COVID-19: The immediate response of european academic dental institutions and future implications for dental education.

The COVID-19 pandemic has had an immediate and dramatic impact on dental education. The Association of Dental Education in Europe decided to carry out an investigation to assess the immediate response of European Academic Dental Institutions. An online survey was sent to both member and non-member dental schools to investigate the impact on non-clinical and clinical education, assessment and the well-being/pastoral care measures implemented. The preliminary findings and discussion are presented in this paper, for the responses collected between the 25 March and 5 April 2020. The survey at this time of publication is ongoing, and detailed results can be accessed https://adee.org/covid-19-european-dental-education%E2%80%99s-immediate-response.

The therapeutic effects of apigenin and dexamethasone on 5-fluorouracil-induced oral mucositis - a pilot study using a Syrian hamster model.

OBJECTIVE: Oral mucositis (OM) is a common complication of chemotherapy and radiotherapy. The aim of this study was to evaluate the effects of treating 5-fluorouracil-induced OM with apigenin and dexamethasone. METHODS: Thirty-six male Syrian hamsters were randomly assigned to one of three groups: control (50% acetic acid + 5-FU), 50% acetic acid + 5-FU + potassium Apigenin (KA), and 50% acetic acid + 5-FU + dexamethasone. The animals from each group were sacrificed 5, 7, 10, and 14 days after inducing the mucositis, and two samples collected from each animal, accounting a total of 72 samples. Macroscopic changes were assessed by histomorphometric analysis, with ulcers being assessed by imaging analysis and the number of inflammatory cells in the ulcerated region quantified in all periods through histomorphometric analysis (H&E). Furthermore, immunohistochemical changes were evaluated by proliferating cell nuclear antigen. RESULTS: All groups presented an increased inflammatory infiltrate after 7 days, compared to other evaluation times (P ≥ 0.05). There was significant difference between apigenin and control group in the 10-days period. Lower quantity of inflammatory cells in the apigenin-treated group in comparison with control group in the 7- and 10-days periods was observed (P < 0.05). No statistically significant difference was verified among the groups in 5- and 14-days periods. The healing process of the control group was slower than that of apigenin and dexamethasone-treated groups, with an overall significant difference between apigenin and the control group in the 10-days period. CONCLUSIONS: Apigenin treatment may enhance healing of OM induced by 5-fluorouracil, thus suggesting that more extensive research in this area may be useful to assess the role of agents of natural origin capable of preventing OM. Hence, further studies involving broader samples are need to confirm the therapeutic potential shown by this study.

Could the PI3K canonical pathway be a common link between chronic inflammatory conditions and oral carcinogenesis?

The association between chronic inflammatory disorders and oral carcinogenesis has been both a source of interest and contention. Based upon its central importance in oral carcinogenesis, the finding that the PI3k/Akt/mTOR pathway is activated in oral lichen planus, chronic graft-versus-host disease, and chronic oral candidiasis suggests that it may provide a link between benign and malignant oral conditions. Here, we discuss a possible mechanistic rationale that addresses the activation of this important signaling pathway and its downstream events, while correlating it with the carcinogenic potential of chronic oral disorders.

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi study.

Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

The Effect of Laser Bio-modulation on Dysplastic Lesions, an Animal Study.

Potentially malignant disorders are one of the clinical challenges. Dysplasia in these lesions can be a predictor of more potential for malignant changes. Photo-bio-modulation in benign lesions has advantages, but there is doubt on its safety in potentially malignant lesions. This study aims to assess if low-level laser can promote dysplastic changes while the method can play an important role in management of dysplastic lesions. Dysplasia was induced on anterior wall of the buccal pouch of 80 young Syrian male hamsters. Then, hamsters were divided to four groups to receive 4 and 12 sessions irradiation of 660 and 810 nanometers low-level lasers. For histopathologic study of the tissue, we used light microscopes. Using SPSS, data were analyzed via Wilcoxon signed rank test and Mann-Whitney U-test. In all of our four groups, the severity of dysplasia had no statistical difference in study sides comparing with their own controls. Wavelength and numbers of laser irradiation sessions had no statistically meaningful effect on the severity of dysplasia either. Low-level lasers appear to show no relevant or significant effect over the aggravation of the dysplasia's severity. Neither the wavelength nor the number of sessions appear to have any impact in the results.

Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective.

A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients' cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.

Medication-related osteonecrosis of the jaw: Is autologous platelet concentrate application effective for prevention and treatment? A systematic review.

PURPOSE: To date, no ideal strategy has been established for treating or preventing medication-related osteonecrosis of the jaw (MRONJ). The aim of the present work was to perform a systematic literature review to determine the efficacy of autologous platelet concentrate (APC) application, for prevention or treatment of MRONJ, together with surgical debridement. MATERIAL AND METHODS: An electronic search was performed using MEDLINE (PubMed), EMBASE, and Cochrane databases until January 2015 using the following search terms: osteonecrosis, bisphosphonates, antiresorptive, antiangiogenic therapy, BRONJ, platelet concentrate, PRP, PRF, and PRGF. Two reviewers assessed the eligibility of articles independently and extracted key data. The methodology used met PRISMA criteria. The Newcastle-Ottawa scale was used to assess the quality of the articles. RESULTS: Preventive applications of platelet-rich plasma (PLP) were reported in 697 dental extractions in patients taking bisphosphonates intravenously, of whom seven patients developed osteonecrosis (five mandibular and two maxillary). In cases of established osteonecrosis, eight studies reported treatment by surgery combined with APC (seven with PRP and one with leukocyte-rich and platelet-rich fibrin) in 123 patients (34 men and 89 women) with ONJ, who received 157 treatments, of which 135 achieved complete resolution (85.98%). CONCLUSION: There are no published scientific data to sufficiently support any specific treatment protocol, including the use of APC together with surgical debridement, for the management of MRONJ. Randomized controlled clinical trials of the use of APC are needed.

[Osteonecrosis of the mandible induced by intravenous bisphosphonates in oncological patients]. / Osteonecrose da mandíbula associada a bifosfonatos intravenosos em doentes oncológicos.

Bisphosphonates are synthetic analogs of inorganic pyrophosphate, which are not only potent inhibitors of osteoclast-mediated bone resorption, but also present an important inhibitory activity of angiogenesis. Bisphosphonates become, since 1996, the standard of care in the management of patients with osteoporoses as well as bone metabolism alterations associated with neoplasias. In 2003 the first case-reports of bisphosphonate induced osteonecrosis of the jaws were published. The authors report 2 new cases of patients with osteonecrosis induced by bisphosphonates. Case 1: Seventy one years-old male patient, undergoing standard antineoplastic therapy and bisphosphonates due to multiple myeloma 4 years ago was referred to an oral surgeon because of bone exposure, after dental extraction. Case 2: Seventy years-old female patient undergoing treatment with bisphosphonates for adenocarcinoma of the breast was referred to an appointment of oral surgery due to bony exposure. The increasing incidence of this new entity, its physiopathological mechanisms and the nonexistence of consensual and evidence-based treatments, calls for a special attention on prevention, with special emphasis on a careful clinical examination of the oral cavity previously to the establishment of a therapeutic approach with intravenous bisphosphonates in oncological patients.