Metabolic and Other Endocrine Elements with Regard to Lifestyle Choices: Focus on E-Cigarettes.

Our objective was to overview recent data on metabolic/endocrine disorders with respect to e-cigarette (e-cig) use. This is a narrative review; we researched English, full-length, original articles on PubMed (between January 2020 and August 2023) by using different keywords in the area of metabolic/endocrine issues. We only included original clinical studies (n = 22) and excluded case reports and experimental studies. 3 studies (N1 = 22,385; N2 = 600,046; N3 = 5101) addressed prediabetes risk; N1 showed a 1.57-fold increased risk of dual vs. never smokers, a higher risk that was not confirmed in N2 (based on self-reported assessments). Current non-smokers (N1) who were dual smokers still have an increased odd of prediabetes (a 1.27-fold risk increase). N3 and another 2 studies addressed type 2 diabetes mellitus (DM): a lower prevalence of DM among dual users (3.3%) vs. cigarette smoking (5.9%) was identified. 6 studies investigated obesity profile (4 of them found positive correlations with e-cig use). One study (N4 = 373,781) showed that e-cig use was associated with obesity in the general population (OR = 1.6, 95%CI: 1.3-2.1, p < 0.05); another (N5 = 7505, 0.82% were e-cig-only) showed that obesity had a higher prevalence in dual smokers (51%) vs. cig-only (41.2%, p < 0.05), while another (N6 = 3055) found that female (not male) e-cig smokers had higher body mass index vs. non-smokers. Data on metabolic syndrome (MS) are provided for dual smokers (n = 2): one case-control study found that female dual smokers had higher odds of MS than non-smokers. The need for awareness with respect to potential e-cig--associated medical issues should be part of modern medicine, including daily anamnesis. Whether the metabolic/endocrine frame is part of the general picture is yet to be determined. Surveillance protocols should help clinicians to easily access the medical background of one subject, including this specific matter of e-cig with/without conventional cigarettes smoking and other habits/lifestyle elements, especially when taking into consideration metabolism anomalies.

Analysis of Temperatures Generated during Conventional Laser Irradiation of Root Canals-A Finite Element Study.

The success of endodontic treatment is dependent on the removal of bacteria. A modern strategy to reduce bacterial load is laser irradiation. During this procedure, there is a local increase in temperature with possible side effects. The aim of this study was to determine the thermal behavior of a maxillary first molar when performing the conventional irradiation technique using a diode laser. For this study, a 3D virtual model of a maxillary first molar was created. The preparation of the access cavity, the rotary instrumentation of the palatal root canal and the laser irradiation protocol were simulated. The model was exported in a finite element analysis program where the temperature and heat flux were studied. Temperature and heat flux maps were obtained, and the temperature increase on the internal wall of the root canal was analyzed. The maximum temperature value exceeded 400 °C and was maintained for less than 0.5 s. The obtained temperature maps support the bactericidal effect of diode laser and the limitation of damage to surrounding tissues. On internal root walls, the temperature reached several hundred degrees Celsius, but for very short durations. Conventional laser irradiation is an adjuvant method of decontamination of the endodontic system.

The Impact of Parental Education on Schoolchildren's Oral Health-A Multicenter Cross-Sectional Study in Romania.

The present study is part of the first national oral health survey for children in Romania. The aim of this study was to determine caries prevalence in correlation with the level of the parents' education, preventive behavior, and socioeconomic parameters in 11-14-year-old schoolchildren in Romania. A cross-sectional epidemiological survey was designed and conducted in 2019-2020. The sampled children were selected from 49 schools distributed in rural and urban areas of Romania, including its capital. Data were collected using the Oral Health Questionnaire for Children developed by the World Health Organization and described in the WHO Oral Health Surveys-Basic Methods, 5th edition, 2013, after positive informed consent. To express prevalence and severity of carious lesions, International Caries Detection and Assessment System (ICDAS) criteria were recorded in school for 814 schoolchildren (388 boys and 426 girls) aged between 11 and 14 years old (mean age 12.29 ± 0.6). Elements regarding the specificity of the child (gender, age, and parental education) were tabulated against preventive behavior. The parents' education was correlated with three clinical indices in order to assess the existence or lack of certain significant differences among schoolchildren in Romania. In terms of correlation between the mother's education and preventive behavior, results showed a significant positive correlation in case of dental check-ups (rs = 0.08 *, p < 0.05), brushing (rs = 0.02 **, p < 0.01), and use of different types of dental hygiene aids (rs = 0.06 **, p < 0.01) and a negative correlation with tooth pain or discomfort (rs = -0.01 **, p < 0.01). A statistically significant positive relationship was highlighted between the mother's education and the presence of restorations (rs = -0.09 **, p < 0.01). Regarding the father's education, there was a positive relationship with oral hygiene behavior (rs = 0.18 **, p < 0.01) but a negative relationship with the D3T index (rs = -0.18 **, p < 0.01). In conclusion, there was a strong correlation between the parents' education, preventive behavior, and oral health status of Romanian schoolchildren.

