Diet Traps during Eating Disorders among Dentate Patients at an Oral Health Glance.

Persons suffering from eating disorders (ED) may often experience a recurrence/persistence symptoms despite the completion of psychiatric therapy. In most cases, their general health status is linked to current nutritional behaviors. Medical professionals, general practitioners (GPs), dieticians, and dentists may see those patients in their practices. At the same time, due to low sense of illness, some patients may delay or never seek professional medical care. The aim of this article is to analyze the main ED types according to dietary behaviors causing oral health problems and discuss oral health complications in affected dentate patients. The second objective is to update oral preventive measures and technological innovations together with active agents for oral hygiene care that might effectively support oral health maintenance during the presence of long-term symptoms. The research method involved a review of clinical reports as a synthesis of the electronic research in the Pubmed, Web of Science, and Google Scholar databases. Based on the research, ED patients were found to present related incidences of oral complications. Studies have reported that the possible course of an ED and comorbidities may be an imbalance in the oral environment. The results showed an association between biological (malnutrition, etc.), behavioral (binge eating episodes, vomiting, acidic diet, poor oral hygiene), and pharmacotherapeutic (addiction, hyposalivation) factors that may threaten oral health. Early diagnosis of the past and present symptoms is essential to eliminate and take control of destructive behaviors. Oral changes need to be tackled with medical insight, and additionally, the perception of dietary interactions is recommended.

Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation.

BACKGROUND: The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study's objective was to assess Covid-19 patients' oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes. MATERIAL AND METHODS: Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined. RESULTS: Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman's analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035). CONCLUSIONS: COVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment.

Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial.

Background: Dental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults. Methods: The primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%). Results: In total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint. Conclusion: Hydroxyapatite was proven to be a safe and efficient anticaries agent in oral care. Clinical trial registration: NCT04756557.

Saliva as Diagnostic Material and Current Methods of Collection from Oral Cavity.

BACKGROUND: In recent years, more and more attention has been paid to the use of saliva in laboratory diagnostics aimed at monitoring both human health and diseases. Providing fundamental overview takes the reader through composition, functions, protective effects and significant role as biomarker. Therefore, the purpose of the research was a current review on the topic of saliva composition in relation to applied secretory stimuli used in clinical laboratory. METHODS: The paper presents human factors, systems, and neurotransmitters on which saliva production depends. Chapters included a description of the collection methods of unstimulated and stimulated saliva according to the condition of the oral cavity and the usefulness of the analysis of the human saliva as a diagnostic material. RESULTS: Salivary usefulness expanded to monitoring medications, determination of the number of intoxicants, tobacco, exposure to infectious diseases as viral, bacterial and fungal contaminations. Nevertheless, it is recommended for saliva samples to be collected after dental consultation or by trained medical personnel to exclude any risk of local inflammation in oral cavity. CONCLUSIONS: It may seem that salivary diagnostics is necessary and worthy of updating. This last feature undoubt-edly opens up new possibilities in the research for predictive and diagnostic factors in many human conditions. Salivary diagnostics may contribute to a better understanding of the general health status, and thus to more effec-tive treatment methods and improved prognosis.

Expression of salivary immunoglobulins and their association with analgesic neuropeptide opiorphin in anorexia nervosa during adolescence.

