Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Periodontal Disease in Young Adults as a Risk Factor for Subclinical Atherosclerosis: A Clinical, Biochemical and Immunological Study.

Although a strong relationship between periodontal disease (PD) and atherosclerosis was shown in adults, little data are published in younger PD patients. Therefore, this study aimed to investigate and correlate clinical parameters of PD, pro- and immunoregulatory cytokines in gingival crevicular fluid (GCF) and serum, biochemical and hematological parameters associated with atherosclerosis risk, and carotid intima-media thickness (IMT) in our younger study participants (n = 78) (mean age 35.92 ± 3.36 years) who were divided into two equal groups: subjects with and without PD. PD patients had higher values of IMT, hs-CRP, triglycerides, total cholesterol, and LDL; most proinflammatory and Th1/Th17-associated cytokines in GCF; and IL-8, IL-12, IL-18, and IL-17A in serum compared to subjects without PD. These cytokines in GCF positively correlated with most clinical periodontal parameters. Clinical periodontal parameters, TNF-α and IL-8 in GCF and IL-17A, hs-CRP, and LDL in serum, had more significant predictive roles in developing subclinical atherosclerosis (IMT ≥ 0.75 mm) in comparison with other cytokines, fibrinogen, and other lipid status parameters. Hs-CRP correlated better with the proinflammatory cytokines than the parameters of lipid status. Except for serum IL-17A, there was no significant association of clinical and immunological PD parameters with lipid status. Overall, these results suggest that dyslipidemia and PD status seem to be independent risk factors for subclinical atherosclerosis in our younger PD population.

Novel flapless esthetic procedure for the elimination of extended gingival metal tattoos adjacent to prosthetic teeth: Er:YAG laser micro-keyhole surgery.

PURPOSE: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes. METHODS: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery. CONCLUSION: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.

The association between vitamin D level and periodontal disease in Saudi population, a preliminary study.

OBJECTIVE: Among other regulatory functions, vitamin D has a role in modulating the inflammatory process of periodontal disease. Therefore, this retrospective study aimed to assess the relationship between vitamin D levels and periodontal health in dental patients from the Eastern Province of Saudi Arabia. METHODS: Radiographs and serum vitamin D levels of patients seeking dental treatment were collected. Exclusion criteria were systemic disease, smoking, recent vitamin D supplementation, and previous periodontal surgery. Gender, age, and alveolar crest height (ACH) were recorded. A total of 67 patients were categorized into three groups according to their serum vitamin D level (<10, <20, and > 20 ng/mL) and their bone loss compared. RESULTS: Differences in means were compared by t-test. ANOVA was used to compare vitamin D groups and the corresponding ACH, as well as the correlation (p < .05). Patients with vitamin D levels > 20 ng/mL demonstrated a mean ACH of 1.6 mm. The mean ACH was 3.1 mm for those with vitamin D levels < 20 ng/mL, and 4.6 mm for vitamin D levels < 10 ng/mL. A weak negative correlation was found between vitamin D and ACH in all groups (r = -0.055, p = .7). CONCLUSION: Serum vitamin D level seems to be an important factor that influences oral health, especially the periodontal condition, of both male and female patients.

Thermal Evaluation by Infrared Thermography Measurement of Osteotomies Performed with Er:YAG Laser, Piezosurgery and Surgical Drill-An Animal Study.

The bone healing process following osteotomy may vary according to the type of surgical instrumentation. The aim of the present in vivo study was to determine thermal changes of the bone tissue following osteotomies performed by Er:YAG laser ablation in contact and non-contact modes, piezoelectric surgery, and surgical drill using an infrared thermographic camera. For each measurement, the temperature before the osteotomy-baseline (Tbase) and the maximal temperature measured during osteotomy (Tmax) were determined. Mean temperature (ΔT) values were calculated for each osteotomy technique. The significance of the difference of the registered temperature between groups was assessed by the ANOVA test for repeated measures. Mean baseline temperature (Tbase) was 27.9 ± 0.3 °C for contact Er:YAG laser, 29.9 ± 0.3 °C for non-contact Er:YAG laser, 29.4 ± 0.3 °C for piezosurgery, and 28.3 ± 0.3 °C for surgical drill. Mean maximum temperature (Tmax) was 29.9 ± 0.5 °C (ΔT = 1.9 ± 0.3 °C) for contact Er:YAG laser, 79.1 ± 4.6 °C (ΔT = 49.1 ± 4.4 °C) for non-contact Er:YAG laser, 29.1 ± 0.2 °C (ΔT = -0.2 ± 0.3 °C) for piezosurgery, and 27.3 ± 0.4 °C (ΔT = -0.9 ± 0.4 °C) for surgical drill. Statistically significant temperature changes were observed for the non-contact laser. The results of the study showed beneficial effects of the osteotomy performed by the Er:YAG laser used in the contact mode of working as well as for piezosurgery, reducing the potential overheating of the bone tissue as determined by means of infrared thermography.

