Beyond the mouth: the impact of periodontal disease on dementia.

DATA SOURCES: The authors searched Medline via PubMed, Scopus, CINAHL, Web of Science, and PsycINFO for relevant studies published until April 2022. STUDY SELECTION: Longitudinal studies that assessed periodontal health as the exposure and cognitive decline and/or dementia as the outcome were included. Case reports, reviews, cross-sectional studies, and animal studies were excluded. DATA EXTRACTION AND SYNTHESIS: Two authors independently reviewed studies for inclusion, extracted data, and assessed study quality. Meta-analysis was conducted to generate pooled odds ratios (ORs) for cognitive decline and hazard ratios (HRs) for dementia. Sources of heterogeneity were explored through subgroup analyses. RESULTS: A total of 24 studies were included for cognitive decline and 23 for dementia. Poor periodontal health was associated with increased odds of cognitive decline (OR = 1.23; 95% CI: 1.05-1.44) and dementia (HR = 1.21; 95% CI: 1.07-1.38). Tooth loss also appeared to increase the risk independently. However, significant heterogeneity existed between studies. CONCLUSIONS: Poor periodontal health may increase the risk of cognitive decline and dementia, but the quality of evidence was low. Further high-quality, longitudinal studies with standardized assessments are needed to establish causality.

Oral manifestations of COVID-19 and its management in pediatric patients: A systematic review and practical guideline.

OBJECTIVES: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID-19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID-19 in children and to recommend appropriate methods of diagnosis and treatment. METHODS: A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID-19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated. RESULTS: A total of 24 studies involving 2112 pediatric patients with COVID-19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi-system inflammatory syndrome in children (MIS-C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications. CONCLUSION: Oral symptoms of COVID-19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS-C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.

Comparative Efficacy of Low-Level Laser Acupuncture and Cupping for Treatment of Patients with Myofascial Pain Dysfunction Syndrome: A Double-blinded, Randomized Clinical Trial: Comparison of the Effects of LLL Acupuncture and Cupping.

Background: Myofascial pain dysfunction syndrome (MPDS) is among the most common causes of facial pain. This study compared the efficacy of low-level laser (LLL) acupuncture and cupping for the treatment of MPDS. Materials and Methods: This double-blind, before-after, randomized clinical trial evaluated 60 MPDS patients that were divided into two groups for LLL acupuncture (808 nm, 0.5 W, 30 J, 4 J/cm2 energy density, 60 seconds; group 1), and cupping (group 2) of masticatory muscle trigger points. Both treatments were performed for maximally eight sessions once every other day. The level of pain at the trigger points was measured upon admission, before and 5 minutes after treatment in each session, at ten days, and two months after treatment completion by a visual analog scale (VAS). The painless maximum mouth opening (MMO) and patient satisfaction with treatment were also assessed at the time as mentioned earlier points. Results: Averagely, 4.5 treatment sessions were required to achieve a 50% reduction in VAS pain score, with no significant difference between the two groups (P=0.9). Both treatments significantly decreased the number of trigger points and pain score, but this reduction occurred significantly sooner in the cupping group (P=0.01). MMO significantly improved in both groups after treatment with no significant difference between them (P=0.2). Patients were significantly more satisfied with LLL acupuncture (P=0.05). Conclusion: Both cupping and LLL acupuncture are equally effective for MPDS; thus, the patient can choose the type of treatment after receiving sufficient information regarding the two modalities.

Geographic Stomatitis with Multiple Areas Involvement of Oral Cavity: A Case Report and Review of Literatures.

Background: Geographic stomatitis is an uncommon migratory benign lesion of oral mucosa with unknown etiology. It can affect all the areas of the oral mucosa, but the dorsum and lateral borders of the tongue are the most commonly involved areas called geographic tongue. The clinical appearance of this condition is the oval or circular erythematous areas with irregular elevated keratotic borders. These characteristic features of geographic stomatitis are diagnostic for all clinicians when appearing on the dorsum of the tongue, despite other affected areas of oral mucosa that can confuse clinicians. This condition may be associated with some diseases such as psoriasis, Reiter's syndrome, and atopic conditions, so the clinicians should rule out these diseases and diagnose the geographic stomatitis. Case Report: A 17-year-old male attended to our department for a routine dentistry checkup. During the intraoral examination, we found multiple erythematous areas surrounded by a thin white border on different surfaces of his oral cavity. His extraoral examinations were completely normal. Conclusion: Due to the rarity of this lesion on the other sites of oral mucosa rather than dorsum and lateral borders of the tongue such as labial mucosa, buccal mucosa, the floor of the mouth, ventral surface of the tongue, and palate, it is necessary to report, study and evaluate each case of this condition that clinicopathologic findings have confirmed this diagnosis, to treat and advice these patients on the best approach.