Dental Caries, Oral Health Behavior, and Living Conditions in 6-8-Year-Old Romanian School Children.

Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father's level of education (ß = −0.33, SE = 0.07, p < 0.01) as well as the mother's education (ß = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior.

A rare case of transmigrated mandibular canine and combined orthodontic-surgical management.

Canines are paramount teeth for esthetics and function. Transmigration of the lower permanent canine is a rare process of alteration of the eruption path toward the opposite part of the mandible. The position of the migrating tooth varies at different ages, so early detection of the tendency to cross the midline is crucial; canines that have already passed through the center of the mandible can be impossible to realign. Transmigration can start any time before the normal age of eruption. Comparing two radiographic images taken at different ages offers important diagnosis information. Camilleri & Scerri (2003) described a progressive alteration of the tooth position in four steps, from the normal appearance to a low position inside the corpus of the mandible. Following this classification, this article's aim was to present a case of an impacted lower canine that was diagnosed between the second and third stage of transmigration, around the age of 10, and to detail the combined orthodontic-surgical treatment strategy for "recapturing" and the orthodontic mechanics used to align it. After the examination of cone-beam computed tomography, we have decided to use a lingual arch as a space maintainer and anchorage tool and to surgically expose the tooth. The canine's initial position and the direction of the force of traction used allowed a proper alignment of the tooth inside the dental arch. The periodontal tissues management was important for good healing, stability, and aesthetics. The early detection allowed a proper interdisciplinary orthodontic-surgical management, and a successful outcome.

Periodontal clinico-morphological changes in patients wearing old nickel-chromium and copper alloys bridges.

Elderly population frequently presents more than one prosthetic restoration realized from different types of dental alloys which, in time, suffer various alterations in the oral environment. Metallic ions are released in saliva due to its electrolytic qualities, interacting with the contact tissues. Studies regarding cytotoxicity of dental alloys are providing contradictory results. Besides biocompatibility, the microbial factor is also greatly influencing the long-term success of the prosthetic rehabilitation. This study's aim was to assess the response of the gingival tissue to nickel-chromium (Ni-Cr) and copper (Cu)-based dental casting alloys from fixed dentures present in many patients from Romania. Gingival samples were taken from 124 patients wearing fixed dental restorations made from these two types of alloys from injured areas surrounding the abutment teeth; histological specimens were prepared, fixed in 10% neutral buffered formalin, paraffin-embedded and stained with Hematoxylin-Eosin (HE). Histological analysis showed the existence of a chronic inflammatory infiltrate in the gingival chorion, necrosis areas, and vascular congestion. Various morphological alterations appeared, depending on the intensity of the inflammation and the immune response. The surface epithelium suffered a hyperplasic reaction, either limited to acanthosis or involving the whole epithelium, the release of the Cu(2+) and Ni(2+) ions from the dental alloys used in bridges and crowns being responsible for inducing gingival hyperplasia and a chronic inflammation in the areas situated around the abutment teeth. The immunohistochemical study allowed us to observe an increased number of positive cluster of differentiation 3 (CD3) T-lymphocytes in periodontium, proving that the cellular immune response is rapid and intense.

Suspicions of titanium allergic reaction influencing the prosthetic solution in a rare case of implant "flowering".

The aim of this paper is to eliminate suspicions of a titanium (Ti) allergy in a rare case of "flowered" implant in a 43-year-old female patient with metal allergies and no history of bruxism, using a histological and immunohistochemical (IHC) analysis to determine the phenotype of cells that participated in the immune response; also, to assess the prognosis of a future implant treatment and to highlight the psychological impact of osseointegrated implant failure caused by fracture, and the influence that the necessity to use extensive surgical procedures for reimplantation can have on the treatment solution chosen by the patient. The results of our IHC analysis did not indicate a clear response for a potential Ti allergy; still, due to psychological reasons, the patient rejected the replantation and considered the use of other restorative option, a three-unit bridge, as being the most appropriate for her. Considering her opinion and attitude, the fixed prosthetic denture assured the therapeutic success.

Unilateral supplemental maxillary lateral incisor: report of three rare cases and literature review.

