Modifications of the Dental Hard Tissues in the Cervical Area of Occlusally Overloaded Teeth Identified Using Optical Coherence Tomography.

Background and objectives: Occlusal overloads produce a series of manifestations in teeth, especially attrition and non-carious cervical lesions (NCCL). Optical Coherence Tomography (OCT) can highlight and evaluate tooth lesions. The aim of this study was to examine the changes of dental hard tissues in the cervical area because of occlusal overload by macroscopic examination and using in vitro Swept Source OCT examination. Materials and Methods: The study was performed on 21 extracted teeth with occlusal trauma. After macroscopic and OCT examination, the 2D OCT images were transformed into 3D images using ImageJ software. Statistical analysis of macroscopic and OCT images was performed with Statistical Package for Social Sciences. Results: On 21 teeth, 88 cervical lesions (cracks) were identified. Upper premolars with an occlusal Smith and Knight tooth wear score of 2 had the most NCCL. Statistical analysis revealed significant differences in the median widths of cervical lesions between teeth with score 1 and score 3. Additionally, we obtained statistically significant differences in median widths between the buccal and oral surfaces. Conclusions: These cracks can be considered precursors of NCCL. NCCL can be located on dental surfaces in the cervical area other than the buccal one. A 3D reconstruction of OCT images emphasized that cracks are located especially at enamel level, evolving towards the enamel-dentin junction, with multiple ramifications.

Applications of Optical Coherence Tomography in the Diagnosis of Enamel Defects.

Developmental defects of enamel (DDEs) are deviations from the normal appearance in terms of the quantity and quality of tooth enamel. They may be genetic or acquired. The most important DDEs are hypomineralization and hypoplasia. The aim of this study was to produce "in vivo" DDE in Wistar rats by administering amoxicillin to pregnant females and to highlight these lesions after sacrifice of the pups by macroscopic and microscopic examination and optical coherence tomography (OCT). Amoxicillin (100 mg/kg) was administered to two pregnant Wistar female rats for the production of DDEs. When the pups were 2 months old, they were sacrificed, and their jaws were harvested together with their teeth. The jaws were examined macroscopically, microscopically, and by OCT. Following the macroscopic and microscopic examination, it was established that four pups had a total of 42 DDE lesions. At the OCT examination, the hypomineralization was characterized by an intense, inhomogeneous OCT signal, and the hypoplasia was characterized by the absence of the signal. Administration of amoxicillin to pregnant females of Wistar rats resulted in DDEs in their offspring. The OCT examination confirmed the presence of these lesions in the teeth of rat pups.

Oral Mucosa Changes Associated with Wearing Removable Acrylic Dentures.

The main purpose of the study was to highlight the incidence of various changes in the oral mucosa associated with wearing removable acrylic dentures. Materials and method. The study was performed on a total of 45 subjects who presented at the Prosthodontics Clinic and the Oral Rehabilitation Clinic of Craiova Faculty of Dental Medicine during January 2018-May 2020. Results. Of the 45 subjects that were wearing at least one acrylic denture 31,11% presented oral mucosa changes or lesions. The most common mucosal lesion was type 1 according to Newton's classification.

Immunohistochemical study of experimentally drug-induced gingival overgrowth.

The increasing frequency of using in the medical practice drugs that have the potential to induce gingival overgrowth (GO) and the existence of many unknown aspects in GO etiopathogenesis have prompted us to carry out this immunohistochemical experimental animal study. We conducted a cell proliferation study by Ki67 immunostaining and a cytokeratin (CK) study using anti-pan-CK AE1∕AE3 and anti-MNF116 antibodies, investigating the differences induced by different classes of drugs that are more frequently involved in the induction of GO. The results of our study indicate that CK AE1∕AE3 plays an important role not only in normal cellular proliferation, but also in hypertrophic tissues, and can be considered a marker of the proliferative process occurring in GO. Immunostaining for the anti-MNF116 antibody was weaker and inconsistent in intensity compared to anti-CK AE1∕AE3 antibody, its staining pattern appearing as diffuse or zonal.

The Role Played by Growth Factors TGF-ß1, EGF and FGF7 in the Pathogeny of Oral Pseudoepitheliomatous Hyperplasia.

