Community-Based Dental Education (CBDE): A Survey of Current Program Implementation at Australian Dental Schools.

Purpose: Community-based dental education (CBDE) diverges from traditional dental school training methods by integrating dental students into primary care community settings. This immersive approach enables students to refine their clinical and hands-on skills while serving the oral health needs of underserved populations. This study aimed to identify ways in which Australian dental schools are currently implementing CBDE and compared to current evidence. Materials and Methods: This study utilized a 24-item, self-completion survey, adapted from existing questionnaires, which was sent to the CBDE coordinators in the nine eligible dental programs in Australia between mid-January 2023 and mid-April 2023. The survey consisted of multiple-choice, binary, and open-ended questions, including information on the level of student involvement, types of external clinics used, length of rotations, student supervision and assessment, pre-rotation preparation, and post-rotation evaluation, as well as challenges faced in implementing programs. Results: Six of the nine invited coordinators responded, resulting in a 66.7% response rate. All participants confirmed that their schools had a community-based teaching program. All six respondents reported that participation in external clinics is required for graduation. Implementation of CBDE appears to be influenced by (1) level of student involvement, (2) the types of clinics utilised, (3) allocation and length of rotation, (4) student supervision and assessment, (5) pre-rotation preparation, and (6) post-rotation evaluation. Six (n = 6) institutions reported requiring a post-rotation reflection from students and all respondents reported seeking feedback from clinical supervisors at external sites. Emerging themes from open-ended questions highlight challenges in coordinating external rosters, securing funding, supervising students at external sites, and ensuring diverse types of student exposure during external rotations. Conclusion: This study provided insights into the implementation of CBDE in Australian dental schools. Results outlined in this research offer valuable insights for dental schools aiming to enhance their programs and improve student learning outcomes.

Understanding interobserver variability of pathologists to improve oral epithelial dysplasia grading.

OBJECTIVE: This study aimed to understand reasons for interobserver variability in the grading of oral epithelial dysplasia (OED) through a survey of pathologists to provide insight for improvements in the reliability and reproducibility of OED diagnoses. METHODS: The study design included quantitative and qualitative methodology. A pre-validated 31-item questionnaire was distributed to general, head and neck, and oral and maxillofacial histopathology specialists worldwide. RESULTS: A total of 132 pathologists participated and completed the questionnaire. Over two-thirds used the three-tier grading system for OED, while about a third used both binary and three-tier systems. Regular reporters of OED preferred the three-tier system and grading architectural features. Continuing education significantly aided recognition of architectural and cytological changes. Irregular epithelial stratification and drop-shaped rete ridges had the lowest prognostic value and recognition scores, while loss of epithelial cell cohesion had the highest. Most participants used clinical information and often sought a second opinion when grading OED. CONCLUSION: Our study has found that frequency of OED reporting and attendance of CME/CPD can play an important role in grading OED. Variations in the prognostic value of individual histological features and the use of clinical information may further contribute to interobserver variability.

Histopathological risk assessment in multisite epithelial dysplasia: A meta-analysis.

OBJECTIVE: Histopathological grading of oral epithelial dysplasia (OED) is the current standard for stratifying cancer progression risk but is associated with subjectivity and variability. This problem is not commonly seen regarding the grading of epithelial dysplasia in other sites. This systematic review aims to compare grading systems for oral, anal, penile, and cervical epithelial dysplasia to determine their predictive accuracy for recurrence and malignant transformation (MT) outcomes. METHODS: The review protocol was registered in PROSPERO (CRD42023403035) and was reported according to the PRISMA checklist. A comprehensive search was performed in the main databases and gray literature. The risk of bias in individual studies was analyzed using the Joanna Briggs Institute checklist for each study design. RESULTS: Forty-six studies were deemed eligible and included in this systematic review, of which 45 were included in the quantitative analysis. Meta-analysis revealed that the binary system demonstrated a higher predictive ability for MT/recurrence of OED compared to multilevel systems. Higher predictive accuracy of MT was also observed for binary grading systems in anal intraepithelial neoplasia. CONCLUSIONS: No significant difference was found between the current grading systems of epithelial dysplasia in different body parts. However, binary grading systems have shown better clinical outcomes.

