tests for each group, a paired-sample t test was conducted. An independent-sample t test and Pearson χ2 test were utilised to assess for significant differences between paediatric dentists and medical students. Least significant post-hoc and one-way analysis of variance (ANOVA) tests were conducted among the three groups. The level of significance was set at p <0.05.Results Paediatric dentists obtained significantly higher scores on both the pre- and post-tests when compared to medical students (8.57 ± 0.96 vs 4.20 ± 1.58; p <0.001 and 8.37 ± 1.09 vs 4.96 ± 1.99; p <0.001, respectively).No significant difference was noted pertaining to the time taken to complete the tests among both the groups. In both the groups, the highest scores were obtained by those who used the mobile app version of the CDST; these subjects, however, recorded the longest time to complete the post-test (p <0.001).Conclusions When compared to the absence of an aid, both the mobile app and print versions of the CDST improved the diagnosis and management of injuries to the primary dentition. With medical students demonstrating significant improvement in primary dental trauma management with CDST usage, these tools are recommended to enhance the diagnosis and treatment for such patients.

Active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) in the COVID-19 pandemic.

INTRODUCTION: Active matrix metalloproteinase (aMMP)-8 utilized in point-of-care testing (POCT) is regarded as a potential biomarker for periodontal and peri-implant diseases. Various host and microbial factors eventually influence the expression, degranulation, levels and activation of aMMP-8. The type of oral fluids (saliva, mouthrinse, gingival crevicular, and peri-implant sulcular fluids [GCF/PISF], respectively) affect the analysis. AREAS COVERED: With this background, we aimed to review here the recent studies on practical, inexpensive, noninvasive and quantitative mouthrinse and GCF/PISF chair-side POCT lateral flow aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) and how they help to detect, predict, monitor the course, treatment and prevention of periodontitis and peri-implantitis. The correlations of aMMP-8 POCT to other independent and catalytic activity assays of MMP-8 are also addressed. EXPERT OPINION: The mouthrinse aMMP-8 POCT can also detect prediabetes/diabetes and tissue destructive oral side-effects due to the head and neck cancers' radiotherapy. Chlorhexidine and doxycycline can inhibit collagenolytic human neutrophil and GCF aMMP-8. Furthermore, by a set of case-series we demonstrate the potential of mouthrinse aMMP-8 POCT to real-time/online detect periodontitis as a potential risk disease for coronavirus disease 2019 (COVID-19). The clinical interdisciplinary utilization of aMMP-8 POCT requires additional oral, medical, and interdisciplinary studies.

Are there any significant craniomaxillofacial manifestations of COVID-19?

Data sources PubMed/Medline, Biomed Central, Embase, Thai Journals and the Cochrane library.Study selection Reports or studies dealing with the craniomaxillofacial (CMF) manifestations of COVID-19 were selected.Data extraction and synthesis The reviewers extracted data from the included studies; however, being a meta-narrative review, it was not deemed fit to contact authors for unpublished work, conduct a meta-analysis, search for unpublished data or search for studies in languages different from English, German, French and Thai. The primary variable for prediction was set as the COVID-19 infection, with the primary outcome variable being manifestation in the CMF region. Parameters of a clinical, demographic, investigative and therapeutic nature were the other included variables. Subsequently, the reports and abstracted data were reviewed for study design, author names, country, size of the sample, level of evidence, signs/symptoms, treatment undertaken and investigations conducted. Studies exhibiting the highest level of evidence were included eventually. As deemed appropriate, uni/bivariate and descriptive statistics were applied.Results Cumulatively, 101 publications were included in the meta-narrative after due screening, the data of which was further divided into five groups of: 1) nose/paranasal sinus/skull base; 2) mouth/throat; 3) periorbital/ocular tissue; 4) skin; and 5) ear.Conclusions The majority of data pertaining to CMF manifestations of COVID-19 qualifies as a low level of evidence. With the exception of taste/smell dysfunction, most CMF manifestations are nonspecific and can be diagnosed by CMF surgeons and dentists, which underscores their role in battling the pandemic.

E-cigarettes and heated tobacco products impact on dental color parameters.

Objectives: Abstaining from tobacco smoking may not only improve general health, but also reduce teeth staining and restore teeth whiteness. Compared with conventional cigarettes, E-cigarettes (ECs) and heated tobacco products (HTPs) may offer substantial reduction in exposure to pigmented tar-like compounds of cigarette smoke. It is possible that improvements in dental color indices may be observed in those who have stopped smoking combustible cigarettes by switching to tar-free nicotine delivery products. Methods: This cross-sectional study evaluated and compared dental color parameters by digital spectrophotometry among five different groups: individuals who currently smoke ; individuals who used to smoke but have quit ; individuals who have never smoked ; exclusive users of electronic cigarettes (former smokers) ; and exclusive users of heated tobacco products (former smokers) . Results: Dental whiteness in current cigarette smokers was notably worse compared with never and former smokers, (13.38 Whiteness Index for Dentistry (WID) units vs. 19.96 and 16.79 WID units). Remarkably high WID values (i.e., whiter teeth) were also observed in ECs (16.72 WID units) and HTPs users (17.82 WID units). Compared to current smokers, difference in dental whiteness for ECs and HTPs users was visually noticeable (ΔWID difference being on average > 2.90 units). The colour differences measured as delta E*(ΔE*) were all visually detectable except for the comparison between ex-smokers and ECs users for which no perceptible color difference was observed (0.415). Conclusion: Exclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance. Clinical significance: Use of alternative nicotine delivery systems may be associated with cosmetic benefits with important implications for those smokers perceiving dental aesthetics as a significant problem. For these an oral-based narrative may be a much more significant reason to refrain from smoking than the fear of developing smoking-related diseases in future.