Pseudoepitheliomatous hyperplasia is an epithelial proliferation that develops in the dermis or lamina propria. It is a lesion associated to another pathology, which appears as a response to a great variety of infectious, neoplastic, inflammatory or traumatic stimuli. The etiopathogeny of this lesion is not clear yet. Therefore, we performed an immunohistochemical study on a group of 20 cases of pseudoepitheliomatous hyperplasia cases associated with inflammatory and neoplastic conditions, by investigating TGFß1 (Beta growth and transformation factor), EGF (Epidermal growth Factor), and FGF7 (Fibroblast growth factor) expressions during in its development. The TGF-ß1 expression was recorded in all the layers of the oral hyperplastic epithelium, going from the basal to the superficial layers, but with a different immunoreactive pattern, according to the region. Our study showed the absence of EGF immunoexpression in the carcinomatous proliferation areas associated to pseudoepitheliomatous hyperplasia and an almost exclusive presence in the hyperplasia lesions associated with inflammatory conditions (in about 30% of the investigated lesions) of a expression varying from poor to moderate for EGF. According to our investigations, we observed the presence of an immunolabeling for FGF7 in 80% of the investigated cases of pseudoepitheliomatous hyperplasia, a maximum of intensity being observed within the cases associated with inflammatory conditions.

Histopathological Study of Oral Pseudoepitheliomatous Hyperplasia.

Pseudoepitheliomatous hyperplasia, also called Heck's disease, is an epithelial, inconstant and conjunctive proliferation that develops as a response to a great variety of stimuli. It is a lesion associated to different diseases, being found in the following etiopathogenic conditions: infectious pathogenic conditions, tumoral pathogenic conditions, inflammatory pathogenic conditions. We studied oral pseudoepitheliomatous hyperplasia for which we performed a histopathological study, on a group of 47 cases of oral pseudoepitheliomatous hyperplasias, where we investigated the following: oral epithelium changes, changes in the underlying lamina propria and associated etiopathogenic conditions. The main changes of the oral epithelium were: elongation of the epithelial apexes (17.02%), acanthosis (100%), dyskeratosis (14.89%), and in the underlying lamina propria: fibrosis (29.78%), inflammatory infiltrate (70.21% and vascular proliferation (10.64%). The most frequent associated etiopathogenic conditions were the infectious ones (55.31%), followed by the tumoral ones (29.79%), on the last place being the inflammatory conditions (14.89%).

Experimental animal model in a histological study of drug-induced gingival overgrowth.

Gingival overgrowth (GO) is a pathology with important aesthetic and functional implications and with a multifactorial pathogenesis. Incriminated etiological factors include antihypertensive, antiepileptic and immunosuppressant medication. We aimed to evaluate the induction of gingival overgrowth on experimental rats, depending on the drug type, dose and duration. In the research conducted by us, the increase in gingival tissue production occurred gradually, depending on the administered medication and the time elapsed after its start. The study conducted shows that experimentally induced gingival overgrowth of the administered drugs is made possible by altering tissue homeostasis through altering the fibrocyte cell populations involved in the tissular turnover as well as those involved in the inflammatory process. A better understanding of the pathogenesis of this undesirable effect may lead to the development of improved management strategies for preventing it, or reducing it through non-surgical methods.

Clinical, imagistic and histopathological study of chronic apical periodontitis.

Periapical lesions are among the most frequent periodontal pathologies in human teeth, generally called apical periodontitis. Apical periodontitis is a continuation of the endodontic space infection and it is manifested as a response of the host defense against the microbial action. It may determine local inflammation, hard tissue resorption, destruction of other periapical tissues. The preliminary diagnosis of chronic periapical lesions is based on the clinical symptoms and imagistic investigation, which represent a reliable diagnosis instrument, but the histological investigation remains essential for a certain diagnosis. We performed a clinical and histological study of the periapical lesions, evaluating the various clinical and imagistic aspects and we compared them with the results of the histological examination, in order to establish the correspondence between the clinical-imagistic aspects and the morphological ones. The relation between the histological aspects, the clinical signs and imagistic aspects may provide valuable data both for establishing an accurate diagnosis and for adopting the most efficient treatment.

Study of some invasiveness markers as pathogenic factors in oral pseudoepitheliomatous hyperplasia.