Identification of Periopathogens in Atheromatous Plaques Obtained from Carotid and Coronary Arteries.

Increasing attention has been paid to the possible link between periodontal disease and atherosclerosis over the past decade. The aim of this study is to investigate the presence of five periopathogens: Porphyromonas gingivalis (P.g.), Aggregatibacter actinomycetemcomitans (A.a.), Tannerella forsythia (T.f.), Treponema denticola (T.d.), and Prevotella intermedia (P.i.) in atheromatous plaques obtained from the carotid and coronary arteries in patients who underwent coronary artery bypass graft surgery and carotid endarterectomy. Group I (carotid arteries) consisted of 30 patients (mean age: 54.5 ± 14.8), and group II (coronary arteries) consisted of 28 patients (mean age: 63 ± 12.1). Clinical periodontal examinations consisted of plaque index, gingival index, sulcus bleeding index, and periodontal probing depth and were performed on the day of vascular surgery. The presence of periopathogens in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction. In both subgingival plaque and atherosclerotic plaque of carotid arteries, P.g., A.a., T.f., T.d., and P.i. were detected in 26.7%, 6.7%, 66.7%, 10.0%, and 20.0%, respectively, while for coronary arteries, P.g. was detected in 39.3%, A.a. in 25%, T.f. in 46.4%, T.d. in 7.1%, and P.i. in 35.7%. The presence of five periopathogens in carotid and coronary atherosclerotic vessels showed correlation in regard to the degree of periodontal inflammation. The present study suggests the relationship between periodontal pathogenic bacteria and atherogenesis. Further studies are necessary in relation to the prevention or treatment of periodontal disease that would result in reduced mortality and morbidity associated with atherosclerosis.

Association between Periodontal Disease and Comorbidities in Saudi's Eastern Province.

The incidence of periodontal diseases is associated with multiple comorbidities that influence a patient's treatment planning. This study evaluates the relation between periodontal disease and multiple comorbidities reported in the Saudi population from the Eastern province. This study was conducted on 190 patients, who visited the periodontology clinics at Imam Abdulrahman Bin Faisal University, Saudi Arabia. Demographic data, smoking habits, past medical and dental histories, blood pressure, random blood glucose, and recent haemoglobin A1c were recorded. A comprehensive periodontal examination included the number of missing teeth, pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and mobility of all teeth except third molars. Radiographic bone loss was measured on standardized full-mouth periapical radiographs. Multivariable regression models were calculated aiming to see the association between different comorbidities and alveolar bone loss with confounders controlled. Out of 190 periodontitis patients, 56 (29.5%) were males and 134 (70.5%) were females. More than half of the patients (60%) were between 26 and 50 years, 30% of them had diabetes, and 18% were smokers. The risk of alveolar bone loss was higher in persons who had diabetes and those who had both diabetes and coronary heart disease than those who did not, although the association was not statistically significant (B = 1.26, 95%CI = -0.30, 2.82, and B = 2.86, 95%CI = -1.25, 6.96, respectively). The risk of alveolar bone loss was significantly higher among persons with diabetes and hypertension (B = 2.82 and 95%CI = 0.89, 4.75). Collectively, the risk of alveolar bone loss in periodontitis patients increases with diabetes in the presence of other comorbidities regardless of smoking or gender.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey.

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics' and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics' and institutions' attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = -1.31, p = 0.006) and upper-middle income (UMICs) (B = -0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = -0.55, p < 0.0001) and in research only (B = -1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = -0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

A novel minimally-invasive approach for metal tattoo removal with Er:YAG laser.