Challenges in implementing community-based dental education programs in Australia: The lived experiences of program coordinators.

PURPOSE: The benefits of community-based dental education (CBDE) are well documented and reach far beyond students' educational growth, encompassing advantages for both dental schools and their community partners. Nonetheless, barriers associated with administering CBDE programs can have a significant impact on program outcomes. This study aims to explore the challenges faced by dental school CBDE coordinators in implementing and managing their programs. METHODS: This Interpretive Phenomenological study employed in-depth semi-structured interviews with CBDE program coordinators from Australian dental schools (n = 6). Interviews, conducted between February and May 2023, via Microsoft Teams, were audio and video recorded and lasted an average of one hour each. Interviews were analyzed using NVivo 13. Questions explored administrative challenges, required resources, student management issues, and development goals for CBDE programs. RESULTS: Data analysis included deductive and inductive coding through a seven-step iterative process, organizing information into codes and sub-codes, forming emerging themes. Four major themes with subthemes emerged: 1) Program administration, encompassing challenges in scheduling, coordinating, and adapting to changes; 2) Funding, crucial for establishing and maintaining remote educational sites; 3) Student experience management, highlighting student supervision, student behavior, and exposure; and 4) Partner site relationships, particularly in clinical supervisor recruitment and training. CONCLUSION: The successful implementation requires meticulous planning, effective coordination, and recognition of CBDE as an educational activity that should be grounded in evidence-based pedagogy. Dental institutions are therefore encouraged to establish collaborative partnerships with local community organizations, allocate resources for outreach initiatives, and facilitate appropriate guidance to coordinators, students, and external clinical supervisors.

Prevalence of Subgingival Aggregatibacter actinomycetemcomitans: Descriptive Cross-Sectional Study.

This paper aims to investigate the presence of Aggregatibacter actinomycetemcomitans and to assess potential indicators of the risk of severe form(s) of periodontitis. A descriptive cross-sectional study of 156 consecutive patients with periodontitis was conducted. Subgingival plaque samples were collected from the participants. The identification of A. actinomycetemcomitans was performed using quantitative polymerase chain reaction. A descriptive analysis, a chi-square test, and a binary logistic regression statistical evaluation were performed. The prevalence of A. actinomycetemcomitans in this population of 156 participants was 17.30% (27 patients). The prevalence of stage-III periodontitis was 75.6% and greater in older men, while the prevalence of stage-IV periodontitis was 22.4% and greater in younger women. We observed a significant relation between the risk of severe periodontitis (stage-IV) and poor oral hygiene (p = 0.006), attendance at dental appointments (p ≤ 0.001), and familial history of periodontitis (p = 0.032). In conclusion, twenty-seven individuals were positive for A. actinomycetemcomitans. Poor oral hygiene, family history of periodontitis, and irregular attendance at dental appointments were identified as potential risk factors for severe periodontitis in this cohort.

The Synergistic Effect of High Intensity Focused Ultrasound on In-vitro Remineralization of Tooth Enamel by Calcium Phosphate Ion Clusters.

Background: Remineralization of dental enamel is an important intervention strategy for the treatment of demineralized lesions. Existing approaches have limitations such as failure to adequately reproduce both the ideal structural and mechanical properties of the native tooth. The ability of ultrasound to control and accelerate the crystallization processes has been widely reported. Therefore, a new approach was explored for in-vitro enamel remineralization involving the synergistic effect of high-intensity focused ultrasound (HIFU) coupled with calcium phosphate ion clusters (CPICs). Methods: The demineralized enamel was treated with CPICs, with or without subsequent HIFU exposure for different periods (2.5, 5, and 10 min). The specimens were characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM), and Raman spectroscopy. The surface hardness and crystallographic properties of the treated specimens were evaluated using Vickers microhardness testing and X-ray diffraction (XRD), respectively. Results: SEM revealed distinct, organized, and well-defined prismatic structures, showing clear evidence of remineralization in the combined CPIC/HIFU treatment groups. AFM further revealed a decrease in the surface roughness values with increasing HIFU exposure time up to 5 min, reflecting the obliteration of interprismatic spaces created during demineralization. The characteristic Raman band at 960 cm-1 associated with the inorganic phase of enamel dominated well in the HIFU-treated specimens. Importantly, microhardness testing further demonstrated that new mineral growth also recovered the mechanical properties of the enamel in the HIFU-exposed groups. Critical to our aspirations for developing this into a clinical process, these results were achieved in only 5 min. Conclusion: HIFU exposure can synergise and significantly accelerate in-vitro enamel remineralization process via calcium phosphate ion clusters. Therefore, this synergistic approach has the potential for use in future clinical interventions.

