Analysis of Coexistence of Oral and Cutaneous Lesions in 253 Patients with Lichen Planus - Single-center Retrospective Analysis.

Lichen planus (LP) is a chronic inflammatory disorder that especially affects the skin, mucous membranes, or both. The aim of the study was to determine the clinical characteristics of patients with LP in the oral cavity and concomitant cutaneous lesions and compare their outcomes with those without cutaneous lesions. 253 records of patients with confirmed diagnosis of oral lichen planus (OLP) were retrospectively analyzed. The following clinical data were obtained from the medical charts: sex, age, clinical presentations of OLP, distributions of the lesions, presence of symptoms, extra oral manifestations of lichen planus, presence of systemic diseases, and treatment provided. The group of patients with cutaneous manifestations was compared for possible clinical differences to those without. Cutaneous lesions were present in 18.2% (46/253) of patients. Significantly more patients with cutaneous lesions had other extra oral manifestations (26.1% versus 1.0%, P<0.00001). Lips were significantly more affected in patients with cutaneous presentation (41.3% versus 16.9%, P=0.00006). Ulcerative OLP was more frequent in patients with cutaneous lesions (23.9% versus 10.6%, P=0.0266). Patients with cutaneous manifestations needed significantly more systemic treatment with systemic steroids (10.9% versus 3.4%, P=0.0466). Patients with cutaneous lesions were more symptomatic and tended to require more treatment than patients with OLP who only had oral involvemen.

The Characteristics of Patients with Oral Lichen Planus and Malignant Transformation-A Retrospective Study of 271 Patients.

INTRODUCTION: Oral lichen planus (OLP) is a chronic inflammatory disease with an unknown etiology rating among oral potentially malignant disorder. The aim of the study was to determine the epidemiological and clinical characteristics of the patients with OLP and rate of malignant transformation. PATIENTS AND METHODS: Data were obtained from the medical records of 271 patients referred to the Oral Medicine Unit at the University Hospital in Hradec Králové diagnosed with oral lichen planus in the period of 2003-2020. The records were retrospectively analyzed. The following clinical data were retrieved from the medical charts: gender, age, systemic diseases, alcohol and tobacco consumption, localization/clinical appearance of lesions, distribution of the lesions, presence of the symptoms, treatment provided and malignant transformation. RESULTS: A total of 271 charts of patients with confirmed diagnosis of OLP were retrospectively analyzed, of whom, 66.4% (180/271) were women and 33.6% (91/271) were men. The mean age of the patients was 56.0 (18.2-85.0) years. The median follow-up of all patients was 15.2 months. Overall, 2 patients (2/271, 0.74%) meeting the above-mentioned criteria for malignant transformation were identified during the follow-up period. Both patients suffered from erosive type OLP and developed squamous cell carcinoma of the tongue. CONCLUSIONS: This retrospective study is in concordance with other studies showing the similar profile and clinical features of the patients with OLP. Malignant transformation rate was 0.74%.

Exogenous Intake of Fluorides in Caries Prevention: Benefits and Risks.

Caries incidence and prevalence have decreased significantly over the last few decades due to widespread use of fluoride. However, an increase in the prevalence of dental fluorosis has been reported in both fluoridated and non-fluoridated communities. Care must be taken to ensure that a balance between the optimal fluoride preventive effect at the individual and community level and minimal risk of dental fluorosis is maintained. This review describes the main sources of fluoride intake that have been identified: fluoridated drinking water, dietary fluoride supplement, and topical forms comprising toothpastes, rinses, gels and varnishes. The cited data were taken from meta-analytic studies and reports from Cochrane database systematic reviews up to December 2019. Efficiency, but safety, of topically applied fluorides in individual home care is dependent on the degree of compliance of individuals/parents and on the level of competence of providers of preventive counselling. The broad spectrum of these resources allows individualization of fluoride prevention based on risk analysis of caries attack and taking into consideration other preventive measures.

The Effects of Cryogenic Storage on Human Dental Pulp Stem Cells.

