Outcomes of invitational and opportunistic oral cancer screening initiatives in Oporto, Portugal.

OBJECTIVE: To assess the utility of oral cancer screening for the early detection of oral potentially malignant disorders (OPMDs) and oral cancer (OC) in a population of Oporto city. MATERIAL AND METHODS: We conducted an OC screening program in the city of Oporto between 2010 and 2011 using two methodologies of population recruitment: Volunteers attending an OC screening day recruited via a mass media campaign; and OC screening during dental visits to a public hospital in the Oporto City. Participants' socio-demographic information and life-style habits were ascertained by interviewers, and an oral mucosal examination (screen) was conducted by previously trained and calibrated group of 20 screeners. RESULTS: A total of 727 individuals (277 males and 450 females) with a mean age of 54 years (range 18-94) were screened. During screening, we detected 22 OPMDs: 13 (59.1%) oral leukoplakias and 9 (40.9%) cases with oral lichen planus. No erythroplakias were detected. In addition, two oral carcinomas were detected, both in the T1 stages of the disease. All screen positives attended a specialist clinic following referral to confirm their diagnoses. A randomly selected sample among negative screens was also examined to assess any false negatives. The sensitivity was 96% and specificity was 98%. Significantly more positive cases were found among older individuals (≥54 years) (P = 0.045). CONCLUSION: Screening data suggest that new cancers and OPMDs can be detected by invitational and opportunistic screening and offer a platform to raise the awareness and knowledge on this cancer in the Portuguese population.

Treatment of an asymmetric malocclusion: a case report.

AIM: This case report describes an adult female patient who presented with dental asymmetry associated with bilaterally missing lower first molars, accompanied by extruded and mesially-tipped lower second and third molars. Masticatory dysfunction and temporomandibular joint (TMJ) pain were present during mouth opening and likely related to a posteriorly positioned condyle and anterior disc displacement with reduction. METHODS: Orthodontic treatment consisted of occlusal plane levelling and mandibular repositioning, achieved using a Multiloop Edgewise Archwire (MEAW) technique. Differential MEAW activation on each side and temporary occlusal composite bite blocks on the lower left third molar were necessary to increase the vertical dimension of the Class II side, which allowed extrusion of the left premolars to a Class I relationship. RESULTS: The bilateral uprighting of the second and third molars was achieved by tip-back wire activation to level the occlusal plane and intrude these teeth. Elastics worn vertically on the right side and Class II elastics on the left side facilitated occlusal correction. Dental implants for fixed prosthetic rehabilitation of the missing lower left first molar were placed to stabilise the posterior occlusion. Articular disc recovery removed TMJ symptoms and the case was finished with stable sagittal and vertical occlusal relationships. CONCLUSION: Successful management of a canted occlusal plane and the stabilisation of the posterior occlusion, resulted in a recovery of a displaced articular disc and improvement of facial symmetry.

Osteonecrosis of the Jaw Associated with Bisphosphonates Infusion for Treatment of Plasma Cell Myeloma-A Retrospective Observational Study of Northern Portuguese Population.

Objectives: To verify medication-related osteonecrosis of the jaw (MRONJ) frequency among patients with plasma cell myeloma (PCM) that had been treated with bisphosphonates, to identify predisposing factors that could influence the development of osteonecrosis. Methods: This observational retrospective study was performed at the Department of Hematology of Hospital Center of Porto (CHUP), Portugal. Results: The study population (n = 112) had a 15.2% (n = 17) prevalence of osteonecrosis. Clinically, bone exposure was the most frequently observed sign, present in 100% (n = 17) of the patients, followed by inflammation in 82.4% (n = 14), orofacial pain in 70.6% (n = 12), suppuration in 47.1% (n = 8), and intra or extra-oral fistula in 17.6% (n = 3) of the cases. The most frequent triggering local factor was dental extraction (82.4%). There was a dependence between the presence of extractions and the development of MRONJ (p < 0.001) but not with the time elapsed from the initiation of infusions with BPs and dental extractions (p = 0.499). In the sample of patients with multiple myeloma (MM), 13.8% were found to be more likely to develop MRONJ after an extraction. Conclusions: The most common local predisposing factor was dental extraction. No dependence was observed between the development of osteonecrosis and the time elapsed from the beginning of treatment with bisphosphonates infusions to surgical procedures.