OBJECTIVE: Few effective and established treatment methods can remove gingival metal or amalgam tattoos. With this case series, we aimed to demonstrate the use of a novel minimally invasive technique to remove metal tattoos using an erbium-doped yttrium aluminum garnet (Er:YAG) laser. MATERIALS AND METHODS: We retrospectively collected clinical data from 18 patients who had undergone Er:YAG laser treatment to remove metal tattoos. Minimal gingival ablation using an Er:YAG laser directed towards the pigmented area was performed, which exposed metal debris within the connective tissue that was carefully removed. A dental microscope was employed to identify the metal debris, for accurate irradiation, and to minimize wounding by reducing invasion. Postoperative gingival color and morphology, and visual analog scale as a patient-reported outcome assessing postoperative pain were evaluated. RESULTS: All patients' metal tattoos were removed completely and safely during short procedures. Considerable esthetic improvements and favorable wound healing were achieved with almost no postoperative pain or complications. CONCLUSION: The findings from this case series suggest that this novel minimally invasive therapy for metal tattoo removal that involved the Er:YAG laser is effective and safe, is associated with successful outcomes, and contributes greatly to patients' esthetic satisfaction. CLINICAL SIGNIFICANCE: Metal tattoo removal using an Er:YAG laser safely and successfully improved gingival esthetics. This novel technique is much simpler and less invasive than conventional periodontal plastic surgery, and it may be more reliable regarding esthetic gingival improvements as it is associated with favorable wound healing, and it could offer significant benefits to patients by alleviating physical and mental stresses via reduced chair time and postoperative pain.

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey.

BACKGROUND: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries. METHODS: We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries. RESULTS: Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007). CONCLUSIONS: Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

An ecological study of the association between environmental indicators and early childhood caries.

OBJECTIVES: A prior study described the association between ecosystem vitality, environmental health, and early childhood caries (ECC). The objective of this study was to determine the association between 24 global environmental indicators and ECC in 3-5-year-old children. RESULTS: In 61 countries, 55.5% of 3-5-year-old children had ECC. Eight factors had a small effect-size association with ECC: percentage of area that is marine-protected (partial eta squared; ƞ2 = 0.03); species habitat index (ƞ2 = 0.06); percentage of tree-cover loss (ƞ2 = 0.03); regional marine trophic index (ƞ2 = 0.03); total carbon dioxide emission intensity (ƞ2 = 0.03); methane emission intensity (ƞ2 = 0.04); nitrous oxide emission intensity (ƞ2 = 0.06); and sulfur dioxide emission intensity (ƞ2 = 0.03). Regression analysis revealed that two of these factors were significantly associated with the prevalence of ECC: methane emission intensity was inversely associated with ECC prevalence (B = - 0.34, 95% CI = - 0.66, - 0.03; p = 0.03), and nitrous oxide had a direct association with ECC prevalence (B = 0.35, 95% CI = 0.04, 0.67; p = 0.03).

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity.

OBJECTIVE: COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors. METHODS: We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms). RESULTS: 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11). CONCLUSIONS: COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

The anti-inflammatory effect of locally delivered nano-doxycycline gel in therapy of chronic periodontitis.

BACKGROUND AND OBJECTIVE: To date, various drugs as host modulating agents had been suggested as adjunctive treatment modality in the therapy of chronic periodontal disease. In this study, the anti-inflammatory effect of subgingivally delivered nanostructured doxycycline gel (nDOX) was evaluated and compared to conventional doxycycline gel (DOX) used as adjunct to scaling and root planning (SRP) in the treatment of moderate chronic periodontitis to reduce probing pocket depth. MATERIAL AND METHODS: Nanostructured doxycycline gel (nDOX) was prepared using spray-drying technique with chitosan (CH) as a matrix polymer, followed by dispersion in polyvinyl alcohol (PVA). The deepest periodontal pocket in 45 patients suffering from moderate chronic periodontitis was selected. The patients were divided into three groups following scaling and root planning (SRP); group I: SRP + nDOX, group II: SRP + DOX and group III: SRP + placeboCH. Plaque Index (PI), Gingival Index (GI), pocket depth (PD) and clinical attachment level(CAL), as well as ginigival crevicular fluid levels of (GCF) IL-6 and TNF-α were assessed at baseline, 1 and 3 months following local drug application. RESULTS: Group I showed significant reduction in probing depth and attachment gain compared with group II and III at one and three months period. The inflammatory mediators levels were significantly reduced in all treatment groups at one-month period. Except for group I, the reduced values were observed at three-month period. CONCLUSION: The results suggest that treatment with nDOX gel as an adjunct to SRP had anti-inflammatory effect by improving both clinical parameters and inflammatory markers up to three months period.

Gingival melanin depigmentation by Er:YAG laser: A literature review.