The oral microbiome and vaccine efficacy.

The immune response elicited by vaccines is crucial in determining their eventual efficacy. The human microbiome, in particular, that of the gut has been demonstrated to influence the immunogenicity of vaccines delivered by both the oral and non-oral routes. There is a significant overlap between the microflora of the mouth and that recovered from the gut, with certain periodontopathogens playing key roles in influencing the gut microflora. The present paper hypothesized that the oral microflora may play a role in the eventual immunogenicity and efficacy of vaccines.

An aMMP-8 Point-of-Care and Questionnaire Based Real-Time Diagnostic Toolkit for Medical Practitioners.

The aim of this cross-sectional study is to propose an efficient strategy based on biomarkers adjunct with an interview/questionnaire covering risk factors for periodontitis for the identification of undiagnosed periodontitis by medical professionals. Active matrix metalloproteinase (aMMP)-8 levels in mouthrinse were analyzed by a point-of-care (PoC)/chairside lateral-flow immunotest, and salivary total MMP-8, total MMP-9 and calprotectin levels were analyzed by enzyme-linked immunosorbent assays (ELISAs) and active MMP-9 by gelatin zymography for 149 Greek patients. Patients underwent a full-mouth oral health examination for diagnosis according to the 2018 classification system of periodontal diseases. In addition, patient characteristics (risk factors: age, gender, education level, smoking and body mass index) were recorded. Receiver operating curve (ROC) analysis indicated better diagnostic precision to identify undiagnosed periodontitis for oral fluid biomarkers in adjunct with an interview/questionnaire compared with a plain questionnaire (i.e., risk factors): aMMP-8 AUC (95% confidence interval) = 0.834 (0.761-0.906), total MMP-8 = 0.800 (0.722-0.878), active MMP-9 = 0.787 (0.704-0.870), total MMP-9 = 0.773 (0.687-0.858) and calprotectin = 0.773 (0.687-0.858) vs. questionnaire = 0.764 (0.676-0.851). The findings of this study suggest that oral fluid biomarker analysis, such as a rapid aMMP-8 PoC immunotest, could be used as an adjunct to an interview/questionnaire to improve the precision of timely identification of asymptomatic, undiagnosed periodontitis patients by medical professionals. This strategy appears to be viable for referring patients to a dentist for diagnosis and treatment need assessment.

Buccal swabs as non-invasive specimens for detection of severe acute respiratory syndrome coronavirus-2.

INTRODUCTION: The current gold standard for detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA involves subjecting nasopharyngeal or oropharyngeal swabs to reverse transcription quantitative PCR (RT-qPCR). However, both sample types need to be collected by trained professionals. Using self-collected buccal swabs as an alternative could simplify and accelerate diagnosis of coronavirus disease 2019 (COVID-19). OBJECTIVE: To assess self-collected buccal swab samples as an alternative method for SARS-CoV-2 detection in patients with COVID-19. METHODS: Buccal swab samples were self-collected by 73 patients with COVID-19. Total RNA was extracted using Qiagen kits. RNA encoding the SARS-CoV-2 Env protein and human RNase P as an internal control was amplified using the TRUPCR® SARS-CoV-2 RT-qPCR kit version 2.1 and a Bio-Rad CFX96 Real-Time Detection System. RESULT: The sensitivity of RT-qPCR from buccal swabs was 58.9% (43/73; 95% confidence interval [CI] 46.77%-70.27%) and that of RT-qPCR from saliva was 62.90% (39/62; 95% CI 49.69%-74.84%) taking positive SARS-CoV-2 RT-qPCR from nasopharyngeal swabs as the gold standard. CONCLUSION: Self-collected buccal swabs are promising alternatives to nasopharyngeal or oropharyngeal swabs for SARS CoV-2 detection.

COVID-19 & Periodontitis: The cytokine connection.

COVID-19 is now recognized as a pandemic throughout the world, leading to a scramble in order to gather knowledge as well as evidence regarding the 'novel' corona virus which causes this disease. Chemokines are a family of cytokines which are chemotactic in nature and cause the recruitment of cells of inflammation. Periodontitis has long been attributed to having its pathophysiology rooted in a cytokine response. The recent COVID-19 pandemic has been reported to have adverse outcomes related to the establishment of a cytokine storm, many of the components of which are common with the cytokine expression profile of periodontitis. This communication explores the connection between COVID-19 and periodontal disease through their cytokine connection to form a translational basis for recommending maintenance of oral hygiene in the COVID era and to red flag patients with periodontitis as having an increased risk of exhibiting COVID related adverse outcomes.

The intriguing commonality of NETosis between COVID-19 & Periodontal disease.

NETosis, being an alternative form of cell death is the creation of web-like chromatin decondensates by suitably primed neutrophils as a response to stimulus aimed at containing and eliminating the same. In certain situations, it causes more harm than benefit in the form of bystander damage directly or via activation of autoimmune mechanisms. Such pathophysiology finds evidence in both Periodontal disease and COVID-19. Coupled with impaired removal, NETs have been implicated in both these disease forms to promote a state of inflammation and be a source of constant harm to the tissues involved. This potentially forms groundwork to implicate Periodontal disease as predisposing towards adverse COVID-19 related outcomes.