SEM Analysis and Micro-CT Evaluation of Four Dental Implants after Three Different Mechanical Requests-In Vitro Study.

STATEMENT OF PROBLEM: Implant-supported rehabilitations are an increasingly frequent practice to replace lost teeth. Before clinical application, all implant components should demonstrate suitable durability in laboratory studies, through fatigue tests. OBJECTIVE: The purpose of this in vitro study was to evaluate the integrity and wear of implant components using SEM, and to assess the axial displacement of the implant-abutment assembly by Micro-CT, in different implant connections, after three distinct mechanical requests. MATERIALS AND METHODS: Four KLOCKNER implants (external connection SK2 and KL; and internal connection VEGA and ESSENTIAL) were submitted to three different mechanical requests: single tightening, multiple tightening, and multiple tightening and cyclic loading (500 N × 100 cycles). A total of 16 samples were evaluated by SEM, by the X-ray Bragg-Brentano method to obtain residual stresses, and scratch tests were realized for each surface and Micro-CT (4 control samples; 4 single tightening; 4 multiple tightening; 4 multiple tightening and cyclic loading). All dental implants were fabricated with commercially pure titanium (grade 3 titanium). Surface topography and axial displacement of abutment into the implant, from each group, were evaluated by SEM and Micro-CT. RESULTS: In the manufacturing state, implants and abutments revealed minor structural changes and minimal damage from the machining process. The application of the tightening torque and loading was decisive in the appearance and increase in contact marks on the faces of the hexagon of the abutment and the implant. Vega has the maximum compressive residual stress and, as a consequence, higher scratch force. The abutment-implant distances in SK2 and KL samples did not show statistically significant differences, for any of the mechanical demands analyzed. In contrast, statistically significant differences were observed in abutment-implant distance in the internal connection implants Vega and Essential. CONCLUSIONS: The application of mechanical compression loads caused deformation and contact marks in all models tested. Only internal connection implants revealed an axial displacement of the abutment into the implant, but at a general level, a clear intrusion of the abutment into the implant could only be confirmed in the Essential model, which obtained its maximal axial displacement with cyclic loading.

The Effectiveness of Osseodensification Drilling versus the Conventional Surgical Technique on Implant Stability: A Clinical Trial.

Background/Objective: To ensure that implants are able to support prosthetic rehabilitation, a stable and functional union between the bone and the implant surface is crucial to its stability and success. To increase bone volume and density and excel bone-implant contact, a novel drilling method, called osseodensification (OD), was performed. To assess the effectiveness of the osseodensification drilling protocol versus the conventional surgical technique on implant stability. Methods: Bone Level Tapered Straumann implants were placed side-by-side with both OD and subtractive conventional drilling (SD) in 90 patients from CESPU-Famalicão clinical unit. IT was measured using a manual torque wrench, and the Implant stability quotient (ISQ) value was registered using the Osstell® IDX. Results: According to the multifactorial ANOVA, there were statistically significant differences in the mean IT values due to the arch only (F(1.270) = 4.702, p-value = 0.031 < 0.05). Regarding the length of the implant, there were statistically significant differences in the mean IT in the OD group (p = 0.041), with significantly lower mean IT values for the Regular implants compared to the Long. With respect to the arch, the analyses of the overall ISQ values showed an upward trend in both groups in the maxilla and mandible. High levels of IT also showed high ISQ values, which represent good indicators of primary stability. Conclusions: OD does not have a negative influence on osseointegration compared to conventional subtractive osteotomy.

Assessment of Oral Health Status in a Prison Population in Northern Portugal.

