Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis.

OBJECTIVES: This systematic review compared platelet concentrates (PCs) versus hyaluronic acid (HA) or saline/Ringer's solution injections as treatments of temporomandibular osteoarthritis and disc displacement in terms of pain and maximum mouth opening (MMO). METHODS: PubMed, Cochrane, and Scopus were searched up to March 6, 2020. Inclusion criteria were randomized clinical trials (RCTs). Exclusion criteria were case series, observational studies, animal studies, and reviews. The Effective Public Health Practice Project (EPHPP) quality assessment tool was used to assess the risk of bias in the included studies. The weighted mean difference was used to compare the results. RESULTS: Nine RCTs were included with a total of 407 patients. The numbers of joints treated were 262, 112, and 112 in the PC, HA, and saline groups, respectively. The quality of studies was rated as strong in 4 studies, moderate in 4 studies, and weak in 1 study. The meta-analysis revealed that PCs decreased pain visual analogue scale (VAS) scores compared to HA by an average of -1.11 (CI, -1.62 to -0.60; P < 0.0001) and -0.57 (CI, -1.55 to 0.41; P = 0.26) at 3 and 12 mo follow-up respectively. Also, the average decrease in pain scores with PC compared to saline was -1.33 (CI, -2.61 to -0.06; P = 0.04), -2.07 (CI, -3.46 to -0.69; P = 0.003), and -2.71 (CI, -4.69 to -0.72; P = 0.008) at 3, 6, and 12 mo, respectively. Regarding MMO measurements, PC was comparable to HA, but it was significantly better than saline after 3 and 6 mo [2.9 mm (CI,1.47 to 4.3; P < 0.0001), and 1.69 mm (CI, 0.13 to 3.25; P = 0.03) respectively]. CONCLUSION: PC reduces pain VAS scores compared to HA during the first 3 m after treatment, and when compared to saline, it reduces pain and increases MMO for longer durations. However, due to differences between groups regarding PC preparation protocols and study heterogeneity, further standardized RCTs are required. KNOWLEDGE TRANSFER STATEMENT: This study provides researchers and clinicians with quantitative and qualitative analyses of the current evidence regarding the clinical outcomes of platelet concentrate injections in the treatment of temporomandibular joint osteoarthritis and disc displacement in terms of pain control and maximum mouth opening.

Potential relationship between periodontal diseases and eye diseases.

Periodontal diseases are inflammatory lesions initiated by oral bacteria and lead to the destruction of the supporting structures of the teeth (gingiva, periodontal ligament and alveolar bone) in susceptible patient. Via several biological mechanisms, periodontal diseases have been associated with multiple systemic diseases, such as rheumatoid arthritis, diabetes, cardiovascular diseases, Alzheimer's disease and adverse pregnancy outcomes. Similarly certain eye diseases have been associated with systemic diseases of the inflammatory pathway. We hypothesized that periodontal diseases are associated with eye diseases. Thus using literature data we find that several studies have reported that eye disorders are associated with the presence of periodontal diseases. But the mechanisms of this relationship are not clear. However the innate immune response involvement, the sharing of similar risk factors in pathogenesis and the changes of eye choroid thickness may be suggested as several hypotheses to explain this potential association.

[Desquamative gingivitis]. / La gingivite desquamative.

The desquamative gingivitis is the clinical term given to the gingival manifestation of mucocutaneous diseases. It is characterized by an erythematous, glazed, friable and hemorrhagic gingiva, which can be accompanied by pains. Except the gingiva, the lesions can be localised on other oral mucous membranes or on the skin. The three principal diseases at the origin of the desquamative gingivitis are by order of frequency: the cicatricial pemphigoïd, erosive lichen planus and pemphigus. The knowledge of the clinical, histological and immunohistochemical characteristics of these three affections is essential for the diagnosis and the suitable treatment of the desquamative gingivitis.