Unraveling the Keratin Expression in Oral Leukoplakia: A Scoping Review.

Intermediate filaments are one of three polymeric structures that form the cytoskeleton of epithelial cells. In the epithelium, these filaments are made up of a variety of keratin proteins. Intermediate filaments complete a wide range of functions in keratinocytes, including maintaining cell structure, cell growth, cell proliferation, cell migration, and more. Given that these functions are intimately associated with the carcinogenic process, and that hyperkeratinization is a quintessential feature of oral leukoplakias, the utility of keratins in oral leukoplakia is yet to be fully explored. This scoping review aims to outline the current knowledge founded on original studies on human tissues regarding the expression and utility of keratins as diagnostic, prognostic, and predictive biomarkers in oral leukoplakias. After using a search strategy developed for several scientific databases, namely, PubMed, Scopus, Web of Science, and OVID, 42 papers met the inclusion and exclusion criteria. One more article was added when it was identified through manually searching the list of references. The included papers were published between 1989 and 2024. Keratins 1-20 were investigated in the 43 included studies, and their expression was assessed in oral leukoplakia and dysplasia cases. Only five studies investigated the prognostic role of keratins in relation to malignant transformation. No studies evaluated keratins as a diagnostic adjunct or predictive tool. Evidence supports the idea that dysplasia disrupts the terminal differentiation pathway of primary keratins. Gain of keratin 17 expression and loss of keratin 13 were significantly observed in differentiated epithelial dysplasia. Also, the keratin 19 extension into suprabasal cells has been associated with the evolving features of dysplasia. The loss of keratin1/keratin 10 has been significantly associated with high-grade dysplasia. The prognostic value of cytokeratins has shown conflicting results, and further studies are required to ascertain their role in predicting the malignant transformation of oral leukoplakia.

Curcumin is effective in managing oral inflammation: An in vitro study.

BACKGROUND: Oral inflammation is among the most prevalent oral pathologies with systemic health implications, necessitating safe and effective treatments. Given curcumin's documented anti-inflammatory and antioxidant properties, this study focuses on the potential of a curcumin-based oral gel in safely managing oral inflammatory conditions. METHODS: This in vitro study utilized four human cell lines: oral keratinocytes (HOKs), immortalized oral keratinocytes (OKF6), periodontal ligament fibroblasts (HPdLF), and dysplastic oral keratinocytes (DOKs). The cells were treated with Lipopolysaccharides (LPS) and curcumin-based oral gel to simulate inflammatory conditions. A panel of cellular assays were performed along with antimicrobial efficacy tests targeting Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis. RESULTS: LPS significantly reduced proliferation and wound healing capacities of HOKs, OKF6, and HPdLF, but not DOKs. Treatment with curcumin-based oral gel mitigated inflammatory responses in HOKs and HPdLF by enhancing proliferation, colony formation, and wound healing, along with reducing apoptosis. However, its impact on OKF6 and DOKs was limited in some assays. Curcumin treatment did not affect the invasive capabilities of any cell line but did modulate cell adhesion in a cell line-specific manner. The curcumin-based oral gel showed significant antimicrobial efficacy against C. albicans and S. mutans, but was ineffective against P. gingivalis. CONCLUSION: This study demonstrates the potential of the curcumin-based oral gel as a safe and effective alternative to conventional antimicrobial treatments for managing cases of oral inflammation. This was achieved by modulating cellular responses under simulated inflammatory conditions. Future clinical-based studies are recommended to exploit curcumin's therapeutic benefits in oral healthcare.

Effect of Photobiomodulation on Salivary Cytokines in Head and Neck Cancer Patients with Oral Mucositis: A Systematic Review.