Dental pulp stem cells (DPSCs) are a type of easily accessible adult mesenchymal stem cell. Due to their ease of access, DPSCs show great promise in regenerative medicine. However, the tooth extractions from which DPSCs can be obtained are usually performed at a period of life when donors would have no therapeutic need of them. For this reason, it is imperative that successful stem cell storage techniques are employed so that these cells remain viable for future use. Any such techniques must result in high post-thaw stem cell recovery without compromising stemness, proliferation, or multipotency. Uncontrolled-rate freezing is not a technically or financially demanding technique compared to expensive and laborious controlled-rate freezing techniques. This study was aimed at observing the effect of uncontrolled-rate freezing on DPSCs stored for 6 and 12 months. Dimethyl sulfoxide at a concentration of 10% was used as a cryoprotective agent. Various features such as shape, proliferation capacity, phenotype, and multipotency were studied after DPSC thawing. The DPSCs did not compromise their stemness, viability, proliferation, or differentiating capabilities, even after one year of cryopreservation at -80 °C. After thawing, they retained their stemness markers and low-level expression of hematopoietic markers. We observed a size reduction in recovery DPSCs after one year of storage. This observation indicates that DPSCs can be successfully used in potential clinical applications, even after a year of uncontrolled cryopreservation.

General and oral health status of preterm one-year-old very low and extremely low birthweight infants (a cross - sectional study).

AIMS: The aim of the present study was to evaluate the general and oral health status of a group of preterm one-year-old very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW). METHODS: A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with P < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated. RESULTS: Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate. CONCLUSION: This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants.

The Association of Caries Increment Dynamics in Preschool Children with Risk Factors: The 3-Year Prospective Study.

This prospective study monitored the dental status, the presence of plaque, and cariogenic microorganism levels of identical children over three years. The aim was to determine the dynamics of caries increment as well as the relationship between risk factors and caries prevalence. A total number of 125 children (72 boys and 53 girls) was included in the study, with an average age of 3.95 ± 0.06 years at the baseline. During the clinical examination at the nursery schools, the presence of dental plaque was recorded, and saliva samples were collected from the tongue of children for the DentoCult SM test providing easy detection of mutans streptococci from saliva samples. At baseline, 65.6% of the children had no caries, 4% had restored teeth with fillings or crowns or missing teeth due to caries, and 30.4% had at least one untreated caries. The percentages of intact teeth, restored or missing teeth, and untreated caries were 52.8%, 8.8%, 38.4% in the second year and 49.1%, 13.8%, and 31.1% in the third year. The dmft index value was 1.41 ± 0.24 in the first year, 2.29 ± 0.30 in the second year, and 2.33 ± 0.31 in the third year. There was a significant correlation between plaque presence and dt and dmft values (p < 0.05; the statistical analyses were performed using the Kolmogorov-Smirnov test). This 3-year longitudinal study highlighted the importance of examining both the oral hygiene and the level of cariogenic microorganisms when undertaking the evaluation of caries risk evaluation in preschool children.

Hyaluronic Acid-Based Medical Device for Treatment of Alveolar Osteitis-Clinical Study.

Alveolar Osteitis (AO) is a complication following the extraction of a tooth. AO manifests through localized pain in, and around, the extraction site, where the post-operative blood clot has been disintegrated. The aim of this single cohort study was to evaluate the outcome of a treatment of AO, using a pharmacological device composed of hyaluronic acid and octenidine dihydrochloride. The tested device is a sponge-like material, composed solely of a fully dissoluble medicaments (hyaluronic acid, calcium chloride, and octenidine dihydrochloride). It was designed to serve as a non-toxic, slow-dissolving antiseptic, that adheres to mucosa and obturates the wound. This study includes 58 subjects who were diagnosed with AO. The tested device was administered once daily until local pain subsided to < 20 mm of the Visual Analog Scale (VAS). The treatment was considered effective when the pain subsided to < 20 mm VAS in < 8 days of treatment; as per comparative studies. Our findings provide a statistically significant success rate of 96.0% (95.0% confidence interval of 75.75% to 97.8%) after pharmacological device administrations. No adverse medical effects were detected. Acquired data confirmed that lyophilized hyaluronic acid, combined with octenidine, is effective for the treatment of AO. The results are clinically important as AO is a common complication after third molar extractions.