Pseudoepitheliomatous hyperplasia is a benign reactivated epithelial lesion secondary to another pathology, whose incidence is difficult to establish. There still exist controversies regarding the origin and pathogenesis of these lesions. For this purpose, we performed an immuno-histochemical study upon 20 cases of oral pseudoepitheliomatous hyperplasia associated with inflammatory and neoplastic conditions, investigating a series of markers with a possible pathogenic potential in developing this type of lesions. Thus, the immunoreactivity study for ß-catenin showed the presence of a membrane reactivity in all the stratum spinosum and a predominantly cytoplasmatic reactivity, more rarely a nuclear one, in the cells of the basal stratum cells, especially in the epithelial apices that descend deeply in the chorion. Instead, in the case of vimentin, the reactivity was present only in the epithelial apices, especially in the peripheral cells, in comparison to the central ones, and especially in the cases where the epithelial apices descended deeply in the sublesional chorion. Moreover, we observed that the MMP9 reactivity in pseudoepitheliomatous hyperplasia lesions was present in the cells at the epithelium-chorion interface and especially in the epithelial apices that descend deeply into the chorion, and also in the epithelial chorion and networks. The study for CXCR4 immuno-reactivity showed a good reactivity in almost all layers of this hyperplastic lesion, with a maximum reactivity especially inside the epithelial apices that descend deeply in the sublesional chorion. Such an immunoprofile suggests the ability of the oral epithelial cells to undergo an epithelial mesenchymal transition process, thus acquiring mesenchymal characteristics through which it deeply migrates in the subadjacent chorion and contributes to the formation of epithelial apices in pseudoepitheliomatous hyperplasia. Moreover, the invasive ability of these lesions is also given by the average quantity of matrix metalloproteinases present in the epithelium-chorion interface determined by the activation of CXCR4 receptors at this level.

Local cause of gingival overgrowth. Clinical and histological study.

The overgrowth, depending on its extension, has multiple effects on the stomatognathic apparatus: functional disorders (impaired speech), difficulty in chewing and aesthetic problems but can cause significant psychological problems. We proposed this study, motivated by the relative increased frequency of the gum outgrowth, its multifactorial etiopathogeny, but especially from the point of view of the specialist practitioner, by the problems that this pathology raises not only for the functionality of the stomatognathic apparatus but also for the facial esthetics, and especially for future therapeutic attitudes needed to solve the existing pathology at this level. We conducted a clinical study and a histological one. For the clinical study, we selected 74 patients who experienced different degrees of gingival outgrowing associated with fillings, dental caries, fixed prostheses, mobile prostheses, orthodontic apparatus. Thirty gingival fragments from patients with gingival outgrowing were processed by paraffin-embedding histological technique and stained with Hematoxylin-Eosin. The morphological results obtained provide the necessary support for understanding the possibility of developing a therapeutic strategy to prevent or minimize the gum outgrowth by administering antibiotic and anti-inflammatory medications associated with medications, which shall cause the apoptosis of the fibroblasts.

The Physician's Attitude towards the End of the Existence.

The physician's attitude towards death, a phenomenon which he frequently encounters in his work practice, is most of the times ambiguous, uncertain, lacking a philosophical significance coherent enough. During the period corresponding to the transition from life to death, when the human being who is about to relinquish life for good lives, suffers, understands and needs assistance, most of the physicians adopt a particular detachment conduct. The physician's participation in assisting the patient, constant until then, natural, sharply decreases the moment the diagnosis has become, "there is nothing else to be done". This phrase "there is nothing else to be done" should be only the conclusion of one phase of the assistance given by a physician, the curative, healing assistance and the beginning of another one, the phase of "assisting the dying person", a phase that has to be an integral part of the physician's mission which represents a more difficult medicine, much more demanding for the physician. At this point, assistance, treatments depend on the ability of the person providing assistance to endure the fear of death in which he is included himself. The necessity of meeting the needs of the dying people has led to the drafting of "a charter of the rights of the dying". Such charter was drafted during the symposium, "Terminally ill patient and helping person" organized by Wayne State University, Detroit, USA. Taking into account the idea that the dying person "has the right to live until the end" within the best possible conditions the palliative care have been developed. According to the French Society of Palliative Care, 1996, the palliative care aim is to ensuring the patient's quality of life (and not extending it by any means) and that of his family. In these conditions the pain control, the psychological, social and spiritual development are essential.