Background: Oral mucositis is a common and distressing side effect of head and neck oncology treatment. Photobiomodulation therapy can be utilized to prevent and treat oral mucositis. Its impact on salivary cytokines has yet to be thoroughly investigated. This is the first systematic review aiming to evaluate the effect of photobiomodulation on salivary cytokines in patients undergoing anticancer treatment. Methods: Numerous data resources, from the Web of Science, Embase, ScienceDirect, PubMed, Cochrane Library, and Scopus were sought. Articles published up until February 2024 were included if they met the following inclusion criteria: clinical trials reporting the effect on salivary cytokines in patients undergoing anticancer therapy. The methodological quality was assessed using several appraisal tools. Results: Four studies were deemed eligible for inclusion. All the studies were conducted in Brazil and used an InGaAlP diode laser with a wavelength of 660 nm. The included studies had a relatively low risk of bias. The head and neck cancer patients' salivary cytokines that were assessed by the studies, along with photobiomodulation therapy, included IL-12p70, TNF-α, IL-6, IL-8, IL-10, CXCL8, and IL-1ß. The results varied among the studies. Conclusions: Our results show that photobiomodulation demonstrated positive results for reducing the severity of OM in all the included studies. Among the examined salivary cytokines, IL-6 is the most relevant cytokine for oral mucositis development and severity. A variation in the cytokine levels between the studies was noted due to differences in the type of anticancer treatment and saliva sampling.

Student and clinical supervisor perceptions of community-based dental educational experiences: A scoping review.

PURPOSE: This scoping review was conducted to map the breadth of experiences in community-based dental education (CBDE), as reported by students and clinical supervisors. METHODS: This scoping review was conducted following the structured framework proposed by Arksey and O'Malley and adhering to PRISMA-SCR guidelines for scoping reviews. Applying specified eligibility criteria, a systematic search of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was followed by data extraction and data synthesis of full-text articles. Research was conducted between June 2022 and September 2022. RESULTS: Sixteen articles were identified for the final full-text review. Utilizing a narrative thematic review, the following five domains emerged: preparation for autonomous practice, understanding of primary care dentistry, understanding of health disparities and patient needs, clinical confidence, clinical diversity, and skill development, and perspectives on quality of teaching and assessment. CONCLUSION: Community/outreach dental education effectively supplements traditional dental school-based education from the perspectives of students and community-based clinical supervisors.

Epigenetics in the diagnosis and prognosis of head and neck cancer: A systematic review.

BACKGROUND: Aberrant epigenetic modifications significantly develop and progress human malignancies including head and neck squamous cell carcinoma (HNSCC). Taking into account issues of late diagnosis and poor prognosis associated with HNSCC, this systematic review is designed to provide an up-to-date insight of epigenetic changes in the management of HNSCC. METHODS: All studies that assessed the diagnostic and prognostic utilities of epigenetic changes (DNA methylation and histone modifications) among patients diagnosed with HNSCC or oral potentially malignant disorders (OPMDs) were considered for inclusion till June 2023. Pre-defined Medical Subject Headings terms were used to search Web of Science, Pubmed, Scopus and Embase Ovid databases. RESULTS: Twenty-five studies were deemed eligible for inclusion with a total number of 3790 samples (2123 HNSCCs, 334 OPMDs and 1333 as controls). DNA methylation was investigated in 18 studies while the role of histone modifications was assessed in seven studies. The most investigated biomarkers among the studies were H3, DAPK and TIMP3. The diagnostic accuracy of the epigenetic biomarkers in detecting HNSCC was assessed in eight studies where the following biomarkers showed the highest area under the curve values: TIPM3, DCC, DAPK, SEPT9, SHOX9, HOXA9 and TRH. None of the studies assessed the predictability of the epigenetic biomarkers in HNSCC and OPMDs. CONCLUSION: Although initial promising results were seen using the epigenetic biomarkers in the early detection of HNSCC, the limited number of patients and the absence of well-designed longitudinal studies limit the clinical applicability of the outcomes.

Adjunctive aids for the detection of oral squamous cell carcinoma and oral potentially malignant disorders: A systematic review of systematic reviews.