The Analysis of Dental Treatment under General Anaesthesia in Medically Compromised and Healthy Children.

Dental care under general anaesthesia (GA) is an option when normal treatment cannot be accomplished due to un-cooperation and systemic or cognitive/intellectual disabilities. The purpose of this retrospective cohort study was to analyse the dental treatment under GA in medically compromised and healthy children. The data were collected from the medical records of children who received their dental treatment under GA. The data regarding patient age, sex, general health, and type of treatment were analysed. This clinical trial included 229 study subjects (138 males, 91 females) with an average age of 8.34 (SD 3.78). Counts and relative counts were used for description of qualitative data. The association between the variables was analysed using contingency tables. The significance of the findings was tested by the chi-square test. Most of the children were older pre-school 63 (27.51%) and young school children 102 (44.54%). Medical disability (systemic or intellectual) was diagnosed in 142 children (62.01%); the remaining 87 (37.99%) were healthy children. Dental treatment of primary teeth was more commonly performed in healthy children (65.52%) compared to medically compromised children (58.45%) (p = 0.287). The total number of medically compromised children and the total number of healthy children were both considered to be 100% for the purpose of the following calculations. In terms of permanent dentition, medically compromised children required more extractions and fillings (38.03%, 57.04%) compared to healthy children (14.94%, 17.24%, respectively). The results of this study revealed that dental treatment under GA was more commonly performed in medically compromised children in permanent teeth only in comparison to healthy children. Based on these findings, both health professionals and state authorities should focus more on preventive care in medically compromised children in order to improve their oral health.

The attitude of Czech dental patients to the use of rubber dam.

BACKGROUND: The most frequent arguments against rubber dam are that patients generally do not like it and the prolonged time of treatment. However, according to several studies, the attitude of patients towards rubber dam is rather positive. OBJECTIVE: To find out the attitudes of patients to treatment with rubber dam; to determine influence of the circumstances of treatment or factors about patients; and to establish a mean time needed for rubber dam placement. DESIGN: A questionnaire survey. SETTING AND PARTICIPANTS: Patients of general dental practitioners, university clinical specialists and undergraduate dental students. RESULTS: A total of 179 questionnaires were distributed, from which 150 were returned. The mean time needed for rubber dam placement was 4 min for students and < 2 min for dentists. For 56% of patients, this had been their first experience with rubber dam. A total of 77% of patients indicated a higher level of comfort during treatment with rubber dam. A preference to the future rubber dam usage was indicated by 86% of patients. The preference to the further rubber dam usage was statistically significantly affected by the level of comfort during the treatment with rubber dam (P < 0.001) and by the sufficiency of explanation of reasons for rubber dam usage (P < 0.05). The other factors presented no statistically significant influence on patients' attitude to rubber dam usage. CONCLUSIONS: The attitude of patients to rubber dam was rather positive in our study. The time needed for rubber dam application was rather short.

The presence of cariogenic and periodontal pathogens in the oral cavity of one-year-old infants delivered pre-term with very low birthweights: a case control study.

