Oral health status of 916 children in Tibetan settlement (Bylakuppe, India): A cross-sectional descriptive study.

BACKGROUND: Dietary and oral hygiene habits among integrated migrant cultural minorities can vary and could impact susceptibility to caries. AIM: This study aimed to assess and compare the oral health status of Tibetan schoolchildren living in the Tibetan settlement of Bylakuppe, India, stratified by type of residence. DESIGN: A descriptive cross-sectional study was conducted among Tibetan schoolchildren attending nine schools in the Bylakuppe region. RESULTS: The study population consisted of 916 children aged 5-17: 702 (76.6%) living in secular houses (LSH) and 214 (23.4%) living in monasteries (LM). The prevalence of dental caries was 70.9%, and the mean value of decayed, missing, filled teeth for mixed and primary dentition (DMFT*; dmft) of LSH children (1.56 ± 2.34/1.74 ± 2.66) was higher than of LM ones (1.14 ± 2.34/0.83 ± 2.80; p < .001). DMFT for LM children (1.46 ± 2.04) was slightly higher than for LSH children (1.38 ± 1.96; p > .05). Among the sample, 99.1% had a good simplified Oral Hygiene Index (OHI) and LM children showed higher rates of good values (99.5% vs. 98.2% in LSH children). Most children needed preventive/routine dental treatment, whereas 16.6% needed urgent dental treatment. In 4.5% of children, oral mucosal lesions were present. CONCLUSION: This study confirms the high need for dental treatment in the children of the Tibetan settlement investigated.

Site-Coded Oral Squamous Cell Carcinoma Evaluation by Optical Coherence Tomography (OCT): A Descriptive Pilot Study.

Optical Coherence Tomography (OCT) is an emerging non-invasive method for oral diagnostics, proving to be a practicable device for epithelial and subepithelial evaluation. The potential validity of OCT in oral cancer assessment has been explored but, to date, there are very few investigations conducted with a systematic comparison between clinical/histological and OCT parameters, especially in strict reference to the anatomical site-codification of the oral mucosa. In this regard, our study performed a two-steps evaluation (in vivo OCT and histological investigations) of suspected OSCCs, progressively recruited, using as references the OCT images of the same site-coded healthy mucosa, to provide as much as possible site-specific determinants. Thirty histologically confirmed OSCCs were recruited. Specific OCT mucosal features (SEL-Stratified Epithelial Layer; BM-Basement Membrane; LP-Lamina Propria) were registered and processed using the SRQR (Standards for Reporting Qualitative Research) statement. The systematic dual descriptive OCT analysis revealed that OSCC scans present a complete alteration of epithelial (KL, SEL) and subepithelial (BM, LP) layers with a site-specificity characteristic; moreover, peculiar OCT configurations such as "icicle-like" structures could be strongly suggestive of neoplastic infiltration. This study supports the OCT use for the development of more specific optical structural models applied to oral carcinogenesis.

Diagnostic Concordance between Optical Coherence Tomography and Histological Investigations for Immune-Mediated Desquamative Gingivitis: Observational Study.

Desquamative gingivitis (DG) denotes a heterogeneous immune-mediated disease for which early diagnosis represents a great challenge. The main aim of this study is to validate diagnostic concordance between specific Optical Coherence Tomography (OTC) patterns for DG related to oral Lichen Planus (OLP), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP) and definitive histological diagnosis. Forty-three patients with suspected immune-mediated DGs, were progressively recruited. Before biopsy, an OCT preliminary evaluation was performed using specific pre-determined OCT diagnostic patterns (i.e., morphology and localization of blisters, status of the basal membrane, epithelial thickness, presence/absence of acantholytic cells into blister and/or inflammatory infiltrate) related to OLP, PV and MMP. After histological confirmation, OCT and histological diagnoses were compared. Using pre-determined patterns, OCT diagnoses of DGs were: 22 (51%) OLP, of which 11 (26%) were with the bullous variant, 4 (9%) PV and 6 (14%) MMP. The same diagnoses were found by histological investigations (with the main OCT discriminatory potential for the bullous variant of OLP). The concordance between the two diagnostic methods was confirmed by the Fisher exact test (p-value < 0.01). These specific OCT patterns show a diagnostic reliability in 100% of the cases investigated, suggesting their accuracy to support the complex diagnosis and management of immune-mediated DGs.