Additional teeth to the normal dentition are called supernumerary teeth; they can be found in higher rates in permanent than in deciduous dentition, in both sexes, associated or not with other diseases or syndromes. The aim of this article is to report three rare cases of unilateral supplemental lateral incisors, in Romanian child and adult patients, and to evaluate the treatment options in each case, considering particularities such as age, physiognomy, associated issues and occlusion. The differential diagnosis between a supernumerary lateral incisor in formation and a rudimentary is sometimes difficult to make using only panoramic X-ray, so a cone-beam computed tomography analysis can be indicated. Usually, due to the pathological issues that they can cause, the supplemental maxillary lateral incisors are removed; although, in some cases, it may be necessary to remove the normal tooth, for example in cases of major crowding, in which the normal tooth is more displaced from the line of the arch than the supplemental one, or when there is a lack of periodontal support surrounding the normal tooth. This article highlights that even if, in younger patients, the majority of these teeth is extracted because later in life they can cause difficulties in orthodontic and prosthetic treatment, there are still rare cases which do not necessitate treatment, because they are asymptomatic, rather well aligned and go unnoticed. Also, the article includes a detailed literature review of reported cases of supplemental maxillary lateral incisor.

A rare case of mandibulary parapremolars in siblings: case report and literature review.

Supernumerary teeth in permanent dentition are influenced by hereditary and environmental, having clinical variations such as location, number and morphology. Parapremolars can be found as a single supernumerary tooth or as multiple, usually in the lower jaw, sometimes in association with other types of supernumerary teeth. Familial inheritance often involves more than one generation. This paper presents a case of two brothers, one with only one parapremolar and a good oral status and hygiene, the other with poor hygiene, multiple parapremolars and one mesiodens, causing various complications. The aim of this paper is to show the presence of parapremolars in brothers with no other medical relevant history, located in the same site, and to point the influence of genetic factors in the etiology of supernumerary teeth. Along with a review of the literature, this article shows the importance of an early diagnosis and follow-up using successive panoramic radiographs of such cases, in order to limit or prevent the inflammatory, carious, periodontal and occlusal complications that can seriously affect both the jaws and the normal dentition.

Maxillary distomolars: case reports, differential diagnosis and literature review.

Supernumerary teeth can be found anywhere in the oral cavity, during deciduous or permanent dentition, in males and females. They are rare, owned to various genetic or environmental factors and usually impacted. This article first reports three cases of young adult patients coming to the office for other reasons than their maxillary distomolars and without any pathology caused by them. The decision of keeping or removing these teeth was made based on other associated factors. The fourth case is one of a 40-year-old partially edentulous male patient, also with a good general health and no other associated condition, having a unilateral maxillary fourth molar; it was small, only partially erupted, with a normal morphology with crown and root and an impacted perpendicular position on the distal face of the third molar. It was extracted because of the periodontal and carious complications that it caused to the third molar facing it. The last reported case is a 64-year-old partially edentulous female patient with a maxillary tooth very similar to a distomolar because of its form and position; it was extracted because it interfered with the new removable partial denture treatment plan. The differential diagnosis between a distomolar and an anatomical variant of a third molar was difficult to make even using panoramic X-ray, also because of a very small inferior third molar. In young patients, distomolars are rather accidentally discovered during radiographic examination; later in life, they can cause both pathological issues and difficulties in diagnosis and prosthetic treatment.

The prevalence of crown injuries to frontal teeth at schoolchildren aged 6 to 14 and their effects on the periodontal tissue.

The research aims at emphasizing the interrelation between the social impact and the self-esteem of schoolchildren with dental crown fractures in the frontal group. Dental traumatic injuries are frequently met to schoolchildren, therefore, the prevention and interception of traumatic pathology within parents, teachers and children is more than necessary. Our statistical study intends to determine the prevalence of dental trauma to southwestern Romanian schoolchildren aged 6 to 14. The survey included a number of 1684 schoolchildren attending public schools, randomly chosen. Data were collected from October 2012 to December 2013. Clinical examination was conducted to assess the dental traumatic injuries. Age and gender distribution, etiological factors, risk factors and the cause of injuries were the parameters taken into consideration. The data collected was processed and analyzed using the SPSS (Statistical Package for the Social Sciences) statistical software. The overall prevalence of dental trauma was 4.63% amongst the subjects examined. The maxillary central incisor was the most commonly affected tooth (85.19% in boys and 97.87% in girls). We observed a significant statistical difference in the number of children with one, two or three fractured teeth from the urban and rural areas. The percentage of schoolchildren with crown fractures that we examined was of 3.09% in the urban area and 1.54% in the rural area. The traumatic injuries of the maxillary upper teeth were most prevalent. Since the dental trauma of incisors has a strong impact on the quality of life of children and their families, health preventive policies are needed in order to avoid psychological implications on the lifelong existence of children affected.