Laser ablation is recently suggested as a most effective and reliable technique for depigmentation of melanin hyperpigmented gingiva. To date, different lasers have been used for gingival depigmentation (CO2, diode, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers). The use of Er:YAG laser for depigmentation of melanin hyperpigmented gingiva has gained increasing importance in recent years. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a literature review. The main outcomes, such as improvement of signs (clinical parameters of bleeding, erythema, swelling and wound healing), symptoms (pain) and melanin recurrence/repigmentation were measured. The literature demonstrated that depigmentation of gingival melanin pigmentation can be performed safely and effectively by Er:YAG laser resulting in healing and an esthetically significant improvement of gingival discoloration. Thus, Er:YAG laser seems to be safe and useful in melanin depigmentation procedure. However, the main issue in giving the final conclusion of the optimal Er:YAG laser use in melanin depigmentation is that, to date, studies are offering completely discrepant Er:YAG laser procedure protocols (complex settings of laser parameters), and different criteria for the assessment of depigmentation and repigmentation (recurrence), thus hampering the comparison of the results. Therefore, further studies are necessary to give an optimal recommendation on the use of Er:YAG laser in gingival melanin hyperpigmentation.

Biological effects of Er:YAG laser irradiation on the proliferation of primary human gingival fibroblasts.

We investigated the biological effects of Er:YAG laser (2940-nm; DELight, HOYA ConBio, Fremont, California) irradiation at fluences of 3.6, 4.2, 4.9, 6.3, 8.1 or 9.7 J cm-2 at 20 or 30 Hz for 20 or 30 seconds on primary human gingival fibroblasts (HGFs). Irradiation at 6.3 J cm-2 promoted maximal cell proliferation, determined by WST-8 assay and crystal violet staining, but was accompanied by lactate dehydrogenase release, on day 3 post-irradiation. Elevation of ATP level, Ki67 staining, and cyclin-A2 mRNA expression confirmed that Er:YAG affected the cell cycle and increased the number of proliferating cells. Transmission electron microscopy showed alterations of mitochondria and ribosomal endoplasmic reticulum (ER) at 3 hours post-irradiation at 6.3 J cm-2 , and the changes subsided after 24 hours, suggesting transient cellular injury. Microarray analysis revealed up-regulation of 21 genes involved in heat-related biological responses and ER-associated degradation. The mRNA expression of heat shock protein 70 family was increased, as validated by Real-time PCR. Surface temperature measurement confirmed that 6.3 J cm-2 generated heat (40.9°C post-irradiation). Treatment with 40°C-warmed medium increased proliferation. Laser-induced proliferation was suppressed by inhibition of thermosensory transient receptor potential channels. Thus, despite causing transient cellular damage, Er:YAG laser irradiation at 6.3 J cm-2 strongly potentiated HGF proliferation via photo-thermal stress, suggesting potential wound-healing benefit.

Lasers in minimally invasive periodontal and peri-implant therapy.

Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri-implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium-doped yttrium aluminium garnet (Nd:YAG), erbium-doped yttrium aluminium garnet (Er:YAG) and erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta-analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence-based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri-implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser-treatment modalities of different wavelengths and better-defined indications for each protocol.

Treatment of recurrent aphthous stomatitis by laser therapy: A systematic review of the literature.

BACKGROUND/AIM: Recurrent aphthous stomatitis (RAS) is defined as multifactor immunologic inflammatory lesions in the oral cavity, characterized by painful, recurrent single/multiple, shallow, round or ovoid ulcerations of mucosal tissues. To date, a considerable number of RAS treatment protocols have been suggested, but since the etiology of RAS is idiopathic, these treatment options have symptomatic rather than curative or preventive effect. Recently, it has been suggested that laser therapy could be successfully used as an efficient treatment approach in therapy of RAS. Therefore, the aim of this review was to estimate the effects of laser therapy in treatment of RAS analyzing results of clinical studies published in peer reviewed journals. METHODS: The studies published until 31 December 2013 were obtained from the Medline/PubMed, Science Direct and Cochrane Library of the Cochrane Collaboration (CENTRAL) online databases, using following search terms and key words: "laser" AND "recurrent aphthous stomatitis", "laser" AND "aphthous", and "laser" AND "aphthae". In total 4 original research articles met the all required inclusion/exclusion criteria, and were used for this review. The main outcome measures assessed were: a reduction of pain associated with RAS and a reduction in episode duration (faster RAS healing). RESULTS: The assessed literature demonstrates the benefits of laser therapy mainly due to immediate analgesia and ability to speed up a RAS healing process. CONCLUSION: Even thoughthe assessed literature suggests beneficial outcomes of laser therapy in treatment of RAS, these results should be interpreted with caution. The issues related to the study designs and different sets of laser irradiation parameters of a limited number of available studies with the same treatment outcomes prevent us from making definite conclusions.