Immune-Mediated Desquamative Gingivitis and Optical Coherence Tomography Diagnostic Patterns: Clinical Implication from a Systematic Review.

Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions.

Microleakage of Direct Restorations-Comparisonbetween Bulk-Fill and Traditional Composite Resins:Systematic Review and Meta-Analysis.

Since the bulk-fill composites were produced, there was a progressive diffusion of their use for direct conservative treatment in posterior teeth. Their chemical structure increases the depth of cure and decreases the polymerization contraction; in this manner, bulk-fill composites can be placed in 4 mm single layers and the treatment times are considerably reduced. However, aesthetic and mechanical properties and impact on microleakage of bulk-fill resins are still unclear.This systematic review and meta-analysis aimed to assess the risk of microleakage of direct posterior restorations made of bulk-fill versus conventional composite resins.Researches were performed on PubMed and Scopus databases. Eligible in vivo studies, published since 2006, were reviewed. Outcomes of marginal discoloration, marginal adaptation, and recurrent caries were considered to conduct the systematic review and meta-analysis. Secondary data were examined to implement additional analysis and assess the risk of bias.Eight randomized clinical trials were analyzed, involving 778 direct restorations. The summary of RCTs led to significant but inconsistent results; the marginal discoloration and recurrent caries were found to be improved respectively by 5.1 and 1.4%, whereas the marginal adaptation was reduced of 6.5%. Secondary analyses revealed that follow-up periods, the adhesive system used and the class of carious lesions evaluated are confounding factors, and they result in a risk of bias across studies.Bulk-fill composites are innovative materials for conservative dentistry and they can be used to reduce treatment steps and duration of operative times. There are insufficient data to explore the relationship between bulk-fill composites and microleakage and further investigations are needed.

Oral Lichen Planus: risk factors of malignant transformation and follow up. Ten years retrospective study.

BACKGROUND: Oral Lichen Planus (OLP) is an inflammatory chronic disease. Modified World Health Organization (WHO) diagnostic criteria (2003) suggest diagnosing OLP both clinically and histologically. Furthermore, it is known the potential of malignant transformation of OLP, especially those affecting mucosa. Aims of this retrospective study on 100 patients were i) to estimate the timing of transformation of OLP lesions in OSCC in a cohort of patients observed between 2008 and 2018; ii) to assess risk factors of OLP patients diagnosed with OSCC; iii) to analyse forms of OLP evolved in cancer. MATERIAL AND METHODS: A database of 100 patients diagnosed with OLP was evaluated and clinical, histological features of lesions, habits of patients and systemic diseases were analysed in a follow up ranged between 5 and 10 years. RESULTS: Mean time of malignant transformation was 31,62± 18,26 months; however, 4 malignant transformations out of 8 occurred about after 4 years of observation. Furthermore, Odds ratios for risk factors showed an association between malignant transformation and location. CONCLUSIONS: More focused attention on follow-up scheduling and designing could be a valuable resource in early diagnosis and cancer prevention in OLP patients. Key words:Oral Lichen Planus, Oral Cancer, Malignant transformation, risk factors.

How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease.

OBJECTIVES: The aim of this narrative review was to collect all findings from literature about oral signs and symptoms of COVID-19, in order to draw a picture of oral involvement of this challenging viral infection, to help oral professionals in a better triage and early diagnosis. MATERIAL AND METHODS: The search for international literature was made including articles written in English and reporting about oral manifestations in patients with a diagnosis of COVID-19. The publication time was limited to 2019 and 2020, up to May 20, 2020. A narrative review was performed. RESULTS: Twenty-three articles were included in this review. Three different oral manifestations were found: taste alteration, oral blister and ulcers, and oral lesions associated with Kawasaki-like diseases (erythema, bleeding of lips, "strawberry tongue"). The higher expression of Angiotensin-converting enzyme 2 in the oral cavity and in endothelial cells might be responsible for oral manifestation and the major report of signs and symptoms in the occidental countries. CONCLUSIONS: Detecting oral signs and symptoms of COVID-19 could be useful to perform a better preliminary triage in dental setting, and in recognizing possible early manifestations of the disease. However, considering the outbreak of COVID-19 and the consequent difficulty of undergoing oral examinations, the oral manifestations might be misdiagnosed; then, we would encourage oral professionals to perform other studies about this topic.