Prosthetic rehabilitation of complete edentulous patients with morphological changes induced by age and old ill fitted dentures.

Extremely old, complete edentulous patients are very difficult to treat both because of their anatomical and psychological condition. Treatment challenges are increasing when this situation is associated with low socio-economic status, poor general health and unrealistic expectations. This article presents a prosthetic rehabilitation of a very old patient, presenting a serious bone atrophy associated with a maxillary flabby ridge, whose dentures accelerated the bone resorption because of their poor fitting, lack of retention and wrong occlusal contacts. Despite his old age and scarce social life, restoring esthetics in the trial phase had a major psychological impact for the patient, making him more optimistic about the result and helping him to accept and functionally integrate the new complete dentures.

Immunohistochemical study of the epithelial and stromal components of Warthin's tumor.

Warthin's tumor is a benign monomorphic adenoma with unclear origin with the highest incidence in the sixth and seventh decades. The analysis of tumor markers involved in the pathogenesis of Warthin's tumor can improve the patients' prognosis. This study included 29 cases of Warthin's tumor, which were histopathologically and immunohistochemically examined for different compartments of tumors. For immunohistochemical study, we used as specific markers for epithelial compartment CD117, CEA and AMA, respectively S100 and D2-40 for the stromal compartment. The evaluation of immunoreactions was performed by semiquantitative analysis. The analysis of the CEA, CD117 and AAM immunoexpression allowed observing various patterns of immunostaining for tumor double-layered epithelia, which has the tendency of being similar to that in the normal ductal epithelia. S100 protein positivity similar to Langerhans cells suggests that delayed hypersensitivity can be involved in tumor development. The presence of D2-40 expression in majority of tumor subcapsular vessels, similar to lymph nodes structure, confirms the hypothesis that Warthin's tumor has its origin in regional lymph nodes.

Effects of therapy with two combinations of antibiotics on the imbalance of MMP-2÷TIMP-2 in chronic periodontitis.

UNLABELLED: Periodontitis represents a chronic bacterial infection that induces immuno-inflammatory conditions affecting gingiva and tooth-supporting tissues. The role of some biological mediators in periodontal disease was widely investigated, especially that of MMP-8 and MMP-9. Recently, MMP-2 was also considered to be an appropriate therapeutic target for prevention of periodontal disease progression. However, effects of the combination of metronidazole with amoxicillin or spiramycin on the release and activation of MMP-2 and the balance MMP-2÷TIMP-2 were rarely studied. This study was designed to assess the influence of two combinations of antibiotics used for treatment of periodontitis on the balance MMP-2÷TIMP-2. Gingival samples obtained from patients with no pharmacological treated chronic periodontitis and those receiving either the association between amoxicillin-metronidazole and spyramicin-metronidazole were processed for paraffin embedding and then used to perform immunohistochemical reactions in order to detect MMP-2 and TIMP-2. All subjects were evaluated clinically and radiographic at the first visit and after treatment completed, the Loe & Silnees gingival index at six sites per tooth for the whole mouth being recorded. Statistical analysis was performed using non-parametrical techniques. Gingiva samples from untreated chronic periodontitis patients revealed a diffuse positive reaction for MMP-2 in the epithelium and also in fibroblasts and macrophages from the lamina propria. For gingiva samples from patients treated with antibiotics, MMP-2 positive reaction was restricted to deep epithelial layers and few cells of the connective tissue. No significant difference was observed for TIMP-2 expression. The clinical indexes were in accordance with immunohistochemical results. After treatment, gingival index values were significantly lower then before (p<0.001) in both groups treated with antibiotics. CONCLUSIONS: The two combinations of antibiotics tested in our study seem to have a dual ability to reduce inflammation as well as to inhibit MMP-2 activity.

Changing the root morphology in a case of periodontal impairment at a maxillary molar used as a sustaining tooth.

Research evolution regarding dental research determines the increase of patient's desire to preserve their dentition for a long time. The loss of a molar tooth as the last teeth present on the dental arch, raises issues regarding how the prosthesis should be placed, still patients are usually reluctant to use as last resort the prosthetic solution. This article describes the technique of root amputation to save a maxillary molar used as bridge abutments.

Restoration of molar morphology with a split cast post and core.

The teeth with extensive coronal destructions due to carious process can be saved by using split cast post and core. This technique has been used for a long time and with positive results recognized by many authors. The clinical case presented here describes indirectly the reconstitution technique with split cast post and core with latch of a maxillary molar with divergent roots and extensive coronal destruction both in area and depth.