This study presents the results of systematic reviews on adjunctive tools in screening and diagnosis of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) and to determine if the current literature supports their use as either an adjunctive tool or replacement of gold standard techniques. Systemic reviews and meta-analysis that evaluated adjunctive tools including chemiluminescence, tissue autofluorescence, tissue fluorescence spectroscopy, vital staining and cytology techniques were systematically examined using AMSTAR II. Twenty-seven systematic reviews were included. Five studies had a low quality of evidence, and nine studies had a critically low quality of evidence. This review found limited evidence to recommend chemiluminescence, tissue autofluorescence tools and vital staining as diagnostic tools, but only serve as clinical adjuncts to conventional oral examination. Cytology techniques and narrow-band imaging may be utilised as a non-invasive diagnostic adjunctive tool for the detection of OSCC and the malignant transformation of OPMD. In conclusion, this paper provides evidence on several types of adjunctive tools and provides recommendations on their use in clinical practice. These tools are considered useful as clinical adjuncts but there is insufficient evidence for their use as a diagnostic tool to replace gold standard conventional oral examination and surgical biopsy.

Emerging histopathological parameters in the prognosis of oral squamous cell carcinomas.

Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, representing 90% of all malignant neoplasms in the head and neck region. Patients with this aggressive tumor have an overall 5-year survival rate of approximately 50%, which drops to less than 30% when tumors are diagnosed at advanced clinical stages. Over decades, several studies provided high-level evidence of the impact of histopathological features on treatment guidelines and prognosis of OSCC. The 8th American Joint Committee on Cancer (AJCC) TNM staging system recognized the importance of depth of invasion to the T category and extranodal extension to the N category for OSCC. This review provides the current knowledge on emerging histopathological parameters identified as potential biomarkers for OSCC, such as depth of invasion, tumor thickness, the pattern of invasion, inflammatory profile, and tumor-stroma ratio, evaluating their clinical relevance on patient outcomes. Analysis, limitations, and potential biological mechanisms are highlighted and discussed. Assessing and reporting these markers are cost-effective and can be incorporated into daily practice.

Use of oral nutritional supplements in irradiated patients with head and neck cancer.

OBJECTIVES: Malnutrition is common among patients with head and neck cancer (HNC) and associated with poorer outcomes. Oral nutritional supplements (ONS) are often prescribed, with concerns raised about their cariogenicity. This study examined ONS use and caries experience in patients with HNC 12 months post-diagnosis. METHODS: Fifty-four patients with HNC referred for pre-radiotherapy dental assessment were recruited. Data collected included: age, gender, residential postcode, smoking, alcohol use, HNC characteristics, dental history, oral hygiene habits, dietary advice and ONS use. Data was collected at diagnosis, during radiotherapy and 6 weeks, three, six- and 12-months post-treatment completion. RESULTS: Fifty-one subjects completed the study. 76.5% of the participants used ONS for an average of 13.8 weeks. Caries developed in 22.9% of ONS users and 11.1% of non-users (p = 0.6585). The mean overall duration of ONS use was 18.7 weeks for the caries group and 8.5 weeks for the caries-free group (p = 0.1507). Lack of collaboration and disconnection was noted between dietary advice given by dieticians and dentists. CONCLUSIONS: ONS use is common among patients with HNC. Larger studies are needed to establish the reasons for caries development and impacts of ONS use on oral health. Importance of multidisciplinary management of malnutrition is highlighted.

Dental and oral health students' preparedness for the management of deaf patients: A cross-sectional survey.