BACKGROUND: Patients who suffer from anorexia nervosa (AN) are characterized by exceedingly lower body weight, micro- and macro-nutrient deficiencies, and hyposalivation as compared to healthy subjects. In addition, AN may predispose to difficulties in oral health maintenance. However, little is known about the relationship between stress-dependent salivary neuro/immunopeptidergic biomarkers such as opiorphin and immunoglobulins (Ig) and AN.The aim of this case-control study was to evaluate salivary opiorphin and immunoglobulins in female children and adolescents diagnosed with AN compared to healthy controls. METHODS: Adolescent patients with clinically-confirmed severe restrictive subtype AN (Body Mass Index BMI < 15 kg/m2, mean age 15.0 ± 1.8, n = 83) were examined in the first week of hospital admission and compared to healthy matched controls (n = 79). Measurements of salivary opiorphin, IgA, IgG, IgM (ELISA technique), and oral hygiene levels (Plaque Control Record index-PCR) were performed. RESULTS: In the AN group, a significantly higher concentration of opiorphin was evidenced (3.1 ± 4.1 ng/ml) compared to the control group (1.1 ± 1.2 ng/ml), (p < 0.001), contrary to IgM, which was significantly lower (311.0 ± 185.3 ng/ml) than in the control group (421.2 ± 168.1 ng/ml), (p < 0.001). There were no significant differences in the levels of IgA and IgG, despite a higher concentration of IgA in the AN group vs. controls (p = 0.14). Spearman analysis revealed a correlation between opiorphin and age (p < 0.05), but also with all immunoglobulins IgA, IgG, IgM (p = 0.006, p < 0.001, p < 0.001). Similarly a correlation was found between PCR index and immunoglobulins IgG, IgM (respectively p = 0.028, p < 0.001), and between body mass, BMI, IBW% and IgA, IgM (all p < 0.05). CONCLUSIONS: In the acute phase of AN, salivary changes in opiorphin and immunoglobulins related to dental plaque suggest an essential role in oral health balance. Changes related to AN may affect the anti-inflammatory and analgesic components of saliva and suggest their use as neurobiological markers in severe malnutrition.

The orofacial region is affected by various inflammatory and autoimmune conditions, which might translate into general and regional changes. Saliva is one of the biological fluids where biomarkers of the aforementioned conditions, including sensitivity to pain, could be detected. It is also noteworthy that anorexia nervosa (AN) and malnutrition may change the saliva's analgesic or immune content, but this scientific area is still not satisfactorily explored. The present work related to analgesic (opiorphin peptide) and anti-infectious agents (immunoglobulins Ig A, IgG, IgM) in said body fluid among 83 adolescent patients with severe AN compared to 79 healthy controls. In addition, oral hygiene levels were assessed in the oral cavity via the Plaque Control Record index (PCR). In the AN group, the concentration of opiorphin was significantly higher as compared to the control group, in contrast to IgM, which was significantly lower than in the control group. There were no notable differences in the levels of IgA and IgG between groups, despite a slightly higher concentrations of IgA in the AN group. A correlation was found between opiorphin and all immunoglobulins. A similar correlation was found between PCR index and all immunoglobulins.The present work shows how analgesic opiorphin depends on the oral inflammatory status. This might be a direction for further investigating the immune alterations in patients with AN-related malnutrition. Inclusion of AN patients in intensive oral hygiene care may also be considered.

Corrigendum: Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study.

[This corrects the article DOI: 10.3389/fpsyt.2022.874263.].

Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study.

Introduction: Restrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18. Methodology: This case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016-2020 in public Psychiatric Unit, BMI < 15 kg/m2, mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m2, age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic. Results: AN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease (p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p < 0.05). Conclusions: Although the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future.

Self-Reported Dietary Choices and Oral Health Care Needs during COVID-19 Quarantine: A Cross-Sectional Study.

The COVID-19 pandemic significantly impacted the healthcare system, including dentistry. However, it is not entirely clear whether affected patients' willingness for regular dental visits and preventive behaviors with regards oral hygiene and diet. This is essential to understanding the potential effects of the COVID-19 pandemic on the acceleration of dental issues in the future. It was aimed at checking the level of dental visit avoidance, self-reported oral health needs, and dietary changes. This cross-sectional questionnaire study conducted in Poland (n = 2574; mean age 44.4 ± 15.6; female 56.3%) assessed nutritional habits and dental care changes during the COVID-19 pandemic. As demonstrated, nearly half of the responders (47.1%) avoided regular dental visits, while only 0.5% used online consultations. Fears related to potential cross-contamination in dental offices dropped from 25% to 11.4% and were associated with increased BMI and age (p < 0.05). Sweet snacking/drinking confirmed 19.1%/33.2% subjects. Self-reported oral health care needs (tooth stain, calculus, gingivitis, loss of fillings) were related to frequent snacking and poor oral hygiene (p < 0.05). The study highlights that pandemic periods are covered by eating and drinking changes combined with inadequate hygiene and dental care impose health complaints in the oral cavity. This can magnify both nutritional and interrelated oral health issues, highlighting the need to implement preventive and mitigation measures.