Aesthetic Dentistry, How You Say and How You See: A 500-People Survey on Digital Preview and Color Perception.

PURPOSE: Digital technologies have improved ways to perform aesthetic dentistry in the last few years. The aims of this survey were to investigate the most preferred way to preview the result of an aesthetic dental rehabilitation among a population of dental professionals and laypeople and to compare aesthetic standards of the general population and dentists in terms of the color of teeth for aesthetic dental rehabilitations. PATIENTS AND METHODS: A questionnaire was sent to the subjects (dentists and laypeople) during a 1-year period and, together with their demographic data, different ways to preview the result of an aesthetic rehabilitation were submitted, such as digital smile design, dental wax-up and oral explanation. Furthermore, an additional section of the questionnaire investigated the most suitable color for an aesthetic rehabilitation based on the colors of the VITA Scale. Results were statistically analyzed (with Chi-square of independence and Mann-Whitney U-test) highlighting differences of answers based on age groups, educational attainment, gender, and belonging or not to the dental field. RESULTS: Findings showed that digital smile design (digital preview) is a high-appreciated method for previewing and communicating with patients both by dental professionals and laypeople. Furthermore, lighter colors were found to be more valued by laypeople and significant differences were highlighted between the two populations assessed. CONCLUSION: It seems to be viable to use digital preview for dentists and laypeople to improve previewing and communicating ways. It might be advisable to better motivate patients in recognizing aesthetical features and to raise their awareness in preferring more mimetic aesthetic results. Great opportunities are opened up by digital smile design in teaching, learning, and routine practice.

Conservative non-surgical management in medication related osteonecrosis of the jaw: A retrospective study.

OBJECTIVES: To date, the best treatment for Medication Related Osteonecrosis of the jaw (MRONJ) is controversial. Recent studies suggest different therapies, considering the stage of MRONJ; however, sometimes patients, although with remarkable extension of disease, cannot undergo surgery. The purpose of present preliminary study was to evaluate the efficacy of conservative non-surgical treatment of MRONJ lesions in a cohort of patients ineligible for surgery or refusing any surgical treatment for stage II and III of MRONJ. MATERIALS AND METHODS: Patients with MRONJ (staging II or III) ineligible for surgical treatment were selected for a retrospective study. A conservative non-surgical therapy (antibiotics and antiseptic) was administered for 1 year. Five scheduled checks were performed to assess changes in signs and symptoms during the observational period. RESULTS: Our observation was carried out on 12 patients. Improvement of signs and symptoms of disease were observed in population. CONCLUSION: This study suggests that non-surgical treatment may be a valid therapeutic option in patients ineligible for surgery. The sample size is small, further studies should be carried out to satisfy the aim of a conservative non-surgical treatment protocol establishment.

A Snapshot of Knowledge about Oral Cancer in Italy: A 505 Person Survey.

Objectives: Patients' knowledge about oral squamous cell carcinoma (OSCC) plays an important role in primary prevention, early diagnosis, and prognosis and survival rate. The aim of this study was to assess OSCC awareness attitudes among general population in order to provide information for educational interventions. Methods: A survey delivered as a web-based questionnaire was submitted to 505 subjects (aged from 18 to 76 years) in Italy, and the answers collected were statistically analyzed. Information was collected about existence, incidence, features of lesions, risk factors of oral cancer, and self-inspection habits, together with details about professional reference figures and preventive behaviors. Results: Chi-square tests of independence with adjusted standardized residuals highlighted correlations between population features (age, gender, educational attainment, provenance, medical relationship, or previous diagnoses of oral cancer in family) and knowledge about oral cancer. Conclusions: Knowledge about OSCC among the Italian population is limited, and it might be advisable to implement nudging and sensitive customized campaigns in order to promote awareness and therefore improve the prognosis of this disease.

Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence.

Oral Lichen Planus (OLP) is an inflammatory chronic disease, its potential of malignant transformation is widely known, especially for lesions affecting mucosa. This letter aims to highlight, thanks to results obtained from a long-term observation of one hundred patient suffering from OLP, the importance to set proper and sufficiently long follow-ups. An important evidence observed is the malignant developing after 4 years of observation in 4 cases of 8. This leads to conclude that follow-up for OLP lesions is required to be as long as possible in order to timeously intercept malignant transformations of these lesions and to perform a realistic early diagnosis. Final suggestion is to design more prospective studies based of long observation period.

Oral MALT Lymphoma: Something to remember.

Oral MALT Lymphoma is rare condition and its pathogenesis are related to persistent immune stimulation caused by chronic infection or inflammation. We report a case of MALT lymphoma of the palatal minor salivary glands in a 73-year-old white woman with clinical history of osteoporosis and systemic lupus erythematosus associated with Sjögren's syndrome. This letter aims to call the attention on large number of factors to take into account in evaluating patients with an history of auto-immune diseases. This idea results from our difficulty in identifying this pathology in first diagnosis, due to rarity of this condition and severe comorbidity associated.

Resin Infiltration in Dental Fluorosis Treatment-1-Year Follow-Up.

Background and objective: Dental fluorosis is a disease affecting dental hard tissues featured with white or yellowish lesions. Several treatments are proposed in the literature, some even invasive. This clinical study aimed to evaluate the effectiveness of resin infiltration in terms of lesions resolution, trend of sensitive teeth and satisfaction of patients over time. Methods and material: 200 fluorosis lesions were treated using ICON infiltrating resin (DMG, Hamburg, Germany). Parameters related to patients were collected by a questionnaire and analyzed aesthetic dissatisfaction about lesions, Shiff Air Index Sensitive Scale, sensitive teeth after treatment, the satisfaction of duration of treatment. The same operator measured dimensions of lesions Tooth Surface Index of Fluorosis (TSIF) and numbers of etching cycles needed for treating lesions. Statistical analysis was performed. The follow-up was of 1-year a measurement were performed at baseline (t0), immediately after the treatment (t1) and every three months during the observation period. Results: All lesions disappeared after one treatment. Pain or sensitive teeth were reported inside the 72 h and they disappeared after. Statistical analysis showed highly statistically correlation between etching cycles and the dimension of lesions and TSIF at the time-points evaluated as well as for pain during treatment, whereas a statistical significance was not noticed where etching cycles were correlated to sensitive teeth after 72 h. Overall, the treatment was found to be statistically significantly associated with differences in answers of aesthetic dissatisfaction between t0 and t1 and those collected between t1 and t2. Between t2 and t3 and between t3 and t4 no statistical differences were found in answers of patients about dissatisfaction, indicating the stability of the results. Conclusions: The ICON resin infiltration technique was found to be effective in lesions resolution with steady results.

Trigeminal trophic syndrome: Strange evolution of maxillofacial surgery.

Trigeminal trophic syndrome (TTS) is a rare facial/cranial affection that arises in ulcerations, itch and paresthesia. Etiology is debated, however trigeminal nerve damage seems to be frequent in pathogenetic patterns. The disease may affect any region innervated by the trigeminal nerve, especially the maxillary branch. A case of TTS, trigged by allergic reaction to osteosynthetic materials and involving infraorbital nerve, was presented. The feature that makes this case one-off in the literature is the association with osteolytic lesion surrounding infraorbital nerve. Diagnosis and treatment were difficult and multidisciplinary approach was required. Treatments administered were satisfying and signs and symptoms remitted, however patient quitted follow-up. TTS is a rare disease, diagnosis is difficult to be performed and it is often a diagnosis of exclusion. Treatment is challenging and it requires a multidisciplinary approach and a great compliance of patients.

