Chronic lymphocytic leukemia presenting as gingival swelling and tooth mobility.

Chronic-lymphocytic-leukemia (CLL) is the most prevalent leukemia in developed countries, caused by monoclonal proliferation of CD5+ B-cells and accumulation of mature-appearing-neoplastic lymphocytes in blood, bone marrow, and secondary lymphoid organs. Oral manifestations of CLL are infrequent and rarely reported in literature. We report a new case of a 67-year old man who presented with the complaints of tooth mobility and gingival swelling. Extra-oral examination was remarkable for cutaneous pallor and bilateral cervical lymphadenopathy involving the submandibular, and deep cervical lymph nodes on both sides of the neck. Complete blood count revealed normal red blood cell count (4.25 × 106/µl), normal platelet count (136 × 103/µl) and increased white blood cell count (25.3 × 103/µl). Differential white blood cell count showed marked lymphocytosis (88%), and blood film revealed the presence of leukocytosis, with small mature-looking lymphocytes, and mild thrombocytopenia. A flow cytometry immune-phenotyping revealed that 55% of peripheral blood cells were monoclonal B-lymphocytes expressing CD19, CD20, CD23, CD200, CD22, CD5, CD38, CD11c, sIgD and Kappa light chain confirming the diagnosis of CLL. Oral healthcare professionals should consider systemic causes, such as CLL, in the differential diagnosis of generalized tooth mobility and gingival swelling, particularly in patients with associated symptoms such as lymphadenopathy, fever, weight loss, and general fatigue.

Oral Colonization by Entamoeba gingivalis and Trichomonas tenax: A PCR-Based Study in Health, Gingivitis, and Periodontitis.

Background: The etiology of periodontitis remains unclear, as is the place of gingivitis in its pathophysiology. A few studies linked the colonization by oral parasites (Entamoeba gingivalis and Trichomonas tenax) to periodontal disease and its severity. The aim of the current study was to estimate the prevalence of these oral parasites among healthy individuals, and in patients with gingivitis and periodontitis in Jordan. Methods: The study was conducted during July 2019-December 2019. Samples were composed of saliva and periodontal material including dental plaque sampled with probes. The detection of oral parasites was done using conventional polymerase chain reaction (PCR). Results: The total number of study participants was 237: healthy (n=94), gingivitis (n=53) and periodontitis (n=90). The prevalence of E. gingivalis was 88.9% among the periodontitis patients, 84.9% among the gingivitis patients and 47.9% in the healthy group. For T. tenax, the prevalence was 25.6% among the periodontitis patients, 5.7% among the gingivitis patients and 3.2% in the heathy group. Positivity for E. gingivalis was significantly correlated with the presence of periodontal disease compared to the healthy group with odds ratio (OR) of 6.6. Periodontal disease was also correlated with lower monthly income (OR=8.2), lack of dental care (OR=4.8), and history of diabetes mellitus (OR=4.5). Colonization by E. gingivalis was correlated with gingivitis (OR=6.1) compared to the healthy group. Colonization by E. gingivalis and T. tenax were significantly correlated with periodontitis (OR=6.4 for E. gingivalis, and OR=4.7, for T. tenax) compared to the healthy group. T. tenax was only detected among individuals with generalized periodontal disease compared to its total absence among those with localized disease (19.6% vs. 0.0%; p=0.039). The co-infection rate by the two oral parasites was 11.0%. Conclusions: The higher prevalence of human oral parasites in periodontal disease compared to healthy individuals appears to be more than a mere marker for the disease and might also be associated with disease severity and potential for progression. Thus, the dogmatic view of E. gingivalis and T. tenax as commensals needs to be re-evaluated and their contribution to pathophysiology of periodontal diseases cannot be neglected.

Dental students' experience and perceived confidence level in different restorative procedures.