BACKGROUND: Recently, the dental literature has focused mainly on the microbial colonization of healthy full-term infants and their mothers or caretakers. However, oral microbial acquisition by premature infants has not been adequately investigated, and the correlation between pre-term birth and the presence of cariogenic and periodontal pathogens has not been determined. The aim of this study was to identify the presence and quantities of representative cariogenic and periodontal pathogens in the oral cavities of 12-month-old infants and compare the occurrence of these microbes between a cohort of pre-term infants with very low birthweights and a control cohort comprising full-term infants. METHODS: The research cohort was composed of 69 one-year-old infants, of whom 24 were born prematurely with very low birthweights and 45 of whom were carried to full term. Information regarding the infants' gestational age, mode of delivery, general health status, birthweight and antibiotic use were obtained from hospital records and through oral interviews. At 12 months of age, both groups of infants were examined, and unstimulated saliva samples from the dorsum of the tongue and dental plaque samples were collected. The microorganisms (Streptococcus mutans, Lactobacillus spp., Actinomyces spp., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Peptostreptococcus micros, Prevotella intermedia, Fusobacterium nucleatum) were identified and their quantities were evaluated using a PCR-based method. The chi-squared and Fisher's factorial tests were used for the statistical evaluations. RESULTS: The infants had a high prevalence of cariogenic microbes and of Fusosbacterium nucleatum and Aggregatibacter actinomycetemcomitans. Cariogenic microbes were detected in 91.7% of the very low birthweight infants and in all full-term infants. Periodontal pathogens were present in 83% of the pre-term infants and in 96% of the full-term infants. A significant difference was found between the cohorts in terms of the presence of S. mutans. Most of the very low birthweight infants had negative values of this microbe, while the full-term infants had positive values. CONCLUSIONS: This study confirms the early transmission of representative cariogenic and periodontal pathogens to the oral cavity of one-year-old infants and a higher prevalence of S. mutans in full-term infants than in premature infants.

A comparison of different rubber dam systems on a dental simulator.

The purpose of this study was to test the hypothesis that more recently developed rubber dam systems (OptraDam ® Plus and OptiDam™) are faster and easier to handle, and that the quality of isolation is not decreased. The rubber dam systems were applied in standard conditions on a dental simulator in several model clinical situations. The time of preparation, application and removal were measured and the quality of isolation was evaluated. The median time of rubber dam placement was 51 s (Q1 = 38 s; Q3 = 79 s). The shortest median time of application was with OptiDam™ (42 s), followed by a conventional rubber dam (53 s), and finally the longest was with OptraDam® Plus (58 s). The median volume of fluid remaining in the isolated space after 5 minutes was 9.5 mL (Q1 = 8 mL; Q3 = 10 mL). The largest median volume of remaining water was with OptiDam™ (10 mL), followed by a conventional rubber dam (9.5 mL) and the least with OptraDam® Plus (8.5 mL). The afore-stated hypothesis about the advantages of modern rubber dam isolation systems was accepted for OptiDam™, but rejected for OptraDam® Plus. The results could contribute to decision-making concerning the choice of rubber dam system.

Alimentary fluoride intake in preschool children.

BACKGROUND: The knowledge of background alimentary fluoride intake in preschool children is of utmost importance for introducing optimal and safe caries preventive measures for both individuals and communities. The aim of this study was to assess the daily fluoride intake analyzing duplicate samples of food and beverages. An attempt was made to calculate the daily intake of fluoride from food and swallowed toothpaste. METHODS: Daily alimentary fluoride intake was measured in a group of 36 children with an average age of 4.75 years and an average weight of 20.69 kg at baseline, by means of a double plate method. This was repeated after six months. Parents recorded their child's diet over 24 hours and collected duplicated portions of food and beverages received by children during this period. Pooled samples of food and beverages were weighed and solid food samples were homogenized. Fluoride was quantitatively extracted from solid food samples by a microdiffusion method using hexadecyldisiloxane and perchloric acid. The content of fluoride extracted from solid food samples, as well as fluoride in beverages, was measured potentiometrically by means of a fluoride ion selective electrode. RESULTS: Average daily fluoride intake at baseline was 0.389 (SD 0.054) mg per day. Six months later it was 0.378 (SD 0.084) mg per day which represents 0.020 (SD 0.010) and 0.018 (SD 0.008) mg of fluoride respectively calculated per kg bw/day.When adding the values of unwanted fluoride intake from the toothpaste shown in the literature (0.17-1.21 mg per day) the estimate of the total daily intake of fluoride amounted to 0.554-1.594 mg/day and recalculated to the child's body weight to 0.027-0.077 mg/kg bw/day. CONCLUSIONS: In the children studied, observed daily fluoride intake reached the threshold for safe fluoride intake. When adding the potential fluoride intake from swallowed toothpaste, alimentary intake reached the optimum range for daily fluoride intake. These results showed that in preschool children, when trying to maximize the benefit of fluoride in caries prevention and to minimize its risk, caution should be exercised when giving advice on the fluoride containing components of child's diet or prescribing fluoride supplements.

