Oral health-related quality of life in elderly: an umbrella review of systematic reviews from a multidisciplinary rehabilitation point-of-view.

Background: Poor oral health is highly prevalent among elderlies and may impact quality of life of elderly people. In this scenario, oral health has been often linked to general health and chronic disorders, including distinct features of frailty. The aim of the present umbrella review of systematic reviews was to assess the scientific literature on the correlation between oral health related quality of life (OHRQoL) and elderly to present a multidisciplinary approach to these complex patients. Methods: We performed a literature search of the databases Pub-Med/Medline, Scopus, Web of Science, and Physiotherapy Evidence Database electronic databases. Two independent reviewers performed the literature research from the inception to 25th November 2023 and screened the studies for eligibility. Results: The search resulted in a total of 676 results eligible articles. After removal of duplicates and full-text screening, a total of 3 systematic reviews were considered to meet the inclusion criteria and were included for this review. Conclusions: Frailty is very common in elderly such as a poor oral health. In this scenario, malnutrition and bad lifestyle habits may affect not only the determinism of many systemic non-communicable diseases but also oral health quality. Taken together, the findings of this umbrella review of systematic reviews showed a strict correlation between the frailty, typical condition of ageing people, and a poor OHRQoL. Therefore, it is mandatory to implement the oral health prevention with specific protocols of oral rehabilitation to improve the OHRQoL in elderly.

Epidemiology of maxillofacial trauma in the elderly: A European multicenter study.

INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P<.05) and a high FISS score (P<.005) were associated with concomitant body injuries too. CONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

Management of mandibular condylar fractures in patients with atrophic edentulous mandibles.

INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Medical students' knowledge of medication related osteonecrosis of the jaw.

INTRODUCTION: The objective of this study was to assess medical students' knowledge of "medication related osteonecrosis of the jaws" (MRONJ). METHODS: A questionnaire survey was administered to all the medical students in the last two years of school of medicine at the University of Eastern Piedmont between January 2019 and March 2019. The questionnaire contained a first section regarding demographic and personal data of the student and a second section regarding the knowledge on MRONJ. RESULTS: On the whole, 72 medical students agreed to participate to this study and filled in the questionnaire. As for indications for the use of bisphosphonates 45 students correctly answered "osteoporosis, osteogenesis imperfecta, multiple myeloma, or metastasis of some malignant tumors". Almost all students (71 out of 72) answered that a thorough examination of oral cavity and a dentist screening is needed and fundamental before starting bisphosphonate assumption. As for drugs responsible for MRONJ, only 12 students out of 72 correctly answered "bisphosphonates, denosumab, and antiangiogenic drugs". DISCUSSION: A better level of knowledge and awareness by medical doctors and young physicians may lead, in future, to minimize incidence of MRONJ as well as to a better resolution of ONJ cases. Theoretical and practical initiatives could be promoted to improve and consolidate the knowledge of future physicians about this important issue.

The surgical management of monostotic fibrous dysplasia of the inferior turbinate.

Fibrous dysplasia is a non-neoplastic, sporadic, slowly progressing disease of the bone in which normal bone is replaced by abnormally overgrowing lesions. There are three different types of fibrous dysplasia: monostotic (affecting a single bone), poliostotic (affecting multiple bones) and syndromic, when it is associated with other diseases (such as McCune Albright syndrome). Fibrous dysplasia affects cranio-facial bones in 10% of the cases. However, its occurrence in the inferior turbinate is extremely rare. To the best of our knowledge, only four cases of monostotic form have been reported so far. Hereafter we describe a case of monostotic FD of the inferior turbinate surgically treated with a trans-nasal endoscopic partial maxillectomy type II.

Comparative assessment of dexamethasone administration routes for the management of postoperative symptoms following third molar surgery.

OBJECTIVE: The surgical removal of third molars (3 Ms) is often associated with postoperative symptoms such as trismus, edema, and pain. The purpose of this study was to perform a comparative assessment of the effect of dexamethasone by different administration routes. STUDY DESIGN: A randomized, prospective study was carried out including patients undergoing the surgical removal of bilateral impacted mandibular 3 Ms. Patients were grouped according to dexamethasone administration routes Group A (intravenous); Group B (intralesional); Group C (oral administration). After surgery, pain, edema, and trismus were recorded. Postoperative symptoms severity (PoSSE) questionnaires were administered too. RESULTS: 108 patients were allocated to group A, 101 to group B, and 106 to group C. Statistically significant differences (P < .05) with better results were observed as for edema, pain and the results of PoSSe questionnaires by groups A and B. CONCLUSION: A single intralesional administration of dexamethasone seems to be effective in decreasing postoperative pain, edema, and symptoms after third molar surgery.

Tuberculous neck lymphadenopathy: A diagnostic challenge.

Tuberculosis (TB) continues to be a major health problem for the developing world and a rise in the number of cases has been noted in the western hemisphere too. TB can affect most organs in the head and neck region, such as the lymph nodes, larynx, middle ear, oral cavity and pharynx. In particular, as for cervical tuberculosis lymphadenopathy, a predominant involvement of the posterior triangle, supraclavicular, and internal jugular group of nodes bilaterally can be observed. As the early manifestation of Head and Neck TB is often similar to neoplasms, clinical consideration usually occurs only after an ineffective anti-inflammatory treatment, fine-needle aspiration, or biopsy/resection. In fact, this type of presentation often represents a diagnostic and therapeutic challenge to the clinician. Therefore, the aim of the present article is to present and discuss the management of a case of cervical tuberculosis lymphadenopathy.

Mandibular trauma: a two-centre study.

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.