A support vector machine-based algorithm to identify bisphosphonate-related osteonecrosis throughout the mandibular bone by using cone beam computerized tomography images.

OBJECTIVE: This study aimed to develop an algorithm to distinguish the patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) from healthy controls using CBCT images by evaluating both trabecular and cortical bone changes through the whole body of the mandibular bone. METHODS: Patient data set was created from axial CBCT images of 7 BRONJ patients (28 slices) and 8 healthy controls (27 slices). The healthy bone of healthy controls, bone sclerosis of BRONJ patients, bone necrosis of BRONJ patients, and normal appearing bone of BRONJ patients (NBP) were labeled on CBCT images by three maxillofacial radiologists. Proposed algorithm had preparation and background cancellation, mandibular bone segmentation and centerline determination, spatial transformation of gray values, and classification steps. RESULTS: Significant differences between the statistical moments (mean, variance, skewness, kurtosis, standard error, median, mode and coefficient of variance) of healthy and diseased (bone sclerosis and necrosis) groups were observed (p = 0.000, p < 0.05). Also, variations were noted between healthy controls and NBP of BRONJ patients (p = 0.000, p < 0.05).The statistical moments were utilized to develop the algorithm which has resulted with accuracy of 0.999, sensitivity of 0.998, specificity of 0.998, precision of 1, recall of 0.998, AUC of 1, and F1 score of 0.999 in identification of BRONJ patients from healthy ones. CONCLUSION: The proposed algorithm differentiated the mandibular bones of the healthy and the BRONJ patients with high accuracy in the present test sample.

Morphological Assessment of Maxillary Sinus Septa Variations with Cone-Beam Computed Tomography in a Turkish Population.

OBJECTIVE: The purpose of this study was to measure and classify sinus septa variables (prevalence, numbers, heights, locations, orientations, and morphology) and to determine the effects of age, gender, and dental status on the presence of septa and also to evaluate the effects of septa on pathological mucosal thickening. MATERIALS AND METHODS: A total of 2,000 patients were analyzed through conebeam computed tomography (CBCT). The total of 500 maxillary sinuses were included in this study. The number of maxillary sinus septa was determined on axial sections of CBCT images. Their locations, orientations, and morphologies were determined on both the axial and sagittal sections, and their heights were determined only on the sagittal sections. The influence of age, gender, dental status, and pathological mucosal thickening on the presence of septa was statistically analyzed. Mann-Whitney U-test and descriptive statistics were used for statistical analysis. RESULTS: The average height of the determined 287 septa was measured as 7.36 mm. The highest rates of septa location, morphology, and orientation were found, respectively, in the middle region septa (57.49%), completed septa (75.95%), and transverse septa (93.37%). The effect of dental status, age, and gender on the presence of septa was not statistically significant (p > 0.05). CONCLUSION: These high rates of findings support the importance of CBCT in the diagnosis of the variations of the maxillary sinus septa. Therefore, it is important to evaluate CBCT images of the relevant region to increase the success of surgical interventions in the maxillary posterior region and to eliminate possible complications.

Saliva levels of caspase-1, TNF-α, and IFN-γ in primary Sjögren's syndrome: oral mucosal abnormalities revisited

Background/aim: Abnormalities in oral mucosal immunity contribute to complex pathogenesis of primary Sjögren's syndrome (pSjS). We aimed to measure saliva and serum levels of caspase-1, tumor necrosis factor-alpha (TNF-α) and interferon gamma (IFN-γ) in patients with pSjS. Materials and methods: We studied 43 pSjS patients fulfilling the AECG criteria and 30 age/sex-matched healthy controls, as well as 39 rheumatoid arthritis (RA) patients as a disease control group. ESSDAI scores were less than seven in all patients with pSjS, indicating low disease activity. Quantitative analyses were made in serum and whole saliva samples. The statistical analysis was performed using SPSS 19.0. Results: While no significant difference was found in serum measurements, saliva levels of TNF-α and caspase-1 were significantly higher in pSjS patients versus healthy controls when using the Mann-Whitney U test. On the other hand, in the pSjS group, saliva levels of TNF-α and caspase-1 were also significantly higher compared to the RA group using Student's t-test. In the pSjS group, those parameters did not show any correlation with disease duration, seropositivity, and smoking. Conclusion: Despite low disease activity, saliva TNF-α and caspase-1 levels were found to be significantly higher in the pSjS group, which may suggest a possible advantage of local anticytokine treatments in selected cases.

Clinical periodontal status and inflammatory cytokines in primary Sjögren syndrome and rheumatoid arthritis.