Immediate restoration with ti-unite implants: practice-based evidence compared with animal study outcomes.

PURPOSE: Clinicians often do not have the benefit of adequate safety or clinical data when evaluating the merit of either newly marketed implant devices or novel clinical procedures. This has been the case for dental implants following the initial documentation of their safety and efficacy and is demonstrated in the evolution of immediate load application. Following demonstration of safety and successful application of an implant in an animal study prior to its market release, this report provides the clinical outcomes for the first 100 Ti-Unite implants provided to 24 patients in a clinical practice over 9 years. MATERIALS AND METHODS: An electronic record/clinical database review of consecutive early loaded implants from a multiple surgeon/single prosthodontist practice was conducted for quality assurance. Data extraction of standard exposure and outcome variables was accomplished by a trained individual not affiliated with the clinical practice. RESULTS: The results revealed one failure before and none following definitive restoration with a variety of prostheses. The mean length of time from immediate to definitive restorations was 5.3 ± 1.1 months for crowns, 3.9 ± 1.3 months for fixed partial dentures, and 7.8 ± 4.1 months for mandibular "hybrid" prostheses. The most common unexpected findings during the initial three postinsertion visits were lost access restoration and cement failure. CONCLUSIONS: Pre-market animal data regarding the safety and success of a new implant used with an early loading protocol was replicated in the clinical results of the first 100 implants used in practice. Additionally, the clinical results are favorable when compared to conventional loading protocols from this same practice and provide helpful comparative metrics (delayed vs immediate loading) to use when discussing implant treatment with patients.

Telomere attrition occurs during ex vivo expansion of human dental pulp stem cells.

We provide a detailed characteristic of stem cells isolated and expanded from the human dental pulp. Dental pulp stem cells express mesenchymal cell markers STRO-1, vimentin, CD29, CD44, CD73, CD90, CD166, and stem cell markers Sox2, nestin, and nucleostemin. They are multipotent as shown by their osteogenic and chondrogenic potential. We measured relative telomere length in 11 dental pulp stem cell lines at different passages by quantitative real-time PCR. Despite their large proliferative capacity, stable viability, phenotype, and genotype over prolonged cultivation, human dental pulp stem cells suffer from progressive telomere shortening over time they replicate in vitro. Relative telomere length (T/S) was inversely correlated with cumulative doubling time. Our findings indicate that excessive ex vivo expansion of adult stem cells should be reduced at minimum to avoid detrimental effects on telomere maintenance and measurement of telomere length should become a standard when certificating the status and replicative age of stem cells prior therapeutic applications.

Stem cells from human exfoliated deciduous teeth--isolation, long term cultivation and phenotypical analysis.

AIMS: Our aims were to isolate stem cells from human exfoliated deciduous teeth (SHED), to cultivate them in vitro and to investigate their basic biological properties, phenotype and to compare our findings with dental pulp stem cells (DPSC) isolated from permanent teeth. METHODS: Dental pulp was gently evacuated from exfoliated teeth. After enzymatic dissociation of dental pulp, SHED were cultivated in modified cultivation media for mesenchymal adult progenitor cells containing 2% FCS and supplemented with growth factors and insulin, transferrin, sodium (ITS) supplement. Cell viability and other biological properties were examined using a Vi-Cell analyzer and a Z2-Counter. DNA analyses and phenotyping were performed with flow cytometry. RESULTS: We were able to cultivate SHED over 45 population doublings. Our results showed that SHED cultivated under same conditions as DPSC had longer average population doubling time (41.3 hrs for SHED vs. 24.5 hrs for DPSC). Phenotypic comparison of cultivated SHED to that of cultivated DPSC showed differential expression CD29, CD44, CD71, CD117, CD 166. During long-term cultivation, SHED did not showed any signs of degeneration or spontaneous differentiation. CONCLUSIONS: We isolated stem cells from exfoliated teeth. In comparison to DPSC, SHED proliferation rate was about 50% slower, and SHED showed slightly different phenotype. These cells may be extremely useful for stem cell tissue banking, further stem cell research and future therapeutic applications.