Background: Prisoners constitute one of the disadvantaged groups and it is observed that these individuals suffer from poor oral hygiene and the prevalence of oral diseases is higher compared to the general population. Material and Methods: The aim of this study is to assess the state of the oral health in a prison population in Northern Portugal. A cross-sectional observational study was conducted involving 103 male prisoners with age between 25 and 75 years old. A questionnaire was presented to all the prisoners and an intraoral clinical examination was performed in each of them. Results: The sample mean age was 41.58 ± 8.94 years. Most participants consume sugary foods, with 32% consuming then on a daily basis. It was noticed that 13.6% of the participants do not brush their teeth. Most of the prisoners smoke (78.6%) and 70 smoke more than 10 cigarettes per day. The mean DMFT was 17.17 ± 8.23 and the component with the highest weight was the number of missing teeth, with a mean value of 13.14 ± 8.32. It was observed that 7 individuals are edentulous and 64 (62.1%) have caries lesions. It has been noted that of the 64 individuals presenting caries lesions, 47 (73.4%) eat sugary foods, however this relationship is not statistically significant. It was found that the prevalence of periodontal health was 26%, gingivitis was 32.3% and periodontitis was 41.7%. Plaque Index was evaluated according to the periodontal condition, it was observed a significantly lower level of plaque index in the periodontally healthy subjects compared to the subjects with gingivitis and the subjects with periodontitis. Conclusions: The prevalence of oral diseases in this prison population is high, as is the loss of teeth. Dental caries is the most observed oral disease, and periodontitis the most common of the periodontal diseases. Key words:Prisoners, Oral health, Caries, DMFT, Periodontitis, Oral diseases.

Study of Prevalence, Severity and Risk Factors of Periodontal Disease in a Portuguese Population.

Periodontal disease is a common worldwide oral inflammation/infection affecting tissues that surround and support teeth. This study aims to evaluate the prevalence, extent and severity of periodontal diseases and its risk factors, according to the most recent periodontal classification, in an adult population of Northern Portugal. This observational study collected data from clinical records of patients who attended the University Clinic of Gandra between April 2021 and April 2022. Of a total of 941 patients included, 457 (48.6%) had periodontitis, 253 (26.9%) had gingivitis and the remaining 231 (24.5%) were healthy patients. The prevalence of stage III severe periodontitis was 51.2%, more prevalent in males, and in the age group of 61-70 years. Gingivitis was more prevalent in females, and in the age group of 31-40 years; in both diseases, the most prevalent extension was the generalized one. Using a binary logistic regression, we observe a significant relation of the risk of periodontitis with age (p = 0.019; OR 1.033; 95% CI 1.005-1.062), tooth brushing (p = 0.002; OR 0.25; 95% CI 0.105-0.599) and dental flossing (p = 0.015; OR 0.63; 95% CI 0.09-0.768). This study revealed a high prevalence of periodontitis. Increased age, lack of tooth brushing and flossing were identified as potential risk factors for periodontitis in the investigated Portuguese population.

Photobiomodulation laser therapy in a Lenvatinib-related osteonecrosis of the jaw: A case report.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction often presenting as a post-surgery complication that may interfere in the quality of the patient's life. In the last decade, additionally to bisphosphonates, other drugs have been associated with MRONJ including other antiresorptive, antiangiogenic or multitarget drugs such as levantinib. The data on MRONJ associated to lenvatinib is scarce with no guidelines for best management option. Our aim is to report a case of MRONJ associated with lenvatinib and the useful of a non-invasive management using local photobiomodulation (PBM) therapy with a 635nm diode laser. MATERIAL AND METHODS: A 61-year-old female patient with a follicular thyroid carcinoma (stage IV) and taking lenvatinib presented to our Oral Medicine Unit with a painful non-healing ulcer with bone exposure, in the posterior right maxilla, after an extraction of a molar tooth which occurred 4 months previously. Bone rarefaction was detected in CT scan in the same affected area. We diagnosis a lenvatinib-related osteonecrosis of the Jaw (LRONJ). We performed 5 sessions of PBM treatment using a 635 nm diode laser, delivering 10J/ cm2 in affected area. RESULTS: At the end of the first session, a relief in the pain was already refereed by the patient. One month after, the oral mucosa was completely healed and tissue integrity was confirmed clinically and on panoramic radiograph and the patient referred an increase in her quality of life. On the last follow up after 6 months the patient was without any recurrence. CONCLUSIONS: A lenvatinib-related osteonecrosis of the maxilla in a female patient is reported here for the first time. Moreover, a non-invasive management using PBM laser therapy has shown a successful healing of involved tissues and immediate symptoms relief improving the quality of life of the patient. Key words:Lenvatinib, MRONJ, osteonecrosis of the jaw, tyrosine kinase inhibitors, photobiomodulation.