Background/purpose: The communication barrier that deaf people face when seeking dental care can impact their experience and may potentially lead to exacerbated dental fear or anxiety. This study aimed to investigate the current attitudes and levels of knowledge and confidence of Australian oral and dental health students in treating a deaf patient. Materials and methods: A 33-item cross-sectional questionnaire was distributed to Australian dental, oral health therapy and dental hygiene students across 13 tertiary institutions. The online questionnaire was distributed to students via their respective course coordinators. Results: 271 viable survey responses were received. While 55.7% of participants reported previous exposure to deaf or hard-of-hearing people, 90.8% had never completed or attempted an Auslan class. These participants who answered 'Yes' to having taken a prior Auslan class were reported to have significantly higher mean knowledge scores and confidence self-efficacy ratings than those who had answered 'No' (p = 0.002). There was no statistically significant association between higher knowledge scores and higher confidence self-efficacy ratings. Most of these participants that answered 'Yes' to having taken a prior Auslan class implied or stated that the party responsible for changing their communication behaviour was the dentist rather than the patient, in contrast to the inconsistent responses from the 'No' group. Conclusion: Inadequate knowledge and cultural competency regarding the Deaf population was reported by Australian dental, oral health therapy and hygiene students. Incorporating more training pertinent to dental curricula is warranted to minimise oral health inequalities.

Awareness and practice of dentists in gulf cooperation council countries regarding medication-related osteonecrosis of the jaw - A web-based survey.

Background/purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication among dental patients undergoing treatment with antiresorptive medications such as bisphosphonate and denosumab. The present survey investigated the awareness and practice of dentists in the Gulf Cooperation Council (GCC) countries regarding MRONJ. Materials and methods: This questionnaire-based study was conducted among dental practitioners in all six GCC countries. A questionnaire was designed and distributed among all potential participants via different social media platforms. SPSS version 22 was used for data analysis, and P-value <0.05 was considered statistically significant. Results: Overall, 1685 dentists from the six GCC countries participated in the present study. The surveyed dentists revealed relatively fair practices and awareness regarding MRONJ and its prevention, with the majority reported asking their patients about history of anti-osteoporotic medications (67.8%), recording name of the medication (73.1%) and duration of treatment (75.5%). However, the majority of the participants were unconfident about the duration of drug holiday prior to dental surgical interventions (70.6%) and the overall good level of knowledge/practice related to MRONJ was just 50.6%. The regression analysis revealed that previous exposure to MRONJ cases and attending a seminar, course, meeting, or conference about osteonecrosis of the jaw were independent predictors for positive awareness/good practice regarding MRONJ (P < 0.05). Conclusion: The results show inadequate awareness and practices of dentists practicing in GCC countries regarding MRONJ, with significant variations among the countries. Therefore, appropriate interventions such as periodic continuous education courses are required to improve dentists' knowledge and practices regarding MRONJ.

Clinical competency of dental health professionals and students in diagnosing oral mucosal lesions.

OBJECTIVE: Proper identification of oral potentially malignant disorders (OPMDs) provides an opportunity for oral cancer prevention. This study aims to assess the competency of dental health professionals in identifying OPMDs and, in turn, reducing the incidence of oral malignancy by early detection. METHODS: A 26-case online questionnaire of oral mucosal lesions was distributed to cohorts of 363 dental health professionals and dental students in Australia. The participants were asked to provide their provisional diagnosis for each case based on the available information. RESULTS: The overall accuracy in identifying oral mucosal lesions was 65.9%. There were no significant differences in the overall diagnostic accuracies between dental specialists, general dental practitioners and final-year dental students (p > 0.05). The lowest diagnostic accuracies were associated with normal mucosal variations and OPMDs. The predoctoral dental curriculum showed statistically significant values in terms of improving skills in diagnosing oral mucosal lesions. CONCLUSIONS: Lack of adequate knowledge in identifying OPMDs was evident among the participants, highlighting a non-promising figure in reducing the incidence of oral cancers in Australia. Comprehensive modifications of the current continuing professional development system are required to ensure adequate knowledge among dental health providers in Australia.

CO2 laser vaporisation in treating oral lichen planus: A split-mouth randomised clinical trial.