BACKGROUND: The aim of the present study is to compare the clinical periodontal findings as well as gingival crevicular fluid (GCF) and plasma levels of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1ß), interferon gamma (IFN-γ) and caspase-1 in primary Sjögren syndrome (pSS) and rheumatoid arthritis (RA) subjects. METHODS: In the present case control study plasma and GCF samples were collected, full-mouth recordings comprising plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were performed in 44 subjects with pSS, 39 subjects with RA and 30 systemically healthy subjects. Plasma and GCF TNF-α, IL-1ß, IFN-gamma and caspase-1 levels were determined by enzyme-linked immunosorbent assay. RESULTS: There were no differences in GCF and plasma levels of IFN-γ and TNF-α in all the study groups (p > 0.05). GCF levels of IL-1ß were higher in pSS group than healthy group (p = 0.035). Caspase-1 GCF levels were significantly higher in pSS group than RA group (p = 0.032). Highest plasma IL-1ß levels were detected in pSS compared to RA and healthy groups (p < 0.001). Healthy group has higher caspase-1 plasma levels than pSS and RA groups (p < 0.001). CONCLUSIONS: The results of the present study reveal that the periodontal status of patients with pSS does not differ from systemically healthy subjects. Further studies involving longitudinal assessments on larger populations with standardized patient inclusion criteria are needed to confirm the findings.

Does the state of dentition effect the type of stylohyoid chain calcification pattern?

INTRODUCTION: The human stylohyoid chain calcification patterns (SCP) present considerable anatomic variability. This study was performed to investigate the calcification on SCP in the dentate and total edentulous population and its relation to mandibular protrusive movement. MATERIALS AND METHODS: The study analyzed 1.234 SCP in digital panoramic radiographs of 617 subjects. The SCP were classified according to Mac Donald-Jankowski. The amount of mandibular protrusion movement limitation was evaluated for each subject. The data were analyzed using one-way Anova, Kruskall Wallis, Mann-Whitney U, and Chi-squared tests with significance set at p = 0.05. RESULTS: Among the 617 subjects evaluated there was symmetry of the SCP between the left and right sides in 87.3 % of the cases. In the study population 501 subjects were dentate (Class I, Class II, Class III molar relationship) and 116 subjects were total edentulous. There were significant differences among dentate and total edentulous patients for the distribution of SCP (p < 0.05). Elongated group was more prevalent in total edentulous subjects while in subjects with Class I occlusion normal SCP was observed. Although mandibular protrusive movement range was within normal limits for all the groups, calcified and elongated groups have numerically less protrusive movement compared to normal groups (p < 0.05). CONCLUSION: Among dentate and total edentulous subjects, similarity in SCP for right and left side was observed. The elongation of SCP was more common in the total edentulous group. Further studies conducted on larger populations are necessary to establish the effect of the state of dentition on the SCP.

Impact of Buccotherm® on xerostomia: a single blind study.

OBJECTIVE: The purpose of this single blind study was to investigate effects of Buccotherm® spray on subjective symptoms of xerostomia patients. METHODS: Twenty patients with dry mouth complaint were instructed to use placebo six times a day for 2 weeks. After a wash period, mineral water spray was provided. Patients were asked to reply questions regarding dry mouth using visual analog scale (VAS). Baseline and subsequent subjective findings on 1 hour after the application of the materials at the end of 1st, 7th, and 14th days were recorded. RESULTS: At the end of 14-day treatment, no statistically significant differences were observed between the efficacy of placebo and commercial mineral water dental spray (p > 0.05). The VAS scores revealed that difficulty in mastication (p = 0.006), difficulty in swallowing (p = 0.00), need to sip liquids while eating (p = 0.000), difficulty in speech (p = 0.003), and waking up at night to sip water (p = 0.005) were statistically lower for placebo than commercial mineral water spray. CONCLUSION: The commercial mineral water dental spray was not more efficient than placebo in the management of dry mouth-related symptoms. CLINICAL RELEVANCE: This study emphasizes the fundamental role of saliva in oral health and evaluates the clinical utility of a commercial dental spray.

Prevalence and pattern of stylohyoid chain complex patterns detected by panoramic radiographs among Turkish population.

OBJECTIVE: The calcified stylohyoid ligament and the elongated styloid process (SP) are identified radiographically, are associated with several syndromes and symptoms. The aim of this study was to classify and determine the incidence of different types of stylohyoid chain patterns in Turkish population to provide a guide for the dentist and maxillofacial surgeon. The effect of menopause, on the elongation of SP was also investigated. METHOD: 1,600 patients, who visited Ege University Faculty of Dentistry, were enrolled. Images were evaluated for the pattern of stylohyoid chain complex according to O'Carroll's classification. The difference between age and gender was evaluated using χ(2) and ANOVA tests. RESULTS: Normal SP (Patterns A, B, C, D) 68.3 %, elongated SP (Pattern E) 27.1 %, calcified stylohyoid ligament (Patterns F, G, H, I, J, K) 1.7 % and absent stylohyoid chain 2.5 % ratios were encountered. Pattern D (52.5 %) was the most prevalent stylohyoid chain pattern followed by Pattern E (27.1 %) and Pattern C (10.7 %), respectively. Among the calcified stylohyoid ligament groups studied, Pattern G (2.6 %) was most frequently observed. There was no difference in gender for the type of stylohyoid chain complex pattern (p > 0.05). No statistically significant difference was found between menopause and non-menopause group (p > 0.05). CONCLUSIONS: According to the results of the present study, styloid process elongation is more common in older adults with no correlation to gender. In addition, menopause had no effect on the calcification or elongation of the stylohyoid chain. The sum of the elongated SP and the calcified stylohyoid ligament was 28.8 %.