Effectiveness of Photobiomodulation in Temporomandibular Disorder-Related Pain Using a 635 nm Diode Laser: A Randomized, Blinded, and Placebo-Controlled Clinical Trial.

Objective: We aimed to evaluate the efficacy of photobiomodulation (PBM), using an 635 nm diode laser, to provide pain relief for temporomandibular disorder (TMD). Background data: TMD involves a set of multiple clinical manifestations where pain is prevalent. Treatment ideally should be noninvasive and innocuous such as PBM. Methods: A randomized, placebo-controlled, clinically blinded trial was performed on 42 patients with painful TMD diagnosed according the Research Diagnostic Criteria for Temporomandibular Disorders. They were randomly placed into two groups: an intervention group (n = 22) subjected to the application of a 635 nm wavelength diode laser (using a 8-mm diameter handpiece in contact mode, delivering 8 J/cm2 over a period of 20 sec applied over the sensitive points where the pain was reported by the participants) and a placebo group (n = 20) following the same protocol but without laser activation. All patients received four sessions of treatment over 4 weeks. Personal pain perception, nonassisted pain-free maximum mouth opening and tenderness elicited during palpation of muscles were used as primary outcomes, evaluated at baseline and at follow-up 1 month later by blinded, calibrated evaluators. Results: There was a significant reduction in the degree of pain recorded in the laser group after treatment (0.63 ± 0.36) compared with the baseline evaluation (4.59 ± 2.36; p < 0.001), which was not observed in the placebo group. Reduction of pain during palpation of most masticatory muscles was significant following treatment in the intervention group. A significant increase in the nonassisted painless mouth opening was observed after treatment (42.14 ± 5.8 mm) compared with baseline values (36.73 ± 9.91 mm) only among the laser group (p = 0.007). There were no reported adverse events or side effects among the patients in the intervention group. Conclusions: Our results suggest that PBM using a 635 nm laser was effective on the remission of painful TMD, without complications.

Oral cancer awareness and knowledge among residents in the Oporto city, Portugal.

OBJECTIVE: To assess the awareness and knowledge on oral cancer in a general population of Oporto city, in Portugal. METHODS: Face-to-face interviews were performed with 1116 individuals, resident in the city of Oporto. Participants' socio-demographic information, lifestyle habits and awareness, knowledge and beliefs on oral cancer were ascertained. RESULTS: Breast cancer was the most mentioned being as heard of (69.8%), while oral cancer was one of the least heard of (23.7%). Tobacco was identified as a risk factor by 54.8% of individuals and this knowledge was associated with their education level (P < 0.001), dentist visits (P = 0.026), and tobacco consumption (P < 0.001). Fewer subjects (24.6%) referred to alcohol as a risk factor, and this knowledge was associated with their education level (P = 0.020) and dentist visits (P = 0.002). More than half the subjects (58.8%) could not identify any sign or symptom of oral cancer. CONCLUSION: There is a general lack of awareness on oral cancer among this Oporto population. Higher education level and better oral health care were significant factors that identified individuals with a better awareness and knowledge of oral cancer, suggesting that educational measures could be useful for the prevention and early diagnosis of oral cancer in the Portuguese population.

Er:YAG Laser Assisted Treatment of Central Odontogenic Fibroma of the Mandible.

Central odontogenic fibroma is a very rare benign odontogenic tumour characterized by a fibrous mature stroma with variable strands or islands of inactive-looking odontogenic epithelium. Our aim is to report a case of a central odontogenic fibroma and describe the clinical usefulness of Er:YAG laser for the surgical treatment of this tumour. A 74-year-old woman presented with an expansive lesion located in a mandible with multilocular and mixed radiographic appearance. A conservative excision using Er:YAG laser was performed. Complete removal was obtained. There were no postoperative complications. The histopatologic features were consistent with the diagnosis of central odontogenic fibroma of rich-epithelium type. No recurrence was observed during follow-up.

Aesthetic Depigmentation of Gingival Smoker's Melanosis Using Carbon Dioxide Lasers.