PURPOSE: Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate self-perceived level of confidence of fifth-year dental students in different restorative-related tasks and the relationship between their clinical training and its corresponding confidence. METHODS: Fifth-year graduate dental students (n = 202) were asked to fill a questionnaire that rated their level of confidence in different clinical restorative dentistry tasks. Additionally, they were asked about the number of times they performed tasks prior to attempting the equivalent competency and in which sub-specialty they felt the most confident. RESULTS: Completed responses were received from 120 students giving a response rate of 59%. Students felt the most prepared and confident in direct restorations and simple endodontic treatment, and they seemed less confident in indirect restorations and complex endodontic treatment. Regarding the steps of indirect restorations, students expressed least confidence in crown preparation compared to impression making and try-in procedures (P < .05). Students rated their confidence highest in operative dentistry, followed by endodontics and lastly fixed prosthodontics. CONCLUSION: The results highlight the areas in which students exhibit the least confidence. Enhancement of student clinical skills and directed exposure is necessary to raise the level of perceived confidence which will reflect positively on their current and future professional performance.

Esthetic outcome of immediately placed and nonfunctionally loaded implants in the anterior maxilla utilizing a definitive abutment: A pilot clinical trial.

BACKGROUND: Immediate dental implants placement and loading utilizing definitive abutments might save time and cost when an esthetic final result is anticipated. The objective of this prospective clinical trial was to evaluate the esthetic outcome of immediate implantation and immediate nonfunctional loading utilizing definitive abutments, with and without bony substitutes filling the peri-implant gap. MATERIALS AND METHODS: In this clinical trial study a total of 11 implants were placed utilizing a flapless immediate post extraction approach in the maxilla (second premolar to second premolar). Atraumatic extraction was performed and implants were immediately placed. The gap was either left without grafting or filled with particulate bone material. Immediate nonfunctional loading was performed utilizing a definitive abutment. The pink esthetic scores (PESs) were assessed preoperatively, at 1- and 2-year follow-up periods. Dental casts were obtained at respective time intervals; scanned, registered, and closest point distances were measured. For all statistical tests, value of P = 0.05 was set as a statistical significance level. RESULTS: The mean of PES at baseline was 9.4 ± 1.69, at 1 year was 9.5 ± 2.07, at 2 years was 10.2 ± 2.75, for the graft group 10.3 ± 2.8, and for nongrafting group was 10.2 ± 2.59. There were no statistically significant differences in PESs at baseline when compared to 1- and 2-year intervals, and for grafting group versus nongrafting group (P = 0.24). Distances between the two time points for all cases were <1 mm in all reference planes. CONCLUSION: Immediate placement and nonfunctional loading utilizing a definitive abutment appear to result in a stable result as far as esthetic outcome and alveolar process sufficiency are concerned.

Dental students' awareness and attitudes toward HPV-related oral cancer: a cross sectional study at the University of Jordan.

BACKGROUND: The incidence of human papilloma virus (HPV)-related oral cancer has recently increased worldwide. The role of dentists is of prime importance in the early detection of oral cancer which would result in a favourable outcome for the patients. The aim of the current study was to assess the knowledge, awareness and attitudes of dental students, interns and postgraduate maxillofacial residents at the University of Jordan (UJ) to different aspects of oral cancer, particularly those related to HPV. METHODS: A paper-based survey was conducted at UJ among all pre-clinical dental students (pre-clinical group), clinical dental students, interns and postgraduate maxillofacial residents (clinical group). The survey included five sections comprising 29 items. The sections included questions investigating oral cancer knowledge, oral cancer screening, HPV knowledge and the ability to discuss personal topics with patients. RESULTS: A total of 376 respondents out of 1052 potential participants completed at least one item of the survey (study coverage of 35.7%). Among the study participants, the pre-clinical group represented 41.2% (n = 155) and the clinical group represented 58.8% (n = 221). The majority of participants in the clinical group showed better knowledge on oral cancer potential anatomic sites, clinical presentation and possible risk factors compared to the pre-clinical group. Most participants in the clinical group (n = 195, 88.2%) correctly identified HPV as a risk factor for oral cancer development. The majority of participants in the clinical group displayed suitable attitude towards oral cancer screening despite their desire for a reliable screening device and additional training in oral cancer screening. A number of limitations in basic knowledge about HPV was noticed among participants in the clinical group particularly related to unawareness of the vaccine availability. The majority of participants in the clinical group displayed hesitancy in discussing personal topics with the patients, including the history of previous sexually transmitted infections and sexual abuse. CONCLUSIONS: Gaps in knowledge regarding HPV-related oral cancer has been detected which necessitate intervention measures including curricular changes, training workshops and awareness campaigns.