Optimization of antimicrobial efficiency of silver nanoparticles against three oral microorganisms in irreversible hydrocolloid impressions.

BACKGROUND AND OBJECTIVES: Silver nanoparticles (Ag-NPs) are potent antimicrobial agents, which have recently been used in dentistry. The aim of the current study was to optimize antimicrobial activity of Ag-NPs used in preparing irreversible hydrocolloid impressions against three microorganisms of Escherichia coli, Streptococcus mutans and Candida albicans. MATERIALS AND METHODS: After assessing antimicrobial activity of the compound using disk diffusion method, three parameters of concentration of Ag-NPs (250-1000 ppm), ratio of hydrocolloid impression material powder to water (0.30-0.50) and time of mixing (20.0-60.0 s), affecting antimicrobial activity of irreversible hydrocolloid impression materials against the three microorganisms, were optimized. This combined process was successfully modeled and optimized using Box-Behnken design with response surface methodology (RSM). Decreases in colony number of E. coli, S. mutans and C. albicans were proposed as responses. RESULTS: Qualitative antimicrobial assessments respectively showed average zone of inhibition (ZOI) of 3.7 mm for E. coli, 3.5 mm for S. mutans and 4 mm for C. albicans. For all responses, when the mixing duration and powder-to-water ratio increased, the circumstances (mixing duration of 59.38 s, powder-to-water ratio of 0.4 and Ag-NP concentration of 992 response) increased. Results showed that in optimum ppm, the proportion of decreases in colony numbers was maximum (89.03% for E. coli, 87.08% for S. mutans and 74.54% for C. albicans). Regression analysis illustrated a good fit of the experimental data to the predicted model as high correlation coefficients validated that the predicted model was well fitted with data. Values of R2Adj with R2Pred were associated to the accuracy of this model in all responses. CONCLUSION: Disinfection efficiency dramatically increased with increasing of Ag-NP concentration, powder-to-water ratio and mixing time.

Effectiveness of Amlexanox and Adcortyl for the treatment of recurrent aphthous ulcers.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common condition that affects approximately 20% of the general population. The ulcers can interfere with speech and eating and cause significant pain and discomfort. This study aimed to evaluate the efficacy of Amlexanox and Adcortyl in the treatment of aphthous ulcers. MATERIAL AND METHODS: In this randomized double blind clinical trial with sequential patient entry, a total of 40 patients who presented with aphthous ulcers were included. Patients were received Amlexanox or Adcortyl four times daily for 7 days. Patients were evaluated for pain, lesion size, and tingling at one day, three days, five days and seven days follow-ups. The treatment effects were then evaluated using the Wilcoxon-Mann-Whitney (WMW) test. Values of p<0.05 were considered significant. RESULTS: No significant differences in pain score, tingling and lesion size were observed on similar days between Amlexanox and Adcortyl groups. In both groups, reduction in the assessed variables was significant between days 1-3, 3-5, and 5-7 (p < 0.001). CONCLUSIONS: This study indicated that Amlexanox as well as Adcortyl was effective in relieving pain and reducing the lesion size during the treatment of aphthous ulcers. Key words:Recurrent aphthous stomatitis, Amlexanox, Adcortyl, pain relief.

Efficacy of Pilocarpine and Bromhexine in Improving Radiotherapy-induced Xerostomia.

Background and aims. Xerostomia is one of the most common complications of head and neck radiotherapy. The aim of this study was to evaluate and compare the efficacy of pilocarpine and bromhexine in improving radiotherapy-induced xerostomia and its associated symptoms. Materials and methods. In this single-blind, randomized crossover study, pilocarpine and bromhexine tablets were used by twenty-five patients suffered from xerostomia, with a medical history of head and neck radiotherapy. At step A, the patients were treated with pilocarpine for 2 weeks. In addition, they were asked to take bromhexine for 2 weeks with a one-week washout period. At step B, the inverse process was conducted (first bromhexine, then pilocarpine). Whole resting saliva was collected from patients before and after receiving each medication by precise measurements. Then, efficacy of the two drugs in the treatment of xerostomia and its related oral complications was evaluated using questionnaires by Dichotomous format. The results were statistically analyzed using t-student and Fisher's exact and chi-squared tests. Statistical significance was set at P<0.05. Results. The difference between saliva secretion rates before and after medications was not significant for bromhexine users at two steps of the study (P=0.35); however, it was significant for pilocarpine users (P=0.0001). Users of both drugs showed significant differences in improvement of xerostomia, chewing, swallowing, tasting and mouth burning. Conclusion. Pilocarpine is probably more effective in improving xerostomia and its associated problems compared with bromhexine, although the use of the latter was also shown to ease some of the consequences of radiotherapy in the head and neck region.

Treatment of Furcal Perforation of Primary Molars with ProRoot MTA versus Root MTA: A Laboratory Study.