Melanic pigmentation results from melanin produced by the melanocytes present in the basal layer of the oral epithelium. One of the most common causes of oral pigmentation is smoker melanosis, a condition associated with the melanocyte stimulation caused by cigarette smoke. This paper aims to illustrate the use of a carbon dioxide laser in the removal of the gingival melanic pigmentation for aesthetic reasons in a 27-year-old female patient with history of a smoking habit. The carbon dioxide laser vaporisation was performed on the gingival mucosa with effective and quick results and without any complications or significant symptoms after the treatment. We conclude that a carbon dioxide laser could be a useful, effective, and safe instrument to treat the aesthetic complications caused by oral smoker melanosis.

Reliability of partial-mouth recording systems to determine periodontal status: a pilot study in an adult Portuguese population.

BACKGROUND: The efficacy of various partial-mouth recording (PMR) systems is analyzed in the evaluation of periodontal status, using index teeth and different combinations of quadrants. METHODS: The study group was formed of 108 adults aged 25 to 65 years old. A full-mouth examination (FME) was performed in all participants to determine the periodontal probing depth (PD) and clinical attachment level (CAL) at six sites per tooth. The results of PMR using the Ramfjord teeth, the Community Periodontal Index of Treatment Needs teeth, and the four quadrants individually and combined in pairs were compared to the results obtained with FME. RESULTS: Concordance with FME in terms of the prevalence of patients with PD ≥4 mm, CAL ≥2 mm, and CAL ≥4 mm was lowest with examination of single quadrants and highest with combinations that included one superior and one inferior quadrant. CONCLUSIONS: PMR systems, particularly with combinations of a superior plus an inferior quadrant, could be useful to evaluate periodontal status based on PD and CAL. This tool could be useful for epidemiologic surveys on periodontal status.

Clinical improvement following therapy for periodontitis: Association with a decrease in IL-1 and IL-6.

Although a number of inflammatory cytokines have been shown to be associated with periodontal pathogenesis, it is important to investigate further whether these biomarkers are associated with the degree of success in nonsurgical treatment of chronic periodontitis. The aim of the present study was to quantify the total levels of interleukin (IL)-1α, -1ß, -6, -10 and tumour necrosis factor (TNF)-α in gingival crevicular fluid (GCF) of chronic periodontitis patients prior to and following nonsurgical periodontal therapy. In total, 52 GCF samples from disease sites of patients with chronic periodontitis, prior to and following periodontal therapy, and ten non-disease sites from non-periodontitis subjects, were collected and cytokine concentrations were determined using a multiplex method. Periodontal parameters, including bleeding on probing, probing pocket depth and the clinical attachment level, in all the sites were recorded. Untreated disease sites exhibited higher cytokine levels in the GCF when compared with the non-disease sites. Nonsurgical periodontal therapy resulted in a statistically significant decrease in the total levels of IL-1α, -1ß and -6 in the GCF, but not in IL-10 or TNF-α. The results support the hypothesis that proinflammatory cytokines, including IL-1α, IL-1ß and IL-6, are likely to be involved in the pathogenesis of periodontitis and are good markers to evaluate the success of nonsurgical therapy in disease sites of patients with periodontitis.

Oral cancer awareness and knowledge in the city of valongo, portugal.

We conducted a questionnaire survey among 602 subjects in order to analyze the awareness and knowledge on oral cancer among residents of the city of Valongo in Portugal. The cancer that most subjects were aware of was breast cancer (99%). Oral cancer was the least mentioned cancer (68.6%). There was awareness of the relationship between oral cancer and smoking among 89.5% subjects, but less of the association with alcohol misuse (63.3%). Nonhealing mouth ulcers were identified as a sign or symptom of oral cancer by 90.0% and red or white patch by only 52.8% subjects. Whereas 94.5% agreed that early detection could improve the treatment outcome, a disheartening 28.1% believed that whether a person developed an oral cancer or not is a matter of luck and therefore is unavoidable. Surprisingly only 1.7% were ever submitted to or had knowledge of receiving a consultation regarding oral cancer. In conclusion, this survey demonstrates a general lack of awareness and knowledge on oral cancer in a population of Valongo. An oral health promotion strategy should involve elements of basic education on oral cancer for this population, and regular oral cancer screenings should be implemented in Valongo.