Medical reliability of a video-sharing website: The gingival recession model.

OBJECTIVES: To evaluate the quality of the scientific/clinical information in dentistry delivered by videos hosted by a popular video-sharing website. METHODS: The gingival recession condition was used as a model and YouTube™ as the video hosting service. A systematic observation of videos containing information on gingival recession was conducted. Videos were analysed to evaluate (i) the scientific reliability and quality of the information using Global Quality Scale (GQS) and DISCREN criteria; and (ii) the understandability of this information using a tailor-made custom comprehensiveness index (CI). RESULTS: One hundred and eighty videos were identified. Videos dealing with surgical procedures were not included in the present review. After selection, 41 videos were analysed. The mean GQS was 2.34 on a 0-5 scale, and 25 (61%) videos showed clear aims according to DISCREN criteria. Misleading content was observed in eight videos (19.5%). The scientific sources of information were unclear in 26 (63.4%) videos. All videos failed to give additional references for supplemental information. Only three videos (7%) provided basic information on aetiology, clinical presentations and management of gingival recession. Based on 0-2 CI scores, three, nine and 29 videos had a score of 2, 1 and 0, respectively. CONCLUSION: The present model indicates that social media websites aiming to provide health information should be carefully accounted, especially when dealing with dentistry. It also suggests professional involvement to improve the quality of the delivered information.

Quality of YouTube(TM) videos on dental implants

BACKGROUND: Patients search YouTube for health-care information. PURPOSE: To examine what YouTube offers patients seeking information on dental implants, and to evaluate the quality of provided information. MATERIAL AND METHODS: A systematic search of YouTube for videos containing information on dental implants was performed using the key words "Dental implant" and "Tooth replacement". Videos were examined by two senior Oral and Maxillofacial Surgery residents who were trained and calibrated to perform the search. Initial assessment was performed to exclude non- English language videos, duplicate videos, conference lectures, and irrelevant videos. Included videos were analyzed with regard to demographics and content's usefulness. "Information for patients" available from the American Academy of Implant Dentistry, European Association of Osseointegration, and British Society of Restorative Dentistry were used for benchmarking. RESULTS: A total of 117 videos were analyzed. The most commonly discussed topics were related to procedures involved in dental implantology (76.1%, n=89), and to the indications for dental implants (58.1%, n=78). The mean usefulness score of videos was poor (6.02 ±4.7 [range 0-21]), and misleading content was common (30.1% of videos); mainly in topics related to prognosis and maintenance of dental implants. Most videos (83.1%, n=97) failed to mention the source of information presented in the video or where to find more about dental implants. CONCLUSIONS: Information about dental implants on YouTube is limited in quality and quantity. YouTube videos can have a potentially important role in modulating patients' attitude and treatment decision regarding dental implants

The effect of globin scaffold on osteoblast adhesion and phenotype expression in vitro.

PURPOSE: Different synthetic and natural biomaterials have been used in bone tissue regeneration. However, several limitations are associated with the use of synthetic as well as allogenous or xenogenous natural materials. This study evaluated, in an in vitro model, the behavior of rat osteoblastic cells cultured on a human globin scaffold. MATERIALS AND METHODS: Rat osteoblastic cells were isolated from the calvaria of 21-day-old fetal Sprague-Dawley rats. They were then grown in the presence of globin. Real-time polymerase chain reaction (RT-PCR) was performed to study the expression of cyclin D1, integrin Β1, Msx2, Dlx5, Runx2, and osteocalcin on days 1, 5, and 9. Moreover, alkaline phosphatase activity was measured on days 1, 3, 5, and 7. Alizarin red staining was performed on day 9 to observe calcium deposition. RESULTS: Cells were able to adhere, proliferate, and differentiate on globin scaffolds. Moreover, RT-PCR showed that globin may stimulate some key genes of osteoblastic differentiation (Runx2, osteocalcin, Dlx5). Globin had an inhibitory effect on alkaline phosphatase activity. Calcium deposits were seen after 9 days of culture. CONCLUSIONS: These results indicate that purified human globin might be a suitable scaffold for bone tissue regeneration.