The Association between Tooth Loss and Alzheimer's Disease: a Systematic Review with Meta-Analysis of Case Control Studies.

Alzheimer's disease is classified as a neurodegenerative condition, a heterogeneous group of illnesses characterized by the slow and progressive loss of one or more functions of the nervous system. Its incidence tends to increase gradually from 65 years of age, up to a prevalence of 4% at age 75. The loss of dental elements is more prevalent in this population and might negatively affect the masticatory capacity, quality of life, and pathogenesis of Alzheimer's disease. This study investigated problems related to oral health and the loss of dental elements in elderly patients suffering from Alzheimer's and considered whether local inflammatory processes could affect the etiopathogenesis of Alzheimer's disease. The purpose of this systematic review is to identify a link between the causes leading to tooth loss and the onset/progression of Alzheimer's disease. We also studied whether there is a higher incidence of tooth loss (primary outcome) and edentulism (secondary outcome) among Alzheimer's patients. We searched records in electronic databases such as PubMed, EBSCO, and Web of Science using the following keywords: Alzheimer's Disease AND periodontal, Alzheimer's Disease AND periodontitis, dementia AND (periodontitis OR periodontal) "Alzheimer's Disease" AND "tooth" OR "dental loss," "dementia" AND "edentulous," "Alzheimer's Disease" AND "edentulous," "dementia" AND "tooth" OR "dental loss." The records were screened, and after applying the eligibility and inclusion criteria, nine articles were left, six of which were analyzed for the primary outcome (loss of dental elements) and six for the secondary outcome (tooth loss). Results from this meta-analysis revealed that Alzheimer's disease patients have an increased risk of dental loss (hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.00-2.30, p = 0.05) and edentulous condition (HR 2.26, 95% CI 1.70-3.01, p < 0.001). A quantitative analysis of the included studies indicated that patients suffering from Alzheimer's disease are characterized by a greater number of lost dental elements and general edentulism compared to the control groups.

In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign.

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

Oral verruciform xanthoma and erythroplakia associated with chronic graft-versus-host disease: a rare case report and review of the literature.

BACKGROUND: Oral verruciform xanthoma is an uncommon benign lesion. Although oral verruciform xanthoma occurs in healthy individuals, it has been also reported in association with some inflammatory conditions. The aim of this study is to report a case of oral verruciform xanthoma associated with chronic graft-versus-host disease and to review the literature on this topic. CASE PRESENTATION: A 47-year-old Caucasian male presented to the Sector of Oral Medicine "V. Margiotta", University Policlinic "P. Giaccone" of Palermo complaining of a mass on the gingiva. He first noticed the painless mass 1 year ago. He reported to have undergone allogenic hematopoietic stem cell transplantation 15 years ago for acute lymphoblastic leukaemia. Intraoral examination revealed a well-circumscribed, sessile yellowish and verrucous nodule upon canine, multiple yellowish and verrucous nodules on the hard palate, yellowish and verrucous nodules on left buccal mucosa. In addiction an area of white striae in a reticular pattern with erythema and ulceration was present on the dorsum of the tongue. This lesion was consistent with a known history of oral chronic graft versus host disease. Moreover, we observed a suspected area of oral erythroplakia yet on the dorsum of the tongue. In biopsy specimen of hard palate histopathological examination revealed a diagnosis of verrucous xanthoma of the oral cavity; in addiction in biopsy specimen of the dorsum of the tongue revealed the presence of erythroplakia with high grade dysplasia. CONCLUSION: Verruciform xanthoma of the oral cavity associated with chronic graft-versus-host disease is a rare condition with a usually benign clinical course but malignant transformation has been described in association with oral potential malignant disorder (e.g. chronic graft versus host disease, erythroplakia). Very rare cases showed association with oral chronic graft versus-host-disease. To date, only eight cases were published in the world literature. Therefore it could be important follow up patients also for oral verruciform xanthoma onset.