Stress/Immune Biomarkers in Saliva among Children with ADHD Status.

Background. This cross-sectional study aimed to evaluate stress and immune biomarkers in saliva samples of attention-deficit/hyperactivity disorder ADHD compared to healthy non-ADHD children. Material and methods. A total of 132 children under 11 years old (8.5 ± 1.1) enrolled in a cross-sectional study: with confirmed ADHD (n = 60) and healthy controls (n = 72). The clinical evaluation included physical measurements (height, waist, hip circumference, body weight, body mass index BMI, BMI z-score) and unstimulated saliva collection and measurements of free cortisol, salivary alpha-amylase (sAA), and secreted immunoglobulins (sIgA, IgG, and IgM) with quantitative assay (ELISA) analysis. Unpaired t-test, Welch test, or Mann-Whitney U test were applied for group comparisons when appropriate, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05. Results. In the ADHD group, body weight (p ≤ 0.01), BMI (p ≤ 0.009), and hip circumference (p ≤ 0.001) significantly differed, while waist size and BMI z-score did not (p > 0.05). Significant elevation of the salivary sAA (p = 0.03), sIgA (p = 0.02), and IgM (p ≤ 0.001) biomarkers were detected, without differences in the morning cortisol (p > 0.05). Significant correlations between cortisol and BMI, hip size, and IgA, as well as between IgG and sAA and IgA were obtained. Conclusions. Saliva can be used to monitor ADHD status with regard to biomarkers indicating the hypothalamus-pituitary-adrenal axis, as HPA axis, and sympathetic activity. The results indicate that morning collection of saliva in contrast to unchanged salivary cortisol, may evaluate mentioned above system dysregulations by measurements of sAA and immunoglobulins among ADHD children.

Salivary Biomarkers (Opiorphin, Cortisol, Amylase, and IgA) Related to Age, Sex, and Stress Perception in a Prospective Cohort of Healthy Schoolchildren.

BACKGROUND: The use of easily accessible biomarkers for assessing young patients' health is weighty. This cohort study is aimed at measuring stress/immune biomarkers in the saliva of healthy school-age children and comparing subgroups according to age, sex, and stress perception. Material and Methods. 503 children under 12 years old (8.7 ± 1.3) were included with anthropometric evaluation (height, waist, hip circumference, body weight, and body mass index (BMI)). Levels of opiorphin (OPI), free cortisol, alpha-amylase (sAA), and secreted immunoglobulin (sIgA) were determined by quantitative assays (ELISA) in unstimulated saliva. Unpaired t-test, Welch test, and Mann-Whitney U test were applied for appropriate group comparisons, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05. RESULTS: sIgA and sAA exhibited significant differences depending on age and sex: IgA (ng/mL): 86 ± 68.6 vs. 104.9 ± 72.1 for (6-7 y.o.) and (8-11 y.o.), respectively, and 108.1 ± 80.1 vs. 94.6 ± 62.2 for male and females, respectively; sAA (U/mL): 78.9 ± 54.4 vs. 100.5 ± 81.2 for (6-7 y.o.) and (8-11 y.o.). No difference related to age or sex between groups was observed for cortisol and OPI. However, OPI levels were higher and correlated to prior stress exposure in children (0.31 ± 0.4 vs. 0.26 ± 0.5 ng/mL, p = 0.031). sAA was negatively correlated to low mood self-declaration in children in the last two weeks (r = -0.10, p = 0.045). CONCLUSIONS: sIgA and sAA can be used as sex- and age-related biomarkers in children 6-12 y.o., which is not the case for free cortisol and opiorphin. However, OPI reflected previous exposure to stress, suggesting its use for evaluating stress-related changes in children.