INTRODUCTION: Furcal perforations are one of the most challenging causes of endodontic failures. Several materials including MTA have been used for non surgical repair of these perforations. The aim of this study was to compare treatment outcome of furcal perforation treatment in primary molars using Root MTA and ProRoot MTA. MATERIALS AND METHODS: This in vitro study was conducted on 54 primary first molars that were randomly divided into the two experimental groups of 24 teeth each and two control groups (n=6). After preparation of access cavities, perforations were made and the perforation areas were repaired using either Root or ProRoot MTAs. After staining and preparation of mesiodistal longitudinal sections, dye leakage was measured using a stereomicroscope. The data was analyzed by the Mann Whitney statistical test. Significant level was set at 0.05. RESULTS: The data indicated that the dye leakage of ProRoot MTA is significantly lesser than Root MTA (P=0.001). CONCLUSION: ProRoot MTA showed good sealing ability in repairing furcal perforations of primary molars.

Evaluation of the use of a peppermint mouth rinse for halitosis by girls studying in Tehran high schools.

BACKGROUND AND AIM: Oral malodor is one of the most common complaints among dental patients. It often creates serious personal and social embarrassment for the afflicted individual. Therefore, a dentist must be able to diagnose the etiology of halitosis and treat it or refer an individual to a specialist. The aim of this study was to evaluate the prevalence of halitosis and the effect of a peppermint mouth rinse on it. MATERIALS AND METHODS: This study was performed in two steps. At the first step, in a cross-sectional study, 504 students who were 14-18 years old were examined to define the students who suffered from halitosis, and then at the second step, the selected 84 students with halitosis were divided into two groups randomly. A total of 43 students in group 1 received a peppermint mouth rinse and 41 students in another group were given placebo. The students in two groups washed their mouth with 15-20 ml of the given solutions three times in a 1-week period (after breakfast, after lunch or on returning to home, before sleeping) and didn't eat anything for 30 min after rinsing. After 1 week, the students were examined again. RESULTS: The prevalence of halitosis was 24.4% totally. In the mouth rinse group, after 1 week 23 students didn't exhibit halitosis, and 11 students in the placebo group were halitosis positive. A chi-square test showed that this difference was significant. CONCLUSION: Based on the results of this study, it can be said that a peppermint mouth rinse can reduce halitosis.

A histopathological comparison of pulpotomy with sodium hypochlorite and formocresol.

INTRODUCTION: Formocresol is widely used in primary teeth pulpotomies; however it is known to have several side effects. The purpose of this study was to assess pulpal changes of primary teeth pulps after pulpotomy with sodium hypochlorite and formocresol. MATERIALS AND METHODS: In this randomized clinical trial, 22 teeth were selected. These teeth were randomly divided into 2 groups (formocresol; n=11 and sodium hypochlorite n=11). Two months post-operatively teeth were extracted and pulpal responses were evaluated by recording the degree of inflammation and extent of pulpal involvement. Dentinal bridge formation was also evaluated. Finally the data was analyzed with McNemartest. RESULTS: The formocresol group demonstrated mild inflammation in 4 cases whereas sodium hypochlorite had mild inflammation in six cases. Severe inflammation was only found in 1 case in the sodium hypochlorite group, but it was present in 4 cases in the formocresol group. In sodium hypochlorite group there were no cases of necrosis, and dentinal bridge was found in 3 cases, unlike, the formocresol group which had necrosis but no dentinal bridge formation. CONCLUSION: Based on the results of this study sodium hypochlorite may be a suitable solution for conducting pulpotomy in primary teeth.

Clinical and Radiographic Success of Pulpotomy with MTA in Primary Molars: 30 Months Follow up.

INTRODUCTION: Pulpotomy of carious primary teeth with an exposed pulp is a common treatment option. Pulpotomy has been conducted with various medicaments over the years. The aim of this study was to evaluate clinical and radiographic success of primary vital pulpotomy with ProRoot and Root MTA. MATERIALS AND METHODS: In this randomized clinical trial, children aged between 3-7 years who met the inclusion criteria were enrolled. A total of 70 teeth were deemed suitable under the inclusion criteria and teeth were randomly divided into the 2 groups; ProRoot and Root MTA. Pulpotomy was performed and immediately followed by coronal amalgam restoration. The clinical and radiographic follow ups were conducted 6, 12, 18, 30 months post-operatively. The data were analyzed using Exact Fisher test. RESULTS: At the final follow up, 28 teeth in ProRoot MTA and 26 teeth in Root MTA were evaluated. In the Root MTA group, 1 tooth had exfoliated and one had an abscess and furcal radiolucency radiographically. In ProRoot MTA group, external resorption was observed in 1 tooth. Statistical analysis did not show significant difference in success rate between 2 groups after 30 months. CONCLUSION: The success rates of Root and ProRoot MTA are similar, indicating that pulpotomy can be carried out successfully in both primary molars.