OBJECTIVES: This study aimed to compare the effectiveness of carbon dioxide (CO2 ) laser vaporisation versus intralesional injection of triamcinolone acetonide (TA) in the management of oral lichen planus (OLP). METHODS: A randomised clinical trial with a split-mouth design was conducted on 16 patients with bilateral symptomatic OLP lesions. One side was treated with CO2 laser vaporisation, and the counterpart was treated with TA intralesional injection. The reticular-erythematous-ulcerative (REU) score, Thongprasom sign scoring (TSS), visual analogue scale (VAS) and lesion area were used to evaluate the lesions at weeks 0, 4 and 9. All participants were followed up for 9 months. RESULTS: Reduction in the REU, TSS scores and lesion area from baseline to the end of treatment was significantly greater in the CO2 group than in the TA group (p values were 0.001, 0.002 and 0.048 respectively). However, the reduction in VAS score did not differ between the two groups (p = 0.54). The recurrence rate was significantly higher in the TA group than in the CO2 group (75% vs. 31.1%; p = 0.016). CONCLUSIONS: CO2 laser vaporisation was more effective than TA intralesional injection in managing OLP and decreased recurrence rates.

Aesthetic Gingival Melanin Pigmentation Treatment in Smokers and Non-Smokers: A Comparison Study Using Nd:YAG Laser and Ceramic Bur.

Aesthetic concerns are increasing rapidly; thus, several approaches have been suggested for treating gingival melanin pigmentation. Lasers have been reported as an effective new tool, and the Nd:YAG laser beam has an affinity for melanin and haemoglobin. However, ceramic gingival bur is simple and has less bleeding effect during operation than conventional techniques. This study aimed to compare the outcomes of gingival depigmentation using the Nd:YAG laser and ceramic bur in two different groups (smokers and non-smokers). A total of 40 patients presenting with gingival melanin pigmentation were enrolled in this split-mouth study. The sample was divided into two groups: smokers and non-smokers. Treatment was performed using the Nd:YAG laser (3 W, 60 mJ/pulse, and 50 Hz) and ceramic bur with a one-week interval between the two methods. Clinical indices were recorded, including intraoperative bleeding, wound healing, post-operative pain, and the recurrence of pigmentation, and follow-up periods were determined in the 3rd, 6th, and 9th months postoperatively. Both treatments promoted a similar pain experience and recurrence rate of pigmentation (p > 0.489, p = 1.000, respectively). Bleeding during surgery and complete healing recovery after one week were statistically significantly higher when using ceramic bur (p = 0.00, p = 0.041, respectively). Concerning the effect of smoking on the treatment, a higher recurrence rate was observed in SG than N-SG in laser sites (50%, and 95%, respectively) and bur sites (60%, and 85%, respectively), but statistically no significant difference was observed (p > 0.080). In conclusion, both procedures are adequate for aesthetic gingival depigmentation treatment. The Nd:YAG laser showed greater effectiveness in controlling bleeding, while ceramic bur showed a faster clinical recovery. Furthermore, smokers were more likely to have low depigmentation treatment stability.

Evaluation of Antibacterial Efficacy of High-Intensity Focused Ultrasound Versus Photodynamic Therapy Against Enterococcus faecalis-Infected Root Canals.

OBJECTIVE: The high incidence of endodontic failure is associated with the remnants of Enterococcus faecalis present within the intricate anatomies of the root canal system (RCS), often inaccessible by the current endodontic practices. This study was aimed at evaluating the effect of high-intensity focused ultrasound (HIFU) and photodynamic therapy (PDT) on E. faecalis biofilms in artificially infected root canals for the potential application in current endodontic practices. METHODS: Forty-five single-rooted extracted teeth were instrumented using hand files, sterilized in an autoclave, infected with E. faecalis and incubated for 4 wk. The specimens were treated and identified as follows: Control, 4% sodium hypochlorite (NaOCl); riboflavin (1 mg/mL); light only; HIFU (250 kHz, 20 W, 60s); PDT; riboflavin/HIFU; light/HIFU; and riboflavin/HIFU/light. Bactericidal efficacy was determined by colony-forming units (CFU), (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) (MTT) assay, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). RESULTS: Enterococcus faecalis biofilm exhibited significantly lower metabolic activity when treated with HIFU (250 kHz, 20 W, 60 s) compared with the control (4% NaOCl) and PDT groups. A similar phenomenon was observed with the CFU assay. HIFU remained the most effective treatment modality, with consistent results in CLSM and SEM. CONCLUSION: This study highlighted the potential application of HIFU as an adjunct drug-free, non-destructive root canal disinfection method for endodontic treatment, suggesting an alternative to the current gold standard of 4% NaOCl and PDT.