Untypical amlodipine-induced gingival hyperplasia.

Amlodipine is a third generation dihydropyridine calcium channel blocker that is frequently used in therapy of hypertension. Among many side effects, amlodipine has been found associated with gingival overgrowth (GO) which usually occurs within the first three months of starting therapy at a dose of 10 mg/day. However, there are very few reports on amlodipine-induced gingival overgrowth (AIGO) at a lower dose (5 mg/day) and only after short term administration. A 64-year-old male patient with hypertension, who received amlodipine (5 mg/day) for four years, sought medical attention at the Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina. The patient complained of masticatory problems due to extensive maxillary GO along with pain, bleeding, and foul odor. The clinical and the histological evidences were consistent with AIGO. The first line treatment consisted of the amlodipine substitution (amlodipine was replaced with enalapril, 5 mg/day) and the scaling and root planning/SRP. At one-month follow-up, drug replacement and SRP resulted in some reduction of the inflammation and significant reduction of symptoms. Further, gingivectomy/gingivoplasty helped overcome the effect of these drugs. The possibility of AIGO should be considered for a lower dose, as well as a late presentation.

Pemphigus vulgaris and laser therapy: crucial role of dentists.

INTRODUCTION: Pemphigus vulgaris is a relatively rare, chronic, autoimmune vesiculobullous disorder characterized by formation of intraepithelial vesiculae and/or bullae in the skin and mucous membrane. Systemic steroids are considered to be the standard first-line therapy for pemphigus vulgaris. However, for patients unresponsive to standard therapy, the new treatment modalities are being sought. Low-level laser therapy has been accepted as an alternative or adjunctive treatment modality for many conditions in medicine and dentistry. Therefore, this study was aimed at presenting the effects of low-level laser therapy in the treatment of pemphigus vulgaris and to emphasize the crucial role of dentists in early recognition and diagnosis of pemphigus vulgaris. MATERIAL AND METHODS: The articles published until May 2013 were obtained from the Medline/PubMed online database, using following search terms and key words: "laser therapy" and "pemphigus vulgaris", "low-level laser irradiation" and "pemphigus vulgaris", "lasers" and "pemphigus vulgaris" and "pemphigus vulgaris". RESULTS: Low-level laser therapy could result in immediate and significant analgesia and improved wound healing within the observation period and follow-up. Furthermore, a decrease in patients' discomfort as well as the absence of recurrence of the pemphigus vulgaris lesions has been claimed. CONCLUSION: Even though available literature suggests that low-level laser therapy can be efficiently used in treatment of oral pemphigus vulgaris, either independently or as a part of combined therapy approach, these results should be interpreted with caution since there are no solid evidence-based proofs to provide the guidelines for the treatment of pemphigus vulgaris with low-level laser therapy. Therefore, further long-term randomized controlled clinical studies are necessary in order to give any solid recommendations on the use of low-level laser therapy in the treatment of pemphigus vulgaris.

Phototherapy approaches in treatment of oral lichen planus.

Oral lichen planus (OLP) is a chronic immunologic mucocutaneous inflammatory disease of the oral mucosa. Since the etiopathology of OLP is idiopathic, treatment is usually symptomatic, therefore showing low predictability. Currently, topical corticosteroids are widely accepted as the standard therapy. However, for patients unresponsive to standard therapy for OLP, new treatment modalities have been sought. Phototherapy has recently been accepted as an alternative or adjunctive treatment modality for many conditions in medicine and dentistry. The aim of this study is to present the advantages and disadvantages of the different kinds of phototherapy used in treatment of OLP (UV phototherapy, lasers, and photodynamic therapy). The main outcome measures compared were improvement of signs and symptoms and OLP recurrence. Although some phototherapy techniques in the selected articles have demonstrated limited effects, there is no solid basis in evidence for the effectiveness of any of these treatments for OLP. Therefore, further research, especially randomized controlled clinical trials with long-term follow-up, is needed to give any solid recommendation on the use of phototherapy in the field of OLP treatment.