Dental students' knowledge of characteristics and management of oral complications of cancer therapy.

OBJECTIVE: The aim of this study is to investigate the level of Turkish senior dental students' knowledge regarding the orodental complications and their treatment methods of cancer patients. STUDY DESIGN: A 15-item questionnaire which was obtained from National Institute of Dental and Craniofacial Research that contained information about the orodental complications of the cancer therapy and the dentists' role to provide their treatment protocols was used. Seventy-seven senior dental students answered the questionnaire and the replies were analyzed with stratified and logistic data analyses. RESULTS: Overall, correct replies ranged from 5.2 to 98.7 %. The students knew the basic knowledge of the complications of cancer therapy; however, they failed to answer to the questions (ranging between 1.3 and 94.8 %) about the required clinical practices. The respondents preferred not to answer the questions about the prophylactic measures dentist shall take during a precancer treatment oral evaluation (9.1 %), management of pain in cancer treatment (6.5 %), and necessary considerations before a dental procedure in a chemotherapy patient (3.9 %). The multiple logistic regression analysis revealed that gender had no statistically significant effect on the correct or false answers to the questions (p > 0.05). CONCLUSION: Our results disclosed that dental students' knowledge about oral complications of cancer therapy and the modalities to manage these complications vary. Reevaluation of current undergraduate curricula and continuing education for graduates might address the gaps identified and an educational program about oral and dental management of patients who are to receive/receiving/have received cancer therapy can be prepared and augmented into dental curriculum.

In vitro antimicrobial effects of commercially available mouth-wetting agents.

Products have been developed to provide palliation for persons with dry mouth. In addition to mouth-wetting agents, some products incorporate antimicrobial constituents with the goal of improving oral microbial defenses. The aim of this in vitro study was to investigate the potential antimicrobial and antifungal effects of two commercially available saliva substitutes on Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans by using the agar-well diffusion method. Antimicrobial activity as measured by the size of the inhibition zone growth for S. mutans and L. acidophilus was observed only with Biotene Dry Mouth Oral Rinse® and BioXtra® gel. The zone of inhibition of Biotene Dry Mouth Oral Rinse was larger than that of BioXtra gel (p= 0.00, p < 0.01). No anticandidal effect was seen with any of the test products. The pH of the preparations, the variations between the amount of active ingredients within the products, and the potential antimicrobial effects of inactive ingredients should be investigated to determine the factors that impacted microbial inhibition.

Effects of hydroxychloroquine on salivary flow rates and oral complaints of Sjögren patients: a prospective sample study.

OBJECTIVE: The objective of this study was to evaluate whether hydroxychloroquine (HCQ) therapy effects subjective and/or objective complaints and salivary flow rates of patients with primary Sjögren's syndrome (PSS). STUDY DESIGN: Thirty women recently diagnosed with PSS, scheduled for HCQ treatment (400 mg daily), participated and were clinically examined before initiation of 30 weeks of HCQ treatment. During baseline evaluation, both the objective and/or subjective oral findings were recorded. Unstimulated (uSFR) and stimulated salivary flow rates (sSFR) were determined. After initiation of HCQ treatment, study parameters were assessed at 6, 12, 18, 24, and 30 weeks. Each patient served as her own control; measurements of the baseline and control times were analyzed by ANOVA. RESULTS: uSFR values increased significantly with HCQ treatment, but sSFR values, objective and/or subjective complaints did not change considerably. CONCLUSION: A positive impact of 30 weeks of HCQ treatment only on uSFRs of SS patients was revealed.

The efficacy of Xialine in patients with Sjögren's syndrome: a single-blind, cross-over study.

Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of unknown cause whose main characteristic is severe dryness of the eyes and the mouth. The decreased functional capacity of the lacrimal and salivary glands which is the result of the inflammatory process and lymphocytic infiltration observed in SS is accountable for this complication. Twenty-nine patients with SS whose ages were ranging between 24-77, who were under treatment in Ege University Faculty of Medicine Department of Rheumatology, participated in the study, and their informed consents were obtained upon enrollment. Each patient recorded their subjective complaints on a separate questionnaire. The baseline and subsequent evaluation of the subjective findings on predetermined times (1 h after application of the material, at the end of the 1st, 7th, and 14th days) were also recorded on separate questionnaire sheets. Throughout the 14-day treatment period, no statistically significant differences were noted between the Xialine and placebo groups with regard to burning tongue, diminished taste, and waking up at night to sip water (p = 0.925, 0.527, and 0.066, respectively). However, patients' satisfaction with placebo decreased by 25.63% at the end of the test period, whereas it increased by 16.37% after Xialine administration. Overall, the patients preferred Xialine at the end of the study (p = 0.011). The main motive to administer saliva substitute is to improve lubrication and hydration of oral tissues. The results of this study indicated that Xialine is helpful in the management of xerostomia-related symptoms of SS patients. However, further investigations in larger scale group of patients are recommended to provide the effects of these agents on various complaints of xerostomia.