Dental pulp stem cells and their characterization.

AIMS: Our aims were to isolate dental pulp stem cells, to cultivate them in various media and to investigate their basic biological properties and phenotype. METHODS: 16 lines of dental pulp stem cells (DPSCs) were isolated from an impacted third molar. After enzymatic dissociation of dental pulp, DPSCs were cultivated in modified cultivation media for mesenchymal adult progenitor cells containing 2 % or 10 % fetal calf serum (FCS), or in modified 2 % FCS cultivation media supplemented with ITS. Cell viability and other biological properties were examined periodically using a Vi-Cell analyzer and Z2-Counter. DNA analysis and phenotyping were done using flow cytometry. RESULTS: We were able to cultivate DPSCs in all tested cultivation media over 40 population doublings. Our results showed that DPSCs cultivated in medium supplemented with ITS had shorter average population doubling time (24.5, 15.55-35.12 hours) than DPSCs cultivated in 2 % FCS (55.43, 21.57-187.14 hours) or 10 % FCS (42.56, 11.86 - 101.3 hours). Cell diameter was not affected and varied from 15 to 16 microm. DPSCs viability in the 9(th) passage was over 90 %. Our phenotypical analysis was highly positivity for CD29, CD44, CD90 and HLA I, and negative for CD34, CD45, CD71, HLA II. DPSC lines cultivated in all media showed no signs of degeneration or spontaneous differentiation during the expansion process. CONCLUSIONS: We showed that ITS supplement in the cultivation media greatly increased the proliferative activity of DPSCs. Other DPSC biological properties and phenotype were not affected.

Antimicrobial agents used in endodontic treatment.

Biomechanical preparation alone does not completely eradicate microorganisms from the root canal, hence the next logical step is to perform root canal procedures in conjunction with antimicrobials. The use of an antimicrobial agent improves the efficacy and prognosis of endodontic treatment. This review enumerates the most widely used antimicrobial agents, their mechanism of action and their potential use in reducing the microbial load.

Early enamel lesion part I. Classification and detection.

There has been a paradigm shift from Black's 'extension for prevention' to a minimal intervention approach in the recent time. The most important aspect in diagnosis of earliest stages of enamel demineralization involves accurate and reliable detection of such lesions. The newer diagnostic aids would enable the dentist to detect and diagnose early enamel lesions and direct appropriate preventive measures to promote remineralization and conservation of the tooth substance. A high level of caries experience necessitates preventive strategies which are more cost effective than surgical intervention and restorative procedures.

Early enamel lesion part II. Histo-morphology and prevention.

There has been a paradigm shift from Black's 'extension for prevention' to a minimal intervention approach in the recent time. The most important aspect in diagnosis of earliest stages of enamel demineralization involves accurate and reliable detection of such lesions. The newer diagnostic aids would enable the dentist to detect and diagnose early enamel lesions and direct appropriate preventive measures to promote remineralization and conservation of the tooth substance. A high level of caries experience necessitates preventive strategies which are more cost effective than surgical intervention and restorative procedures.

Root canal microflora.

Modern day endodontics is undergoing a massive change with the introduction of new molecular based techniques for microbial identification. This review focuses on the microbiota in untreated and root-filled canals. It will also describe briefly the recent developments in microbial identification and the mechanisms by which certain species of microbes are able to invade and establish themselves in the root canal.